Abstract
Objectives
Hospital-associated disability (HAD), defined as loss of independence in activities
of daily living (ADL) following acute hospitalization, is observed among older adults.
The study objective is to determine overall prevalence of HAD among older adults hospitalized
in acute care, and to assess the impact of study initiation year in moderation of
prevalence.
Design
Meta-analysis of data collected from randomized trials, quasi-experimental, and prospective
cohort studies. English-language searches to identify included studies were completed
February 2018 and updated May 2018 of electronic databases and reference lists of
studies and reviews. Included studies were human subjects investigations that measured
ADL ≥2 time points before or during and after hospitalization and reported prevalence
of ADL decline among older adults.
Setting
Acute care hospital units.
Participants
Adults aged ≥65 years hospitalized in medical-surgical acute care; total sample size
across all included studies was 7375.
Methods
Independence in ADL was assessed using the Katz Index of Independence in Activities
of Daily Living and Barthel Index of Independence in Activities of Daily Living.
Results
Random effects meta-analysis across included studies identified combined prevalence
of HAD as 30% (95% CI 24%, 33%; P < .001). The effect of study initiation year on the prevalence rate was minimal.
A large amount of heterogeneity was observed between studies, which may be due in
part to nonstandardized measurement of ADL impairment or other methodological differences.
Conclusions and implications
Hospitalization in acute care poses a significant risk to functional independence
of older adults, and this risk is unchanged despite shorter lengths of stay. The evidence
supports the continued need for hospital-based programs that provide assessment of
functional ability and identification of at-risk older adults in order to better treat
and prevent HAD.
Keywords
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Article info
Publication history
Published online: November 13, 2019
Footnotes
Funding: University of Alabama at Birmingham-2018 AMC21 Multi-Investigator Pilot Award partially supported the effort on this project. C.L. is partially supported by NIH grant K12 GM088010; ADM is partially supported by NIH and VA grants; T.W.B. is partially supported by NIH grant P2CHD086851; N.C.W. is partially supported by NIH grant K01 NIAMS 1K01AR068400. R.E.K. is partially supported by multiple NIH and VA grants. C.J.B. is partially supported by a VA Rehabilitation R&D Merit Award I01 RX001995.
The authors declare no conflicts of interest.
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
