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Background: Loss of functional independence occurs frequently with hospitalization. In community-dwelling elders, lower extremity disability is an important predictor of functional loss. Ambulation assistive devices (canes, walkers), as markers of lower extremity disability, may predict functional decline associated with hospitalization, but this has not been evaluated previously. We sought to determine the association of mobility impairment, as indicated by cane or walker use prehospitalization, with adverse outcomes at hospital discharge and 3 months post discharge.Methods: Subjects were community-dwelling adults (N = 1212) aged 70 and older, hospitalized for acute medical illness. The study was a secondary analysis of the Hospital Outcomes Project for the Elderly, a prospective randomized trial at three university and two private acute-care hospitals, which randomized patients to usual care or an intervention group designed to maintain functional abilities.Results: After controlling for demographic and illness-related characteristics and prehospital function, mobility impairment was significantly associated with functional decline. Use of a walker was associated with 2.8 times increased risk for decline in ADL function by hospital discharge (p = .0002). Three months after discharge, patients who used assistive devices prior to hospitalization were more likely to have declined in both ADLs (p = .02) and IADLs (p = .003).Conclusions: Hospitalized patients with mobility impairment, as indicated by use of a cane or a walker, are at high risk for functional decline. Such patients may benefit from more intensive in-hospital and post-hospital rehabilitative therapy to maintain function. [ABSTRACT FROM AUTHOR]

Background: The ability to walk independently may become jeopardized during hospitalization. It is unknown which patients are at risk for decline in walking, or to what extent patients will recover. The purpose of this study was to determine the incidence of, risk factors for, and outcomes associated with new walking dependence after hospitalization.Methods: Baseline characteristics and functional outcomes at hospital discharge and 3 months after discharge were measured for 1,181 community-dwelling adults aged 70 and over who were hospitalized for medical illness and who walked independently prior to hospitalization.Results: At discharge, 16.8% of patients were newly dependent in walking. Risk factors included age > 85 (odds ratio [OR] 2.7 vs age <75, 95% confidence interval [CI] 1.5-4.9), functional impairment before hospitalization (OR 1.4 for each impairment, CI 1.1-1.7), Caucasian race (OR 1.9, CI 1.1-3.3), and use of a walker (OR 1.8, CI 1.04-3.2) or wheelchair (OR 3.2, CI 1.3-7.6) before admission. A cancer diagnosis (OR 2.3, CI 1.2-4.6) and more than four comorbid conditions (OR 1.9, CI 1.2-3.0) were also predictive. New walking dependence was associated with discharge to a nursing home (p = .0001) and higher postdischarge mortality (p < .001). Twenty-seven percent of patients who developed new walking dependence and survived 3 months continued to be dependent in walking.Conclusions: New walking dependence occurs frequently with hospitalization, may be predicted by specific risk factors, and portends a poor prognosis. Strategies are needed to help at-risk patients maintain walking independence during and after hospitalization. [ABSTRACT FROM AUTHOR]

Background: The study objectives were (a) to describe the occurrence, types, and preventability of adverse drug events (ADEs) in hospitalized patients 70 years of age and older; (b) to examine the association between potential risk factors and ADEs; and (c) to examine the relationship of an ADE occurrence and hospital length of stay (LOS) and functional decline.Method: Consecutive general medical admissions (n = 157) of community-dwelling persons were prospectively monitored daily for ADE occurrence. Admission assessment included demographic factors, cognition, preadmission medication use, and functional status. Discharge assessment included functional status. LOS, discharge diagnoses, and medication use during the hospitalization.Results: Twenty-three patients (14.6%) experienced 28 probable ADEs, of which 54.2% (13/24) were judged to be potentially preventable. Patients experiencing an ADE had a significantly lower mean Mini-Mental State Examination score (23.6 +/- 4.3 vs 25.5 +/- 3.6, p = .039) and were prescribed significantly more new inpatient medications (4.0 +/- 2.3 vs 2.6 +/- 1.7, p = .01) compared to non-ADE patients. Age, gender, functional status prior to admission, percent with more than four active diagnoses, or number of preadmission medications were not associated with ADE status. Upon discharge, 50.0% of ADE patients experienced a decline in one or more activities of daily living (ADLs), compared with 24.1% of non-ADE patients (p = .017). ADE patients had a longer LOS (8.7 +/- 4.9 vs 6.6 +/- 3.0 days, p = .022) compared to non-ADE patients.Conclusions: ADEs were associated with number of new inpatient medications and admission cognitive status, but not demographic, disease, or physical function variables. Patients experiencing an ADE were more likely to experience a longer LOS and to decline in ADL function. ADEs may be one factor contributing to functional decline during hospitalization. Future research in this area should include larger samples and multivariable analyses controlling for potential confounders. [ABSTRACT FROM AUTHOR]