Motivation and expectation may be factors in helping older adults regain lost functional ability after hospitalization, say researchers with the Birmingham Veterans Administration Medical Center and UAB (University of Alabama at Birmingham).
In findings published in March in the Annals of Internal Medicine, researchers found that patients hospitalized for surgery returned to normal baseline function more quickly and more completely than did patients hospitalized for illness.
Researchers used UAB's Study of Aging Life-Space Assessment, a measure of mobility developed at UAB's Center for Aging, to determine the functional level of seniors before and after hospitalization. On average, patients hospitalized for surgery had a sharp decline in life-space scores immediately after surgery, but returned to or exceeded pre-surgical scores within one year. Patients hospitalized for illness or other medical reasons experienced a lower post-hospitalization decline but did not return to pre-hospitalization scores, experiencing a marked functional decline following hospitalization even after two years.
"The difference may be caused by the presence of increased expectations of recovery and increased motivation in patients presenting for surgery," said Cynthia Brown, M.D., an investigator with the VA's Geriatric Research, Education and Clinical Center and assistant professor in UAB's Division of Gerontology, Geriatrics and Palliative Care. "Patients who undergo surgery expect their medical condition to be fixed and thus to be able to function as well as or better than before. Our analysis indicates that, by and large, that occurs."
The problem, said Brown, are the non-surgical older patients hospitalized for medical issues such as pneumonia or heart disease. The findings show this group on average does not return to baseline, but experiences a permanent decline in their level of mobility.
One hypothesis is that there is no real expectation of full recovery of function by the patient, family or health care providers. Additionally, patients tend to remain immobile in a hospital bed during their stay and may have multiple ailments that complicate treatment. Increased medication also may promote confusion and depression.
"All of these factors can start patients down a slippery slope of functional decline," said Brown. "Our findings suggest that surgical patients return to function, those hospitalized for illness do not. We need to look at our hospital culture to understand why that happens, and to develop interventions to prevent that decline."
Brown said concepts such as Acute Care for Elders (ACE) units, which use patient-centered care, discharge planning, medication review and a specialized environment have shown promise in reducing the decline. Efforts to boost physical and cognitive activity should also be examined.
"Mental status and physical function are targets for intervention during hospitalization," she said. "We need to see about getting these patients up and out of their hospital beds. If we can get these people up faster, perhaps we can reduce hospitalization stays and reduce the risk of falls."
The Life-Space Assessment, developed by Richard Allman, M.D., and Patricia Baker, Ph.D., of UAB's Center for Aging, measures an individual's mobility and degree of independence. Life-space is based upon the distance a person routinely travels to perform activities. The Life-Space Assessment measures how often a person leaves his or her residence, the distance from the residence traveled and how much assistance is needed from other individuals or from assistive devices.
"It is a measure of community mobility and participation in everyday life," Brown said. "Can the individual go to church, go out to dinner, and go to the doctor's office. A life-space decrease may result in a decrease in the distance and frequency of travel from home, thus limiting participation in society. Mobility is a core function that reflects the lifestyle of community-dwelling adults and is an important predictor of morbidity and mortality."
Primary funding for the study came from the National Institute on Aging.
The UAB Center for Aging is a world leader in optimizing function, enhancing management of illness and reducing health disparities among older adults. The Center involves an interdisciplinary community of more than 200 faculty members and staff working together to promote the health and well-being of older persons and their families. For more information, go to www.aging.uab.edu/.Media Contact
Bob Shepard | EurekAlert!
Further reports about: > Acute Care for Elders > Antidepressants > Functional Airspace Blocks > Geriatric > Geriatrics > Gerontology > Mental status > Palliative Care > UAB > assistive devices > brain aging > cognitive activity > decline > functional decline > hospitalization > normal baseline function > older adults > physical function > pre-surgical scores
Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)
The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft
University of Maryland researchers contribute to historic detection of gravitational waves and light created by event
On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...
Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.
Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....
Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).
When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...
Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.
How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...
Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.
It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...
17.10.2017 | Event News
10.10.2017 | Event News
10.10.2017 | Event News
19.10.2017 | Materials Sciences
19.10.2017 | Materials Sciences
19.10.2017 | Physics and Astronomy