Hospitalization and restricted activity can lead to disability among elderly

Illnesses and injuries leading to hospitalization or restricted activity are key sources of disability for independent older persons, regardless of physical frailty, Yale researchers report in the November 3 issue of JAMA.

“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 conferred the highest risk of disability.”

The inability of older persons to perform essential activities of daily living (ADL), such as bathing, dressing, walking across a room, and transferring from a chair without assistance, is common, potentially deadly and costly. Gill said preventing the development of disability in ADLs is therefore an important goal in older adults, but relatively little is known about the disabling process. He and his team conducted a prospective, longitudinal study on the relationship between intervening events (hospitalization and restricted activity) and the development of disability. They also determined whether this relationship is modified by the presence of physical frailty.

Monthly phone interviews for up to five years with 754 New Haven residents, age 70 or older, were used to determine exposure to intervening events and the occurrence of disability. The team found that disability developed among 55 percent of participants, 49 percent were hospitalized, and 80 percent had at least one episode of restricted activity, where they stayed in bed or cut down on usual activities.

The study was conducted at the Yale Pepper Center/Program on Aging and was supported by grants from the National Institute on Aging.

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.