Hospitalization Can Lead to the Development of Disability in the Elderly
In the US, there are more than 35 million adults who are 65 and older—this is one of the fastest growing segments of the population. However, it is estimated that the number of chronically disabled people in this age group exceeds seven million.
Disability in this age group is associated with an increase in death, as well as nursing home admittance. In addition, it places a significant burden on the disabled adult, family and friends, and the health care system. An estimated $26 billion a year is spent on medical and long-term care for newly disabled elderly.
If disability can be prevented, burden to the individual, caregivers, and the health care system may be lessened. And the first step towards prevention is identifying events that may lead to disability.
A study published in the November 3, 2004 issue of the Journal of the American Medical Association looked at the relationship between two events—hospitalization and restricted activity from illness or injury—and the development of disability.
About the Study
The study included 754 adults aged 70 and older who had no significant cognitive impairment and had no trouble completing four essential activities of daily living (ADLs): bathing, dressing, walking inside the house, and transferring from a chair. They were divided into two groups based on whether or not they were physically frail (determined by walking speed).
The participants were telephoned once a month to evaluate any illness or injury that led to hospitalizations or restricted activity, and the development of disability. During the calls, participants were asked if, since the last interview, they had:
- Stayed overnight in a hospital
- Cut down on usual activities due to an illness, injury, or other problem
- Stayed in bed for at least half a day due to an illness, injury, or other problem
In addition, participants were asked if they could complete all of the previously mentioned ADLs (bathing, dressing, walking inside the house, or transferring from a chair) without help, or if they needed help from another person. Disability was defined as the need for personal assistance in one or more of the four ADLs.
During the five years of follow up, 372 of the participants were hospitalized and 600 experienced at least one episode of restricted activity. Also during the five-year study, 417 (55.3%) participants developed disability (using the study’s definition). Of this group, 278 (36.9%) developed a persistent disability and 199 (26.4%) experienced a disability that resulted in a nursing home admission.
The findings revealed that participants who developed disability were significantly more likely to have experienced an illness or injury that led to hospitalization or restricted activity than those who did not develop disability. In fact, the risk of disability within a month of hospitalization was increased more than 60 times, and within a month of restricted activity, almost 6 times. Also, members of the group determined to be physically frail were more likely to develop disability than those who were not physically frail.
The most common causes of hospitalization were cardiac-related, including ]]>coronary heart disease]]> and ]]>congestive heart failure]]> , and infection. But, fall-related injuries brought with them the highest risk of disability. The most common reasons for restricted activity that led to disability were fatigue, pain or stiffness in the back or joints, and dizziness or unsteadiness.
How Does This Affect You?
The study’s findings show that illnesses and injuries that lead to hospitalization and restricted activity increase the incidence of disability. The authors found that several of the most common events identified were either preventable, or manageable by aggressive in-hospital treatment or interventions after discharge. Targeting these events for intervention, and possibly prevention, may help decrease disability in the elderly and lighten the burden for caregivers and the health care system.
The authors suggest fall prevention as an excellent place to start. The National Institute on Aging recommends many things elderly individuals can do in their homes to help prevent falls, including:
- Make sure there is good lighting; use night-lights at night
- Keep walking areas neat and dry
- Keep electric cords and telephone wires near walls and away from walking paths
- Tack down all carpets and area rugs firmly to the floor
- Arrange furniture (especially low coffee tables) and other objects so they are always out of the way when you are walking
- Have handrails on both sides of all stairs
- Mount grab bars near toilets and on both the inside and outside of the tub and shower
- Place non-skid mats, strips, or carpet on all surfaces that may get wet in the kitchen and bathroom
Administration on Aging
Alliance for Aging Research
American Geriatrics Society
National Council on the Aging
National Institute on Aging
Gill TM, et al. Hospitalization, restricted activity, and the development of disability among older persons. Journal of the American Medical Association . 2004; 292(17): 2115-2124.
Preventing falls and fractures. 2004. National Institute on Aging Web site. Available at: http://www.niapublications.org/engagepages/falls.asp . Accessed November 3, 2004.
The 65 years and older population: 2000. US Census Bureau Web site. Available at: http://www.census.gov/prod/2001pubs/c2kbr01-10.pdf . Accessed November 3, 2004.
Last reviewed Nov 4, 2004 by ]]>Richard Glickman-Simon, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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