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Loss of independence in Katz’s ADL ability in connection with an acute hospitalization: early clinical markers in French older people

  • Geriatric Epidemiology
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Background

The preservation of autonomy and the ability of elderly to carry out the basic activities of daily living, beyond the therapeutic care of any pathologies, appears as one of the main objectives of care during hospitalization.

Objectives

To identify early clinical markers associated with the loss of independence in elderly people in short stay hospitals.

Methods

Among the 1,306 subjects making up the prospective and multicenter SAFEs cohort study (Sujet Agé Fragile: Évolution et suivi—Frail elderly subjects, evaluation and follow-up), 619 medical inpatients, not disabled at baseline and hospitalized through an emergency department were considered. Data used in a multinomial logistic regression were obtained through a comprehensive geriatric assessment (CGA) conducted in the first week of hospitalization. Dependency levels were assessed at baseline, at inclusion and at 30 days using Katz’s ADL index. Baseline was defined as the dependence level before occurrence of the event motivating hospitalization. To limit the influence of rehabilitation on the level of dependence, only stays shorter than 30 days were considered.

Results

About 514 patients were eligible, 15 died and 90 were still hospitalized at end point (n = 619). Two-thirds of subjects were women, with a mean age of 83. At day 30 162 patients (31%) were not disabled; 61 (12%) were moderately disabled and 291 severely disabled (57%). No socio-demographic variables seemed to influence the day 30 dependence level. Lack of autonomy (odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.2–3.6), walking difficulties (OR = 2.7, 95% CI = 1.3–5.6), fall risk (OR = 2.1, 95% CI = 1.3–6.8) and malnutrition risk (OR = 2.2, 95% CI = 1.5–7.6) were found in multifactorial analysis to be clinical markers for loss of independence.

Conclusions

Beyond considerations on the designing of preventive policies targeting the populations at risk that have been identified here, the identification of functional factors (lack of autonomy, walking difficulties, risk of falling) suggests above all that consideration needs to be given to the organization per se of the French geriatric hospital care system, and in particular to the relevance of maintaining sector-type segregation between wards for care of acute care and those involved in rehabilitation

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Author information

Authors and Affiliations

  1. Department of Rehabilitation and Geriatrics, Hospital of Trois-Chêne, University Hospitals of Geneva, Chemin du Pont-Bochet 3, Thônex-Genève, 1226, Geneva, Switzerland

    Pierre-Olivier Lang

  2. University of Reims Champagne-Ardenne, School of Médecine, E.A.3797, Reims, France

    Pierre-Olivier Lang, Moustapha Dramé, Nicolas Jovenin, Dominique Somme, Jean-Luc Novella, Damien Jolly & François Blanchard

  3. Department of Public Health, University Hospitals of Strasbourg, Strasbourg, France

    Nicolas Meyer

  4. Department of Geriatrics, University Hospitals of Strasbourg, Strasbourg, France

    Damien Heitz

  5. Department of Gerontology, University Hospitals of Reims, Reims, France

    Moustapha Dramé, Jean-Luc Novella & François Blanchard

  6. Clinical Research Unit, University Hospitals of Reims, Reims, France

    Nicolas Jovenin & Damien Jolly

  7. Center of Gerontology, Hospital Sainte Perrine, Assistance Publique Hôpitaux de Paris, Paris, France

    Joël Ankri

  8. Geriatrics Unit, European Hospital Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France

    Dominique Somme & Olivier Saint-Jean

  9. Center of Geriatrics Medicine, Hospital Porte Madeleine, General Hospital Center of Orleans, Orleans, France

    Jean-Bernard Gauvain

  10. Geriatrics Clinic, University Hospitals of Grenoble, Grenoble, France

    Pascal Couturier & Isabelle Lanièce

  11. Geriatrics and Gerontology Center, University Hospitals of Toulouse, Toulouse, France

    Thierry Voisin

  12. Geriatrics unit, University Hospitals of Nimes, Nimes, France

    Benoit de Wazières

  13. Clinical gerontology unit, University Hospital of Saint Etienne, Saint Etienne, France

    Régis Gonthier

  14. Center of clinical gerontology, University Hospitals of Montpellier, Montpellier, France

    Claude Jeandel

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  1. Pierre-Olivier Lang
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Correspondence to Pierre-Olivier Lang.

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Lang, PO., Meyer, N., Heitz, D. et al. Loss of independence in Katz’s ADL ability in connection with an acute hospitalization: early clinical markers in French older people. Eur J Epidemiol 22, 621–630 (2007). https://doi.org/10.1007/s10654-007-9150-1

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  • DOI: https://doi.org/10.1007/s10654-007-9150-1

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