Abstract
Objectives
Acute illnesses and subsequent hospital admissions present large health stressors
to older adults, after which their recovery is variable. The concept of physical resilience
offers opportunities to develop dynamical tools to predict an individual's recovery
potential. This study aimed to investigate if dynamical resilience indicators based
on repeated physical and mental measurements in acutely hospitalized geriatric patients
have added value over single baseline measurements in predicting favorable recovery.
Design
Intensive longitudinal study.
Setting and Participants
121 patients (aged 84.3 ± 6.2 years, 60% female) admitted to the geriatric ward for
acute illness.
Measurements
In addition to preadmission characteristics (frailty, multimorbidity), in-hospital
heart rate and physical activity were continuously monitored with a wearable sensor.
Momentary well-being (life satisfaction, anxiety, discomfort) was measured by experience
sampling 4 times per day. The added value of dynamical indicators of resilience was
investigated for predicting recovery at hospital discharge and 3 months later.
Results
31% of participants satisfied the criteria of good recovery at hospital discharge
and 50% after 3 months. A combination of a frailty index, multimorbidity, Clinical
Frailty Scale, and or gait speed predicted good recovery reasonably well on the short
term [area under the receiver operating characteristic curve (AUC) = 0.79], but only
moderately after 3 months (AUC = 0.70). On addition of dynamical resilience indicators,
the AUC for predicting good 3-month recovery increased to 0.79 (P = .03). Variability in life satisfaction and anxiety during the hospital stay were
independent predictors of good 3-month recovery [odds ratio (OR) = 0.24, P = .01, and OR = 0.54, P = .04, respectively].
Conclusions and Implications
These results highlight that measurements capturing the dynamic functioning of multiple
physiological systems have added value in assessing physical resilience in clinical
practice, especially those monitoring mental responses. Improved monitoring and prediction
of physical resilience could help target intensive treatment options and subsequent
geriatric rehabilitation to patients who will most likely benefit from them.
Keywords
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Article info
Publication history
Published online: December 10, 2019
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
