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Elderly Develop Disabilities After Restricted
Activity, Hospitalization
 Nov. 3, 2004 - Illnesses and injuries leading to
either hospitalization or restricted activity are strongly associated
with the development of disability for older persons living in the
community, regardless of their physical condition, according to a study
in todays issue of JAMA.
The authors provide as background information that
while the prevalence of disability is decreasing, there are currently
more than 7 million chronically disabled individuals aged 65 years or
older in the United States.
"The risk of developing disability within a month
of hospitalization was elevated more than 60-fold, while the risk of
developing disability within a month of restricted activity was elevated
nearly six-fold," said principal investigator Thomas M. Gill, M.D.,
associate professor of medicine/geriatrics at the Yale University School
of Medicine. "Falls and fall-related injuries (causing restricted
activity) conferred the highest risk of disability."
"Disability is associated with increased mortality
and leads to additional adverse outcomes, such as nursing home placement
and greater use of formal and informal home services, all of which place
a substantial burden on older persons, informal caregivers, and health
care resources. In the aggregate, the additional cost of medical and
long-term care for newly disabled U.S. elderly individuals is estimated
to be $26 billion per year."
Gill and colleagues from Yale University School of
Medicine, New Haven, Conn., assessed 754 people aged 70 years or older,
who were not disabled (not requiring personal assistance) in four
essential activities of daily living: bathing, dressing, walking inside
the house, and transferring from a chair. Participants were categorized
into 2 groups according to the presence of physical frailty and were
followed up with monthly telephone interviews for up to 5 years to
determine exposure to intervening events (illnesses or injuries) and the
occurrence of disability.
"During the 5-year follow-up period, disability
developed among 417 (55.3 percent) participants, 372 (49.3 percent) were
hospitalized and 600 (79.6 percent) had at least one episode of
restricted activity," the authors found. "
participants who developed
disability were significantly more likely to have been hospitalized or
to have had restricted activity than those who did not develop
disability."
"In absolute terms, illnesses and injuries leading
to hospitalization accounted for about 50 percent to 80 percent of the
disability outcomes. Another 5 percent to 19 percent of the disability
outcomes were attributable to illnesses and injuries leading to
restricted activity but not to hospitalization. Depending on the
specific disability outcome, the risk of disability was elevated more
than 5-fold in the setting of restricted activity." The authors add that
"falls and fall-related injuries resulting in hospitalization or
restricted activity conferred the highest risk of disability
"
"The results of the current study highlight the
importance of intervening events as a potential target for the
prevention of disability, regardless of the presence of physical
frailty," the authors write. "In the setting of an acute illness or
injury leading to hospitalization, functional outcomes are improved by
management of older persons on specialized inpatient services and,
posthospitalization, by highly coordinated gerocentric care provided in
the home."
Gill is a leading authority on the epidemiology and
prevention of disability and functional decline among older persons.
Other Yale researchers on the study include Theodore Holford, the Susan
Dwight Bliss Professor of Epidemiology and Public Health, and Heather
Allore, associate director of the Biostatistics Core of the Yale Pepper
Center/Program on Aging.
Editor's Note: The work for this article was funded
by a grant from the National Institute on Aging and grants from the
Robert Wood Johnson Foundation, Paul Beeson Physician Faculty Scholar in
Aging Research Program, and Patrick and Catherine Weldon Donaghue
Medical Research Foundation. The study was conducted at the Yale Claude
D. Pepper Older Americans Independence Center. Dr. Gill is the recipient
of a Midcareer Investigator Award in Patient-Oriented Research from the
National Institute on Aging.
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