Functional Decline and Recovery of Activities of Daily Living in Hospitalized, Disabled Older Women: The Women's Health and Aging Study I
Cynthia M. Boyd MD, MPH
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorMichelle Ricks MS
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorLinda P. Fried MD, MPH
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorJack M. Guralnik MD, PhD
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorQian-Li Xue PhD
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorJin Xia MS
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorKaren Bandeen-Roche PhD
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorCynthia M. Boyd MD, MPH
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorMichelle Ricks MS
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorLinda P. Fried MD, MPH
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorJack M. Guralnik MD, PhD
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorQian-Li Xue PhD
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorJin Xia MS
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorKaren Bandeen-Roche PhD
From the * Division of Geriatric Medicine and Gerontology † Center on Aging and Health, School of Medicine and Bloomberg School of Public Health ‡ Department of Medicine, School of Medicine § Departments of Epidemiology ∥ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Maryland; and # Biostatistics, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Search for more papers by this authorAbstract
OBJECTIVES: To determine, in disabled, older, community-dwelling women who were hospitalized, the rates and predictors of functional decline, the probability and time course of subsequent functional recovery, and predictors of functional recovery.
DESIGN: Population-based observational cohort.
SETTING: Woman's Health and Aging Study.
PARTICIPANTS: A subset of the 1,002 moderately to severely disabled community-dwelling older women who were hospitalized over 3 years (N=457).
MEASUREMENTS: Functional decline and complete and partial recovery were defined using a 0 to 6 scale of dependencies in activities of daily living (ADLs) evaluated every 6 months over 3 years. Complete recovery was defined as returning to baseline function (function at visit immediately preceding hospitalization) after functional decline; partial recovery was defined as any improvement in the ADL scale after functional decline. Multiple logistic regression analysis was used to determine predictors of functional decline. Kaplan-Meier curves estimate the proportions recovering as a function of time since hospitalization. Discrete-time proportional hazards models regress the time-to-recovery hazards on the predictor variables.
RESULTS: Thirty-three percent of hospitalized women experienced functional decline at the first visit after hospitalization. Frailty, longer length of stay, and higher education were associated with functional decline. Fifty percent fully recovered over the subsequent 30 months, with 33% recovering within 6 months and an additional 14% over the following 6 months. Younger women were more likely to recover (aged 80 to 70, hazard ratio=0.39, 95% confidence interval=0.24–0.64).
CONCLUSION: Although most recovery of function occurs by 6 months after the first visit after a hospitalization, a substantial proportion of disabled community-dwelling women recover over the following 2 years.
Supporting Information
Figure S1. Defining Study Time: WHAS I. Footnote: Full functional recovery was defined as returning to prehospitalization baseline function after decline observed at the first visit posthospitalization at any time point subsequently. Partial recovery was defined as any improvement in number of ADL dependencies after observed decline at the first visit posthospitalization, but failure to return to prehospitalization number of ADL dependencies. No recovery was defined as no improvement in number of ADL dependencies after observed decline at the first visit posthospitalization.
Table S2. Distribution of Baseline Characteristics of Older, Disabled, Community-Dwelling Women in WHAS who experienced a hospitalization (N=457) (available in Online Version).
Please note: Wiley-Blackwell is not responsible for the content or functionality of any supporting materials supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article.
| Filename | Description |
|---|---|
| JGS_2455_sm_suppltable.doc77.5 KB | Supporting info item |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1 Gill TM, Allore HG, Holford TR et al. Hospitalization, restricted activity, and the development of disability among older persons. JAMA 2004; 292: 2115–2124.
- 2 Boyd CM, Xue QL, Simpson CF et al. Frailty, hospitalization, and progression of disability in a cohort of disabled older women. Am J Med 2005; 118: 1225–1231.
- 3 Boyd CM, Xue QL, Guralnik JM et al. Hospitalization and development of dependence in activities of daily living in a cohort of disabled older women: The Women's Health and Aging Study I. J Gerontol A Biol Sci Med Sci 2005; 60A: 888–893.
- 4 McCusker J, Kakuma R, Abrahamowicz M. Predictors of functional decline in hospitalized elderly patients: A systematic review. J Gerontol A Biol Sci Med Sci 2002; 57A: M569–M577.
- 5 Covinsky KE, Palmer RM, Fortinsky RH et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. J Am Geriatr Soc 2003; 51: 451–458.
- 6 Sager MA, Rudberg MA, Jalaluddin M et al. Hospital Admission Risk Profile (HARP): Identifying older patients at risk for functional decline following acute medical illness and hospitalization. J Am Geriatr Soc 1996; 44: 251–257.
- 7 Pedone C, Ercolani S, Catani M et al. Elderly patients with cognitive impairment have a high risk for functional decline during hospitalization: The GIFA Study. J Gerontol A Biol Sci Med Sci 2005; 60A: 1576–1580.
- 8 Volpato S, Onder G, Cavalieri M et al. Characteristics of nondisabled older patients developing new disability associated with medical illnesses and hospitalization. J Gen Intern Med 2007; 22: 668–674.
- 9 Wu AW, Damiano AM, Lynn J et al. Predicting future functional status for seriously ill hospitalized adults. The SUPPORT prognostic model. Ann Intern Med 1995; 122: 342–350.
- 10 Fortinsky RH, Covinsky KE, Palmer RM et al. Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J Gerontol A Biol Sci Med Sci 1999; 54A: M521–M526.
- 11 Hardy SE, Gill TM. Recovery from disability among community-dwelling older persons. JAMA 2004; 291: 1596–1602.
- 12 Gill TM, Robison JT, Tinetti ME. Predictors of recovery in activities of daily living among disabled older persons living in the community. J Gen Intern Med 1997; 12: 757–762.
- 13 Hardy SE, Dubin JA, Holford TR et al. Transitions between states of disability and independence among older persons. Am J Epidemiol 2005; 161: 575–584.
- 14 Hardy SE, Gill TM. Factors associated with recovery of independence among newly disabled older persons. Arch Intern Med 2005; 165: 106–112.
- 15 Hansen K, Mahoney J, Palta M. Risk factors for lack of recovery of ADL independence after hospital discharge. J Am Geriatr Soc 1999; 47: 360–365.
- 16 Ostir GV, Goodwin JS, Markides KS et al. Differential effects of premorbid physical and emotional health on recovery from acute events. J Am Geriatr Soc 2002; 50: 713–718.
- 17 Verbrugge LM, Reoma JM, Gruber-Baldini AL. Short-term dynamics of disability and well-being. J Health Soc Behav 1994; 35: 97–117.
- 18 Miller RR, Zhang Y, Silliman RA et al. Effect of medical conditions on improvement in self-reported and observed functional performance of elders. J Am Geriatr Soc 2004; 52: 217–223.
- 19 Dejong G, Palsbo SE, Beatty PW et al. The organization and financing of health services for persons with disabilities. Milbank Q 2002; 80: 261–301.
- 20 Fried TR, Bradley EH, Williams CS et al. Functional disability and health care expenditures for older persons. Arch Intern Med 2001; 161: 2602–2607.
- 21 Kozak LJ, DeFrances CJ, Hall MJ. National hospital discharge survey: 2004 annual summary with detailed diagnosis and procedure data. Vital Health Stat 2006; 13: 1–209.
- 22 Simonsick EM, Maffeo CE, Rogers SK et al. Methodology and feasibility of a home-based examination in disabled older women: The Women's Health and Aging Study. J Gerontol A Biol Sci Med Sci 1997; 52A: M264–M274.
- 23 Kasper JD, Shapiro S, Guralnik JM et al. Designing a community study of moderately to severely disabled older women: The Women's Health and Aging Study. Ann Epidemiol 1999; 9: 498–507.
- 24 Guralnik J, Fried L, Simonsick E et al. eds. The Women's Health and Aging Study: Health and Social Characteristics of Older Women With Disability. Bethesda, MD: National Institute on Aging; NIH publication 95-4009. 1995.
- 25 Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–198.
- 26 Yesavage JA, Brink TL, Rose TL et al. Development and validation of a geriatric depression screening scale: A preliminary report. J Psychiatr Res 1982; 17: 37–49.
- 27 Penninx BW, Guralnik JM, Bandeen-Roche K et al. The protective effect of emotional vitality on adverse health outcomes in disabled older women. J Am Geriatr Soc 2000; 48: 1359–1366.
- 28 Penninx BW, Guralnik JM, Simonsick EM et al. Emotional vitality among disabled older women: The Women's Health and Aging Study. J Am Geriatr Soc 1998; 46: 807–815.
- 29 Fried LP, Tangen CM, Walston J et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56A: M146–M156.
- 30 Bandeen-Roche K, Xue QL, Ferrucci L et al. Phenotype of frailty: Characterization in the Women's Health and Aging studies. J Gerontol A Biol Sci Med Sci 2006; 61A: 262–266.
- 31 Fried LP, Borhani NO, Enright P et al. The Cardiovascular Health Study: Design and rationale. Ann Epidemiol 1991; 1: 263–276.
- 32 Prentice RL, Gloeckler LA. Regression analysis of grouped survival data with application to breast cancer data. Biometrics 1978; 34: 57–67.
- 33 Wegman EJ, Wright IW. Splines in statistics. J Am Statist Assoc 1983; 78: 351–365.
- 34 Gill TM, Williams CS, Tinetti ME. The combined effects of baseline vulnerability and acute hospital events on the development of functional dependence among community-living older persons. J Gerontol A Biol Sci Med Sci 1999; 54A: M377–M383.
- 35 Makary M, Takenaga R, Pronovost P et al. Frailty in elderly surgical patients: Implications for operative risk assessment. J Surg Res 2006; 130: 212.
- 36 Sager MA, Rudberg MA. Functional decline associated with hospitalization for acute illness. Clin Geriatr Med 1998; 14: 669–679.
- 37 Boaz RF. Improved versus deteriorated physical functioning among long-term disabled elderly. Med Care 1994; 32: 588–602.
- 38 Ferrucci L, Bandinelli S, Guralnik JM et al. Recovery of functional status after stroke. A postrehabilitation follow-up study. Stroke 1993; 24: 200–205.
- 39 Berg K, Intrator O. Postacute care following stroke or hip fracture: Single services and combinations used by Medicare beneficiaries (1987–1992). J Aging Health 1999; 11: 27–48.
- 40 Ottenbacher KJ, Smith PM, Illig SB et al. Trends in length of stay, living setting, functional outcome, and mortality following medical rehabilitation. JAMA 2004; 292: 1687–1695.
- 41 Gill TM, Baker DI, Gottschalk M et al. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med 2002; 347: 1068–1074.
- 42 Prentice RL, Kalbfleisch JD, Peterson AV Jr et al. The analysis of failure times in the presence of competing risks. Biometrics 1978; 34: 541–554.
- 43 Guralnik JM, Ferrucci L. Underestimation of disability occurrence in epidemiological studies of older people: Is research on disability still alive? J Am Geriatr Soc 2002; 50: 1599–1601.
- 44 Parente ST, Weiner JP, Garnick DW et al. Developing a quality improvement database using health insurance data: A guided tour with application to Medicare's National Claims History file. Am J Med Qual 1995; 10: 162–176.
- 45 Gage B. Impact of the BBA on post-acute utilization. Health Care Financ Rev 1999; 20: 103–126.
- 46 Kane RL, Lin WC, Blewett LA. Geographic variation in the use of post-acute care. Health Serv Res 2002; 37: 667–682.
