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Hospitalization and Development of Dependence in Activities of Daily Living in a Cohort of Disabled Older Women: The Women's Health and Aging Study I

¹ Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
² Center on Aging and Health
³ Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
⁴ National Institute on Aging, Bethesda, Maryland.

Address correspondence to Cynthia Boyd, MD, MPH, Center on Aging and Health, 2024 E. Monument St., Suite 2-700, Baltimore, MD 21205. E-mail: cyboyd{at}jhmi.edu

Background. Changes in self-reported function in older adults are known to occur in the 2 weeks prior to, during, and in the first few months after hospitalization. The long-term outcome of hospitalization on functional status in disabled older adults is not known. The objective of this study was to determine whether hospitalization predicts long-term Activities of Daily Living (ADL) dependence in previously ADL independent, although disabled, older women.

Methods. The Women's Health and Aging Study I is a population-based, prospective cohort study of disabled, community-dwelling women 65 years old. We evaluated participants who were independent in ADLs at baseline and excluded women with incident stroke, lower extremity joint surgery, amputation, or hip fracture. We examined the association between self-reported incident hospitalization at three consecutive 6-month intervals and incident dependence in at least one ADL at 18 months (n = 595).

Results. Of 595 women evaluated, 32% had at least one hospitalization. Women who were hospitalized were more likely to become dependent in ADLs than were women who were not hospitalized (17% vs 8%, p =.001). In a multivariate model, hospitalization was independently predictive of development of ADL dependence that persisted at 18 months after baseline (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.7–5.8), adjusting for age, race, education, baseline walking speed, difficulty with ADLs, self-reported health status, depressive symptoms, cognitive status, and presence of congestive heart failure, diabetes, or pulmonary disease. Increasing numbers of 6-month intervals with hospitalizations were independently predictive of higher risk in an adjusted model: one (OR, 2.3; 95% CI, 1.1–4.6), two (OR, 5.8; 95% CI, 2.4–14.4), and three (OR, 12.5; 95% CI, 2.7–57.6).

Conclusions. These results suggest that hospitalization has an independent and dose-response effect on loss of ADL independence in disabled older women over an 18-month period.