Impact of hospitalization in functional and mobility capacity of older adults

Detalhes bibliográficos
Ano de defesa: 2017
Autor(a) principal: Menezes, Karla Vanessa Rodrigues Soares
Orientador(a): Guerra, Ricardo Oliveira
Banca de defesa: Não Informado pela instituição
Tipo de documento: Tese
Tipo de acesso: Acesso aberto
Idioma: por
Instituição de defesa: Não Informado pela instituição
Programa de Pós-Graduação: PROGRAMA DE PÓS-GRADUAÇÃO EM CIÊNCIAS DA SAÚDE
Departamento: Não Informado pela instituição
País: Brasil
Palavras-chave em Português:
Área do conhecimento CNPq:
Link de acesso: https://repositorio.ufrn.br/jspui/handle/123456789/24122
Resumo: Introduction: As people get older, it remains a challenge maintaining functional capacity. Functioning consists of the ability to perform self-care activities (i.e. activities of daily living - ADLs) classified inside the level of “activity and participation” of the International Classification of Functioning, Disability and Health (ICF). Previous studies have identified different risk factors for worsening functional capacity during hospitalization, including older age, sociodemographic characteristics, pre-existing impairment, cognitive loss, delirium, and comorbidity. In-hospital mobility has received particular attention due to its important association to loss of functional capacity. Few studies about hospitalization effects on older adults have been done in Brazil. Identifying older adults at risk for loss in functional capacity during hospitalization will help researchers and clinicians in order to make informed decisions. Objectives: This study contemplates three objectives: first, to provide an updated review to identify and appraise relevant instruments for measuring older adults’ mobility based on the ICF conceptual framework in the context of an acute care or intensive geriatric rehabilitation unit, and to appraise and compare their measurement properties; second, to evaluate if in-hospital mobility assessed at admission is predictive of loss in functional capacity during hospitalization of older adults and to verify if other variables combined with in-hospital mobility can better predict loss in functional capacity; third, to assess functional changes of hospitalized older adults from pre-admission (baseline) until discharge and identify predictors of loss in functional capacity. Methods: This cohort prospective study was conducted at the Onofre Lopes University Hospital (HUOL), Natal/RN, Brazil, between January 1, 2014 and April 30, 2015. The study enrolled all consecutive patients aged 60 years and older who were acutely admitted and met the following inclusion criteria: 1) ability to provide informed consent; 2) admitted directly from the community; 3) screening for study eligibility performed in the first 24 hours of admission. Independent variables included personal characteristics, domestic living activities (i.e. instrumental activities of daily living – IADL) evaluated by Lawton and Brody’s scale, cognition evaluated by Leganés cognitive test, depression assessed by Geriatric Depression Scale (GDS-15), and in-hospital mobility evaluated by the Short Physical Performance Battery (SPPB). The dependent variable of functional capacity was assessed by the Katz scale. These instruments were applied at two different times: at admission (first 24 hours) and at discharge (12-24 hours before). Analysis included descriptive statistics, bivariate and multivariate analysis by means of frequencies, means ± standard error, receiver-operating characteristic (ROC), logistic binary regression and Generalized Estimating Equation (GEE). Data were entered into the Statistical Package for Social Sciences (SPSS) version 18.0 for Windows. Results: From the 1256 included at discharge, 65 (5.1%) died during hospitalization, thus the final sample consisted of 1191 older adults. The mean age was 70.02 (±7.34) and mean length of hospital stay was 7.65 days (±9.94). Our sample had a high prevalence of surgery (70.1%). Regarding the best instruments to assess mobility, the De Morton Mobility Index (DEMMI) and SPPB presented the best balance between mobility coverage, measurement properties and applicability to acute care and intensive geriatric rehabilitation units. A SPPB cutoff point of 6.5 (62% sensitivity, 54% specificity) identified 593 (49.8%) patients at risk for loss in functional capacity. In logistic regression, SPPB alone presented a statistically significant prediction loss of functional capacity between admission and discharge. Finally, regarding changes in functional capacity, 52.5% of the older adults were discharged with worse functional capacity than baseline. Being dependent for domestic life activities, presence of depression symptons, low levels of cognition and in-hospital mobility were risk factors for greater loss in functional capacity after a hospitalization event. Conclusion: We conclude that DEMMI and SPPB were the best instruments to assess mobility in hospitalized older adults. Regarding functional capacity, half the sample presented loss in functioning between baseline and discharge, while in-hospital mobility evaluated by SPPB can predict loss of function in hospitalized older adults. In addition to in-hospital mobility, dependence for domestic living activities, low levels of cognition and depression improve the detection of cases for being at risk of loss in functional capacity.