Hospital-Associated Functional Decline: The Role of Hospitalization Processes Beyond Individual Risk Factors

Objectives: To investigate the combined contribution of processes of hospitalization and preadmission individual risk factors in explaining functional decline at discharge and at 1-month follow-up in older adults with nondisabling conditions. Design: Prospective cohort study. Setting: Internal medicine wards in two Israeli medical centers. Participants: Six hundred eighty-four individuals aged 70 and older admitted for a nondisabling problem. Measurements: Functional decline was measured according to change in modified Barthel Index from premorbid to discharge and from premorbid to 1 month after discharge. In-hospital mobility, continence care, sleep medication consumption, satisfaction with hospital environment, and nutrition intake were assessed using previously tested self-report instruments. Results: Two hundred eighty-two participants (41.2%) reported functional decline at discharge and 317 (46.3%) at 1 month after discharge. Path analysis indicated that in-hospital mobility (standardized maximum likelihood estimate (SMLE) = −0.48, P <.001), continence care (SMLE = −0.12, P <.001), and length of stay (LOS) (SMLE = 0.06, P <.001) were directly related to functional decline at discharge and, together with personal risk factors, explained 64% of variance. In-hospital mobility, continence care, and LOS were indirectly related to functional decline at 1 month after discharge through functional decline at discharge (SMLE = 0.45, P <.001). Nutrition consumption (SMLE = −0.07, P <.001) was significantly related to functional decline at 1 month after discharge, explaining, together with other risk factors, 32% of variance. Conclusion: In-hospital low mobility, suboptimal continence care, and poor nutrition account for immediate and 1-month posthospitalization functional decline. These are potentially modifiable hospitalization risk factors for which practice and policy should be targeted in efforts to curb the posthospitalization functional decline trajectory.