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Functional disability in late-middle-aged and older adults admitted to a safety-net hospital.

ABSTRACT: To determine the prevalence of preadmission functional disability in late-middle-aged and older safety-net inpatients and to identify characteristics associated with functional disability by age.Cross-sectional analysis.Safety-net hospital in San Francisco, California.English-, Spanish-, and Chinese-speaking community-dwelling individuals aged 55 and older admitted to a safety-net hospital with anticipated return to the community (N = 699).At hospital admission, participants reported their need for help performing five activities of daily living (ADLs) and seven instrumental activities of daily living (IADLs) 2 weeks before admission. ADL disability was defined as needing help performing one or more ADLs and IADL disability as needing help performing two or more IADLs. Participant characteristics were assessed, including sociodemographic characteristics, health status, health-related behaviors, and health-seeking behaviors.Overall, 28.3% of participants reported that they had an ADL disability 2 weeks before admission, and 40.4% reported an IADL disability. The prevalence of preadmission ADL disability was 28.9% of those aged 55 to 59, 20.7% of those aged 60 to 69, and 41.2% of those aged 70 and older (P < .001). The prevalence of IADL disability had a similar distribution. The characteristics associated with functional disability differed according to age; in participants aged 55 to 59, African Americans had a higher odds of ADL and IADL disability, whereas in participants aged 60 to 69 and aged 70 and older, inadequate health literacy was associated with functional disability.Preadmission functional disability is common in individuals aged 55 and older admitted to a safety-net hospital. Late-middle-aged individuals admitted to safety-net hospitals may benefit from models of acute care currently used for older adults that prevent adverse outcomes associated with functional disability.

SUBMITTER: Brown RT

PROVIDER: S-EPMC4241128 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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Functional disability in late-middle-aged and older adults admitted to a safety-net hospital.

Brown Rebecca T RT Pierluissi Edgar E Guzman David D Kessell Eric R ER Goldman L Elizabeth LE Sarkar Urmimala U Schneidermann Michelle M Critchfield Jeffrey M JM Kushel Margot B MB

Journal of the American Geriatrics Society 20141103 11

<h4>Objectives</h4>To determine the prevalence of preadmission functional disability in late-middle-aged and older safety-net inpatients and to identify characteristics associated with functional disability by age.<h4>Design</h4>Cross-sectional analysis.<h4>Setting</h4>Safety-net hospital in San Francisco, California.<h4>Participants</h4>English-, Spanish-, and Chinese-speaking community-dwelling individuals aged 55 and older admitted to a safety-net hospital with anticipated return to the commu ...[more]

PMID: 25367281

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Project description:BackgroundLittle is known about the association of handgrip strength (HGS) asymmetry with functional disability in China. We aimed to examine the individual and combined association of HGS asymmetry and weakness with functional disability among middle-aged and older Chinese adults.MethodsWe included participants aged ≥45 years from two waves of the China Health and Retirement Longitudinal Study (2011 and 2015). HGS weakness was defined as the maximal HGS<28 kg for men and <18 kg for women. HGS asymmetry was measured by dividing the maximal nondominant HGS (kg) by the maximal dominant HGS (kg), with the value <0.90 or >1.10 considered as asymmetry. Functional disability was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL) and was defined as encountering difficulty in completing one or more ADL/IADL tasks. The logistic regression models were used to explore the association between HGS measures and functional disability.Results11 950 (mean age 59.2 ± 9.6 years, 47.9% males) and 7540 (mean age 57.5 ± 8.6 years, 50.1% males) participants were included in the cross-sectional and prospective study, respectively. HGS asymmetry and weakness, individually or simultaneously, were associated with an increased prevalence of functional disability. During the four-year follow-up, 1822 (24.2%) participants had incident functional disability. The separate exposure to HGS asymmetry (odds ratio (OR) = 1.18; 95% confidence interval (CI) = 1.05-1.32) or weakness (OR = 1.59; 95% CI = 1.30-1.95) was independently associated with functional disability. For combined associations, those with both weakness and asymmetry showed the greatest risk of new-onset functional disability (OR = 1.91; 95% CI = 1.45-2.52).ConclusionsHGS asymmetry and weakness were associated with a higher risk of functional disability. Assessing HGS asymmetry together with weakness may help to better identify those at risk of functional disability to enable early interventions.

Project description:BackgroundMany adults are living longer with health conditions in the United States. Understanding the disability-adjusted life years (DALYs) for such health conditions may help to inform healthcare providers and their patients, guide health interventions, reduce healthcare costs, improve quality of life, and increase longevity for aging Americans. The purpose of this study was to determine the burden of 10 health conditions for a nationally-representative sample of adults aged 50 years and older in the United States.MethodsData from the 1998-2014 waves of the Health and Retirement Study were analyzed. At each wave, participants indicated if they were diagnosed with the following 10 conditions: cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, diabetes, back pain, hypertension, a fractured hip, myocardial infarction, rheumatism or arthritis, and a stroke. Years lived with a disability and years of life lost to premature mortality were summed for calculating DALYs. Sample weights were utilized in the analyses to make the DALY estimates nationally-representative. Results for the DALYs were presented in thousands.ResultsThere were 30,101 participants included. Sex stratified DALY estimates ranged from 4092 (fractured hip)-to-178,055 (hypertension) for men and 13,621 (fractured hip)-to-200,794 (hypertension) for women. The weighted overall DALYs were: 17,660 for hip fractures, 62,630 for congestive heart failure, 64,710 for myocardial infarction, 90,337 for COPD, 93,996 for stroke, 142,012 for cancer, 117,534 for diabetes, 186,586 for back pain, 333,420 for arthritis, and 378,849 for hypertension. In total, there were an estimated 1,487,734 years of healthy life lost from the 10 health conditions examined over the study period.ConclusionsThe burden of these health conditions accounted for over a million years of healthy life lost for middle-aged and older Americans over the 16 year study period. Our results should be used to inform healthcare providers and guide health interventions aiming to improve the health of middle-aged and older adults. Moreover, shifting health policy and resources to match DALY trends may help to improve quality of life during aging and longevity.

Project description:BackgroundHospital-acquired disability (HAD) is common and often related to low physical activity while in the hospital.ObjectiveTo examine whether wearable hospital activity trackers can be used to predict HAD.DesignA prospective observational study between January 2016 and March 2017.SettingAn academic medical center.ParticipantsCommunity-dwelling older adults, aged 60?years or older, enrolled within 24?hours of admission to general medicine (n = 46).Main measuresPrimary outcome was HAD, defined as having one or more new activity of daily living deficits, decline of four or greater on the Late-Life Function and Disability Instrument (calculated between baseline and discharge), or discharge to a skilled nursing facility. Hospital activity (mean active time, mean sedentary time, and mean step counts per day) was measured using ankle-mounted accelerometers. The association of the literature-based threshold of 900 steps/day with HAD was also evaluated.ResultsMean age was 73.2?years (SD = 9.5?years), 48% were male, and 76% were white. Median length of stay was 4?days (interquartile range [IQR] =?2.0-6.0?days); 61% (n = 28) reported being able to walk without assistance of another person or walking aid at baseline. Median daily activity time and step counts were 1.1 h/d (IQR = 0.7-1.7 h/d) and 1455.7 steps/day (IQR = 908.5-2643 steps/day), respectively. Those with HAD (41%; n = 19) had lower activity time (0.8 vs 1.4 h/d; P = .04) and fewer step counts (1186 vs 1808 steps/day; P = .04), but no difference in sedentary time, compared to those without HAD. The 900 steps/day threshold had poor sensitivity (40%) and high specificity (85%) for detecting HAD.ConclusionsLow hospital physical activity, as measured by wearable accelerometers, is associated with HAD. Clinicians can utilize wearable technology data to refer patients to physical/occupational therapy services or other mobility interventions, like walking programs. J Am Geriatr Soc 68:261-265, 2020.

Dataset Information

Functional disability in late-middle-aged and older adults admitted to a safety-net hospital.

Publications

Functional disability in late-middle-aged and older adults admitted to a safety-net hospital.

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