Impact of hospital admission on functional and cognitive measures in older subjects

Introduction Hospital admission is frequently a major health transition for older adults, related with physical and mental disability that may persist after hospital discharge. We aimed to describe changes in physical and cognitive status in hospitalized older subjects, both during hospital admission and 3 months after hospital discharge, and to search for risk factors of impairment in physical and cognitive function. Methods Randomized sample of all patients over 65 years admitted during a 5-month period, both for urgent or elective care. Basic and instrumental ADL and mental status were assessed on admission, at hospital discharge, and 3 months after discharge. Predictors of physical and mental disability were assessed. Results Hundred and ninety-nine patients, mean age 75.9 years, were included. At hospital discharge, 16.5% of them had suffered a meaningful decrease in basic ADL, 24.6% in instrumental ADL, and 30.2% in cognitive tests. Three months later, 12.1% of those not lost or dead still reduced ability to perform basic ADL, 21.1% in instrumental ADL, and 35.2% had reduced cognitive scoring. In multivariate analysis, admission to surgical departments and discharge to a nursing home were related to loss of basic ADL; urgent admission and being widowed were related to loss of instrumental ADL; and older age, urgent admission, polypharmacy, and nursing home admission were related to reduced cognitive performance. Conclusions Physical and cognitive status change with hospitalization and after hospital discharge in older subjects. Some risk factors can be identified that predict these changes and allow for specific targeting of patients for preventive interventions.