Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis |
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| Affiliation: | 1. Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL;2. Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, AL;3. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL;4. Lister Hill Library of the Health Sciences, University of Alabama at Birmingham, Birmingham, AL;1. Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia;2. Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands;1. Department of Epidemiology & Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC - location VU University medical center, Amsterdam, the Netherlands;2. Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain;3. CIBERFES, Ministerio de Economía y Competitividad, Spain;4. Department of Physiology, University of Valencia, Valencia, Spain;5. Department of Geriatrics, Hospital Universitario de Getafe, Madrid, Spain;1. Department of Internal Medicine, Yale School of Medicine, New Haven, CT;2. Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, The Netherlands;1. Department of Health and Kinesiology, Center for Translational Research in Aging and Longevity, Texas A&M University, College Station, TX, USA;2. Department of Specialized Nutrition, Danone Nutricia Research, Utrecht, the Netherlands;3. Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Theme Ageing, Karolinska University Hospital, Stockholm, Sweden;4. Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands;5. Department of Medicine and Aged Care, @AgeMelbourne, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia;6. Department of Nutrition and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands;1. University of Jyvaskyla, Faculty of Information Technology, P.O. Box 35, FI-40014, University of Jyvaskyla, Finland;2. Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland;3. General Practice Unit, Kuopio University Hospital, Primary Health Care, Kuopio, Finland |
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| Abstract: | ObjectivesHospital-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.DesignMeta-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.SettingAcute care hospital units.ParticipantsAdults aged ≥65 years hospitalized in medical-surgical acute care; total sample size across all included studies was 7375.MethodsIndependence 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.ResultsRandom 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 implicationsHospitalization 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. |
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| Keywords: | Hospitalization disability activities of daily living older adult |
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