Physical function and disability after acute care and critical illness hospitalizations in a prospective cohort of older adults

Objectives To investigate associations between acute care and critical illness hospitalizations and performance on physical functional measures and activities of daily living (ADLs). Design Prospective cohort study. Setting Large health maintenance organization. Participants Two thousand nine hundred twenty-six participants in Adult Changes in Thought, a study of aging enrolling dementia-free individuals aged 65 and older not living in a nursing home from 1994 to September 30, 2008 (N = 2,926). Measurements The exposure of interest was hospitalization during study participation, subdivided by presence of critical illness. Outcomes included gait speed, grip strength, chair stand speed, and difficulty and dependence in performing ADLs measured at biennial visits. Results Median time between hospital discharge and the next study visit was 311 days (interquartile range (IQR) 151-501 days) after acute care hospitalization and 359 days (IQR 181-420 days) after critical illness hospitalization. Gait speed was slower after acute care (-0.05 m/s, 95% confidence interval (CI) = 0.01-0.04 m/s slower, P <.001) and critical illness (-0.16 m/s, 95% CI = -0.22 to -0.10, P <.001). Grip was weaker after acute care hospitalization (-0.8 kg, 95% CI = -1.0 to -0.6, P <.001) but not significantly different after critical illness hospitalization. Chair-stand speed was slower after acute care hospitalization (-0.04 stands/s, 95% CVI = -0.05 to -0.04, P <.001) and critical illness hospitalization (-0.09, 95% CI = -0.15 to -0.03, P =.003). The odds of difficulty with (odds ratio (OR) = 1.4, 95% CI = 1.2-1.6, P <.001) or dependence in (OR = 2.0, 95% CI = 1.2-3.2, P =.006) one or more ADLs was higher after acute care hospitalization, as were the odds of difficulty with (OR = 1.9, 95% CI = 1.1-3.6, P =.03) or dependence in (OR = 7.9, 95% CI = 2.5-25.7, P =.001) one or more ADLs after critical illness. Conclusion In older adults, hospitalization, especially for critical illness, was associated with clinically relevant decline in gait and chair stand speed and strongly associated with difficulty with and dependence in ADLs.