HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Cited by other online articles Google Scholar Articles by Sands, L. P. Articles by Covinsky, K. Articles citing this Article PubMed PubMed Citation Articles by Sands, L. P. Articles by Covinsky, K.

The Effects of Acute Illness on ADL Decline Over 1 Year in Frail Older Adults With and Without Cognitive Impairment

^a Center on Aging, Division of Geriatrics,
^b Departments of Medicine, Division of Geriatrics,
^c Psychiatry, University of California, San Francisco
^d Neurology, University of California, San Francisco
^e Epidemiology and Biostatistics, University of California, San Francisco
^f Institute for Health and Aging, University of California, San Francisco
^g Veterans Affairs Medical Center, San Francisco, California

Correspondence: Laura P. Sands, Center on Aging, Department of Medicine, Division of Geriatrics, University of California, San Francisco, 3333 California Street, Box 1265, San Francisco, CA 94143-1265 E-mail: lsands{at}medicine.ucsf.edu.

Background. Acute illness may lead to long-term losses in older adults' ability to independently perform activities of daily living (ADLs). The magnitude of these losses may differ for patients with and without cognitive impairment. These relationships have not been described for the frailest of older adults whose high rates of acute illness and cognitive impairment put them at the greatest risk for loss of ADL functioning.

Methods. We conducted a prospective study of 2593 patients enrolled in a nationwide medical and psychosocial program for frail, community-living, nursing home-eligible patients. We determined the independent and interactive effects of baseline cognitive impairment and admission for an acute illness on change in ADL functioning over 1 year.

Results. ADL decline over 1 year occurred in 53% of cognitively impaired patients who were admitted for an acute illness, 38% of cognitively impaired patients who were not admitted for an acute illness, 42% of noncognitively impaired patients who were admitted for an acute illness, and 25% of noncognitively impaired patients who were not admitted for an acute illness (p < .001). The amount of additional decline in ADLs associated with an admission for an acute illness was similar between patients with and without cognitive impairment (-.85 vs -.74; p for interaction = .86). Among patients who were admitted for an acute illness, significant decline in ADL functioning occurred only in the quarter surrounding the acute illness with no evidence of recovery in the months after the acute illness episode.

Conclusions. Among frail older adults, loss of ADL functioning over 1 year is independently associated with both acute admission for an acute illness and cognitive impairment. Frail elders, especially those with cognitive impairment, are in need of interventions that reduce the long-term functional consequences of acute illness.

This article has been cited by other articles: (Search Google Scholar for Other Citing Articles)

				G. A. Caplan, J. Coconis, and J. Woods Effect of Hospital in the Home Treatment on Physical and Cognitive Function: A Randomized Controlled Trial J. Gerontol. A Biol. Sci. Med. Sci., August 1, 2005; 60(8): 1035 - 1038. [Abstract] [Full Text] [PDF]

				C. F. Mendes de Leon, W. Bang, J. L. Bienias, T. A. Glass, V. Vaccarino, and S. V. Kasl Changes in Disability Before and After Myocardial Infarction in Older Adults Archives of Internal Medicine, April 11, 2005; 165(7): 763 - 768. [Abstract] [Full Text] [PDF]

				T. M. Gill, H. G. Allore, T. R. Holford, and Z. Guo Hospitalization, Restricted Activity, and the Development of Disability Among Older Persons JAMA, November 3, 2004; 292(17): 2115 - 2124. [Abstract] [Full Text] [PDF]

				W. A. Banks and J. E. Morley Memories Are Made of This: Recent Advances in Understanding Cognitive Impairments and Dementia J. Gerontol. A Biol. Sci. Med. Sci., April 1, 2003; 58(4): M314 - 321. [Full Text] [PDF]

				R. Rozzini, T. Sabatini, and M. Trabucchi Letters to the Editor: Acute Illnesses, ADL Decline, and Hospitalization J. Gerontol. A Biol. Sci. Med. Sci., January 1, 2003; 58(1): M94 - 94. [Full Text] [PDF]

				J. E. Morley Editorial: Hot Topics in Geriatrics J. Gerontol. A Biol. Sci. Med. Sci., January 1, 2003; 58(1): M30 - 36. [Full Text] [PDF]