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Predictors of Functional Decline in Hospitalized Elderly Patients

A Systematic Review

^a Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, and Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada

Jane McCusker, Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital Center, 3830 Lacombe Avenue, Room 2508, Montreal, Quebec H3T 1M5, Canada E-mail: jane.mccusker{at}mcgill.ca.

Background. This article will systematically review the methodological characteristics and results of studies of variables and indices that predict functional decline in older hospitalized patients.

Methods. We restricted this review to original longitudinal studies of predictors of either physical functional decline or nursing home admission among patients aged 60 and older. Two reviewers independently abstracted information on methodological characteristics and substantive results.

Results. Thirty articles were identified, derived from 27 different studies, reporting on 33 substudies. Substantial variability was found with respect to study design, outcomes measured, period of follow-up, predictors investigated, and analytic methods. Multivariable predictive indices were significantly associated with adverse outcomes in the majority of studies that investigated them, as were the following variables: age, diagnosis, activities of daily living, cognitive impairment (including delirium), and residence.

Conclusions. The methodological heterogeneity of the studies identified limits quantitative synthesis of the results. Predictive indices for hospitalized elders appear to have moderate short-term predictive ability.

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