Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis.
Christine Loyd, Alayne D Markland, Yue Zhang and 8 others
PMID 31734122WHAT IT FOUND
30% of older adults lose independence in daily activities such as bathing, dressing, toilet use or eating after acute hospitalization.
Check ADL status on admission and discharge, because loss is associated with nursing home placement and death.
Key findings
01The pooled prevalence of ADL decline from before hospitalization to after hospitalization was 30%, with an uncertainty range of 24% to 36%.
02Across hospital-based studies, prevalence ranged from 17% to 61%.
03The year a study began did not significantly change the prevalence of ADL decline.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The pooled estimate came from 15 studies with 7,375 participants, but the studies varied widely in how they defined and measured ADL decline. All but two studies used modified Katz or Barthel scales; 9 studies excluded continence, 10 added walking, and 2 added grooming. Several fair-quality studies did not report blinding of assessors or participation rates, and the pattern of results suggested possible publication bias. Thirteen studies were hospital-based and two were community-based; patients in inpatient rehabilitation or geriatric specialty units were excluded, so the results may not apply to those settings. Some functional decline may have been caused by the illness that led to admission, such as stroke or hip fracture, rather than hospitalization itself.
Declared interests
No conflicts of interest were declared. The article is listed as supported by NIH, non-U.S. government, and U.S. government non-PHS research support.
The easy way to misread this
Do not conclude from the 30% prevalence that hospitalization itself caused disability in all older adults, or that programs such as ACE are proven by this paper. This was a prevalence meta-analysis, not a treatment trial, and the included studies used different ADL definitions and showed substantial heterogeneity.