Failure to Regain Function at 3 months After Acute Hospital Admission Predicts Institutionalization Within 12 Months in Older Patients

OBJECTIVES: To study the effects of functional decline on admission to long-term institutionalized care within 12 months from acute hospital admission.

DESIGN: Pooled analyses of 3 longitudinal cohorts.

SETTING: Tertiary and secondary hospital.

PARTICIPANTS: A total of 1085 community-dwelling patients older than 65 years acutely admitted to an internal medicine or orthopedic ward.

MEASUREMENTS: Demographic data and medical data were collected within 2 days from hospital admission. Functional status (activities of daily living [ADL]) was assessed at baseline (reflecting preadmission status 2 weeks before admission) and 3 months after admission, and function loss (change between preadmission and 3 months) was calculated. Living situation was assessed 3 and 12 months after hospitalization. Cox regression analysis was used to predict institutionalization (living in a long-term assisted care or nursing home facility) within 12 months.

RESULTS: ADL function loss in the 3 months following hospital admission increased the risk of institutionalization also in patients without preadmission impairment (loss of function in 1 item HR = 5.3, 95% CI 2.2-12.6, p < .001; ≥2 items HR = 7.3, 95% CI 3.4-15.7, p < .001) compared with patients without impairment and function loss. The risk progressively increased with higher preadmission impairment. Patients with preadmission ADL impairment in 2 or more items without additional loss of function had an increased risk (HR = 6.4, 95% CI 3.1-13.3, p < .001) for institutionalization. This model was adjusted for age, gender, cognitive impairment, social situation, use of health care services, length of hospital stay, and comorbidity.

CONCLUSION: Loss of function in ADL tasks following hospitalization increased the risk for institutionalization, irrespective of preadmission ADL impairment. Potentially, counteracting loss of function in ADLs after acute hospital admission by more intensive rehabilitation may partly reduce the need for institutionalization.