Daily Living in Older Adults After Hospitalization for Acute Illness
Objectives: To compare functional outcomes in the year after discharge for older adults discharged from the hospital after an acute medical illness with a new or additional disability in their basic self-care activities of daily living (ADL) (compared with preadmission baseline 2 weeks before admission) with those of older adults discharged with baseline ADL function and identify predictors of failure to recover to baseline function 1 year after discharge.
Design: Observational.
Setting: Tertiary care hospital, community teaching hospital.
Participants: Older (aged ≥70) patients nonelectively admitted to general medical services (1993-1998).
Measurements: Number of ADL disabilities at preadmission baseline and 1, 3, 6, and 12 months after discharge. Outcomes were death, sustained decline in ADL function, and recovery to baseline ADL function at each time point.
Results: By 12 months after discharge, of those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at baseline function. Of those discharged at baseline function, 17.8% died, 15.2% were alive but with worse than baseline function, and 67% were at their baseline function (P<.001). Of those discharged with new or additional ADL disability, the presence or absence of recovery by 1 month was associated with long-term outcomes. Age, cardiovascular disease, dementia, cancer, low albumin, and greater number of dependencies in instrumental ADLs independently predicted failure to recover.
Conclusion: For older adults discharged with new or additional disability in ADL after hospitalization for medical illness, prognosis for functional recovery is poor. Rehabilitation interventions of longer duration and timing than current reimbursement allows, caregiver support, and palliative care should be evaluated.

Hospitalization for acute medical illness frequently precipitates disability in activities of daily living (ADLs). The loss of self-care abilities results in serious short-term consequences for patients and families, because patients dependent in ADLs cannot successfully live at home without the assistance of caregivers, but the long-term significance of new or additional disabilities in ADLs associated with acute medical illness is not known. Recovery from disability in community-dwelling older persons is common, with rates of recovery from episodes of disability as high as 80%. In the short term, rates of recovery for people who have been hospitalized may be higher than for those whose disability develops more progressively without having been hospitalized, but hospitalization does not predict persistent recovery, and little is known about functional recovery for more than 1 to 3 months after hospital discharge. High rates of mortality and nursing home placement after hospitalization suggest that functional outcomes may be poor.

An understanding of the rates, time course, and predictors of functional recovery for older adults hospitalized for medical illness is essential for planning for the care needs of these patients, optimizing preventive and rehabilitative strategies for these patients, and informing health policy. Furthermore, formal rehabilitative services are less commonly provided after hospitalization for medical illness than for illnesses such as stroke or some surgical procedures, and many of these services are of short duration and low intensity. The objectives of this study were to describe long-term functional outcomes in the year after discharge for medical hospitalization in older adults discharged with a new or additional disability in their self-care ADLs, (compared with their preadmission baseline 2 weeks before admission), to compare these functional outcomes with the outcomes of older adults who were discharged with baseline self-care ADL function, and to identify predictors of failure to recover to baseline function 1 year after hospital discharge in older people with new or additional disabilities in self-care ADLs.