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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.

Depressive symptoms and apathy are both causes for and a consequences of hospitalization among older persons. Depressive symptoms and apathy are highly heterogeneous in its course, and psychological or physical recovery may be related to distinct trajectories. These trajectories are unknown in the context of acute hospitalization and possibly important for post-hospital recovery. Therefore, the aim of this study was to identify distinct trajectories of depressive symptoms and apathy from acute hospitalization until three months post-discharge and to study the incidence of functional decline and mortality three months post-discharge in these trajectories. We conducted a multicenter prospective cohort study, the Hospital-Associated Disability and impact on daily Life (Hospital-ADL) study, including 400 acutely hospitalized patients of 70 years and above. Data were collected in six Dutch hospitals. We identified three depressive symptoms consistently trajectories among acutely hospitalized patients: 1]high level of depressive symptoms (10%), 2]moderate level of symptoms (28%), and 3]minimal symptoms (62%). Percentages of functional decline in the first, second and third group were 32%, 31%, and 12%, respectively. Mortality rates per group were 25%, 17%, and 5%, respectively. We identified three apathy trajectories: 1]consistently high level of symptoms (19%), 2]), 2]consistently moderate level (23%), and 3]moderate level of symptoms and decreasing post-discharge (15%). Percentages of functional decline were 23%, 7%, and 15% respectively. Mortality rates per group were 14%, 3%, and 0% respectively. These distinct trajectory groups of depressive symptoms and apathy provide information about the possible prognosis of these symptoms and functional recovery after an acute hospitalization.

Acute hospitalization often initiates events leading to changes in cognitive functioning. The majority of studies that investigated cognitive trajectories over time focused on specific patient-populations such as patients who suffered a hip fracture, stroke, or delirium. Moreover, previous studies have had only long-term follow ups. Trajectories of cognitive changes within the short critical three months post-discharge are hence unknown. Therefore, the aim of this study was to identify distinct trajectories of cognitive functioning from acute hospitalization up to three months post-discharge and to study the incidence of functional decline and mortality. We conducted a multicenter prospective cohort study, the Hospital-Associated Disability and impact on daily Life (Hospital-ADL) study, including 400 acutely hospitalized patients of 70 years and older, who had a minimal MMSE-score of 15 at admission. Data were collected in six hospitals in the Netherlands. We identified three cognitive trajectories: 1] consistently high level of cognitive functioning (69%), 2] moderate cognitive functioning and improvement (22%), and 3] consistently minimal cognitive functioning (9%). In the group with a consistently high level of cognitive functioning, 14% had functional decline and the mortality rate was 11% at three months post-discharge. Of the participants with moderate cognitive functioning and improvement, 24% experienced functional decline and the mortality rate was 6.5%. Finally, of the participants with consistently low cognitive functioning, 41% had functional decline and 14% died within three months post-discharge. These distinct trajectory groups of cognitive functioning provide information about the possible prognosis of cognition and functional recovery after an acute hospitalization.