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Objectives To study (i) the association of general self-efficacy (GSE) on the course of subjective (i.e. basic and instrumental activities of daily living (ADLs and IADLs) and objective physical performance outcomes (short physical performance battery (SPPB)) among older persons from discharge up to 3 months post-discharge and (ii) the extent to whether motivational factors such as depressive symptoms, apathy and fatigue mediate this association. Methods Prospective multi-centre cohort of acutely hospitalised patients aged ≥70 (Hospital-ADL study). Structural equation modelling was used to analyse the structural relationships. Results The analytic sample included 236 acutely hospitalised patients. GSE had a significant total effect on the course of subjective and objective performance outcomes (ADLs: β  = −0.21, P  < 0.001, IADLs: β  = −0.24, P  < 0.001 and SPPB: β  = 0.17, P  < 0.001). However, when motivational factors as mediator were included into the same model, motivational factors (IADLs: β  = 0.51, P  < 0.001; SPPB: β  = 0.49, P  < 0.001) but not GSE remained significantly associated with IADLs (β  = −0.06, P  = 0.16) and SPPB (β  = 0.002, P  = 0.97). Motivational factors partially mediated the relationship between GSE and ADLs (β  = −0.09, P  = 0.04). The percentage of mediation was 55, 74 and 99% for ADLs, IADLs and SPPB, respectively. Conclusions Motivational factors and GSE are both associated with subjective and objective performance outcomes. However, the relationship between GSE and subjective and objective performance outcomes was highly mediated by motivational factors. Taken together, this suggests that GSE is important to being physically active but not sufficient to becoming more physical active in acutely hospitalised older patients; motivation is important to improving both subjective and objective performance. [ABSTRACT FROM AUTHOR]

Background: Acute hospitalization may lead to posthospital syndrome, but no studies have investigated how this syndrome manifests and geriatric syndromes are often used as synonym. However, studies on longitudinal associations between syndromes and adverse outcomes are scarce. We aimed to analyze longitudinal associations between geriatric syndromes and functional decline (FD), readmission, and mortality.Methods: Prospective cohort study, including 401 acutely hospitalized patients (aged ≥ 70). We performed: (i) logistic regression analyses to assess associations between patterns of geriatric syndromes as they develop over time (between admission and 1 month postdischarge), and FD and readmission; (ii) generalized estimating equations to assess longitudinal associations between geriatric syndromes over five time points (admission, discharge, 1, 2, and 3 months postdischarge) and FD, mortality, and readmission at 3 months postdischarge.Results: After syndrome absent, syndrome present at both admission and 1 month postdischarge was most prevalent. Persistent patterns of apathy (odds ratio [OR] = 4.35, 95% confidence interval [CI] = 1.54-12.30), pain (OR = 3.26, 95% CI = 1.21-8.8), malnutrition (OR = 3.4, 95% CI = 1.35-8.56), mobility impairment (OR = 6.65, 95% CI = 1.98-22.38), and fear of falling (OR = 3.17, 95% CI = 1.25-8.02) were associated with FD. Developing cognitive impairment (OR = 6.40, 95% CI = 1.52-26.84), fatigue (OR = 4.71, 95% CI = 1.03-21.60), and fall risk (OR = 4.30, 95% CI = 1.21-16.57) postdischarge, was associated with readmission; however, only 4%-6% developed these syndromes. Over the course of five time points, mobility impairment, apathy, and incontinence were longitudinally associated with FD; apathy, malnutrition, fatigue, and fall risk with mortality; malnutrition with readmission.Conclusion: Most geriatric syndromes are present at admission and patients are likely to retain them postdischarge. Several geriatric syndromes are longitudinally associated with mortality and, particularly, persistently present syndromes place persons are at risk of FD. Although few persons develop syndromes postdischarge, those developing cognitive impairment, fatigue, and fall risk were at increased readmission risk. [ABSTRACT FROM AUTHOR]

Background: 30 to 60% of the acute hospitalized older adults experience functional decline after hospitalization. The first signs of functional decline after discharge can often be observed in the inability to perform mobility tasks, such as raising from a chair or walking. Information how mobility develops over time is scarce. Insight in the course of mobility is needed to prevent and decrease mobility limitations. Objectives: The objectives of this study were to determine (i) the course of mobility of acute hospitalized older adults and (ii) the association between muscle strength and the course of mobility over time controlled for influencing factors. Methods: In a multicenter, prospective, observational cohort study, measurements were taken at admission, discharge, one- and three months post-discharge. Mobility was assessed by the De Morton Mobility Index (DEMMI) and muscle strength by the JAMAR. The longitudinal association between muscle strength and mobility was analysed with a Linear Mixed Model and controlled for potential confounders. Results: 391 older adults were included in the analytic sample with a mean (SD) age of 79.6 (6.7) years. Mobility improved significantly from admission up to three months post-discharge but did not reach normative levels. Muscle strength was associated with the course of mobility (beta = 0.64; p<0.01), even after controlling for factors as age, cognitive impairment, fear of falling and depressive symptoms (beta = 0.35; p<0.01). Conclusion: Muscle strength is longitudinally associated with mobility. Interventions to improve mobility including muscle strength are warranted, in acute hospitalized older adults. [ABSTRACT FROM AUTHOR]

Background The transition between hospital and home is a vulnerable period for acutely hospitalized older patients during which they are at increased risk for adverse health outcomes. Yet, studies describing experiences of a geriatric patient population postdischarge from a patient perspective are missing. Objective To characterize patient experiences with recovering at home after acute hospitalization. Design and Methods Qualitative semi-structured interviews, involving 20 recently discharged patients (age ≥ 70), were conducted. A thematic analysis of the content was performed. Results Ten categories were identified as recurring topics, which were grouped into 3 major themes. The first theme describes the effect of hospitalization on daily life. Participants described that the problems they encountered were mostly caused by symptoms they experienced since discharge, which were grouped into 2 themes: (a) physical consequences of hospitalization and (b) motivational and psychological problems after hospitalization. Among most frequently presented symptoms were fatigue, apathy, unsteadiness while standing, and fear of falling. Implications Impairment in mobility and instrumental activities of daily living was the dominant experience for interviewed patients. This disability was mainly attributed to four main symptoms: fatigue, apathy, unsteadiness while standing, and fear of falling. We propose a tentative model that summarizes the role of posthospital symptoms in the recovery process and the potential syndromes (frailty, posthospital syndrome, palliative symptoms, and sickness behavior) that could underlie these shared symptoms which may act as a conceptual framework for future research. Our study points at the relevance of symptom experiences in functional recovery postdischarge. [ABSTRACT FROM AUTHOR]

Background: Over 30 % of older patients experience hospitalization-associated disability (HAD) (i.e., loss of independence in Activities of Daily Living (ADLs)) after an acute hospitalization. Despite its high prevalence, the mechanisms that underlie HAD remain elusive. This paper describes the protocol for the Hospital-Associated Disability and impact on daily Life (Hospital-ADL) study, which aims to unravel the potential mechanisms behind HAD from admission to three months post-discharge.Methods/design: The Hospital-ADL study is a multicenter, observational, prospective cohort study aiming to recruit 400 patients aged ≥70 years that are acutely hospitalized at departments of Internal Medicine, Cardiology or Geriatrics, involving six hospitals in the Netherlands. Eligible are patients hospitalized for at least 48 h, without major cognitive impairment (Mini Mental State Examination score ≥15), who have a life expectancy of more than three months, and without disablement in all six ADLs. The study will assess possible cognitive, behavioral, psychosocial, physical, and biological factors of HAD. Data will be collected through: 1] medical and demographical data; 2] personal interviews, which includes assessment of cognitive impairment, behavioral and psychosocial functioning, physical functioning, and health care utilization; 3] physical performance tests, which includes gait speed, hand grip strength, balance, bioelectrical impedance analysis (BIA), and an activity tracker (Fitbit Flex), and; 4] analyses of blood samples to assess inflammatory and metabolic markers. The primary endpoint is additional disabilities in ADLs three months post-hospital discharge compared to ADL function two weeks prior to hospital admission. Secondary outcomes are health care utilization, health-related quality of life (HRQoL), physical performance tests, and mortality. There will be at least five data collection points; within 48 h after admission (H1), at discharge (H3), and at one (P1; home visit), two (P2; by telephone) and three months (P3; home visit) post-discharge. If the patient is admitted for more than five days, additional measurements will be planned during hospitalization on Monday, Wednesday, and Friday (H2).Discussion: The Hospital-ADL study will provide information on cognitive, behavioral, psychosocial, physical, and biological factors associated with HAD and will be collected during and following hospitalization. These data may inform new interventions to prevent or restore hospitalization-associated disability. [ABSTRACT FROM AUTHOR]

Decreased appetite is one of the main risk factors of malnutrition. Little is known on how appetite changes during hospitalization and after discharge and how it relates with sarcopenia-related outcomes. We analyzed data of the Hospital-ADL study, a multicenter prospective cohort study that followed 400 acutely hospitalized older adults (≥70 year). Appetite (SNAQ), handgrip strength (Jamar), muscle mass (BIA), mobility (DEMMI), and physical performance (SPPB) were assessed within 48 h of admission, at discharge, and at one and three months post-discharge. The course of decreased appetite was analysed by Generalised Estimating Equations. Linear Mixed Model was used to analyse the associations between decreased appetite and the sarcopenia-related outcomes. Decreased appetite was reported by 51% at hospital admission, 34% at discharge, 28% one month post-discharge, and 17% three months post-discharge. Overall, decreased appetite was associated with lower muscle strength (β = −1.089, p = 0.001), lower mobility skills (β = −3.893, p < 0.001), and lower physical performance (β = −0.706, p < 0.001) but not with muscle mass (β = −0.023, p = 0.920). In conclusion, decreased appetite was highly prevalent among acute hospitalized older adults and remained prevalent, although less, after discharge. Decreased appetite was significantly associated with negative sarcopenia-related outcomes, which underlines the need for assessment and monitoring of decreased appetite during and post hospitalization. [ABSTRACT FROM AUTHOR]

Background: The transition between hospital and home is a vulnerable period for acutely hospitalized older patients during which they are at increased risk for adverse health outcomes. Yet, studies describing experiences of a geriatric patient population postdischarge from a patient perspective are missing., Objective: To characterize patient experiences with recovering at home after acute hospitalization., Design and Methods: Qualitative semi-structured interviews, involving 20 recently discharged patients (age ≥ 70), were conducted. A thematic analysis of the content was performed., Results: Ten categories were identified as recurring topics, which were grouped into 3 major themes. The first theme describes the effect of hospitalization on daily life. Participants described that the problems they encountered were mostly caused by symptoms they experienced since discharge, which were grouped into 2 themes: (a) physical consequences of hospitalization and (b) motivational and psychological problems after hospitalization. Among most frequently presented symptoms were fatigue, apathy, unsteadiness while standing, and fear of falling., Implications: Impairment in mobility and instrumental activities of daily living was the dominant experience for interviewed patients. This disability was mainly attributed to four main symptoms: fatigue, apathy, unsteadiness while standing, and fear of falling. We propose a tentative model that summarizes the role of posthospital symptoms in the recovery process and the potential syndromes (frailty, posthospital syndrome, palliative symptoms, and sickness behavior) that could underlie these shared symptoms which may act as a conceptual framework for future research. Our study points at the relevance of symptom experiences in functional recovery postdischarge., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)