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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 60:1180-1183 (2005)
© 2005 The Gerontological Society of America

Relationship Between Functional Loss Before Hospital Admission and Mortality in Elderly Persons With Medical Illness

Renzo Rozzini1,, Tony Sabatini1, Angela Cassinadri1, Stefano Boffelli1, Marco Ferri1, Piera Barbisoni1, Giovanni B. Frisoni2 and Marco Trabucchi1

1 Medical Unit for the Acute Care of the Elderly, Poliambulanza Hospital, and Geriatric Research Group, Brescia, Italy.
2 Laboratory of Epidemiology & Neuroimaging, IRCCS S Giovanni di Dio–FBF, Brescia, Italy, and AfaR–Associazione Fatebenefratelli per la Ricerca, Rome, Italy.

Address correspondence to Renzo Rozzini, Geriatric Research Group, via Romanino 1, 25122 Brescia, Italy. E-mail: renzo.rozzini{at}

Objective. This hospital-based prospective study tests the hypothesis that, in a large group of hospitalized elderly patients, those who report functional decline between pre-illness baseline and hospital admission have a higher risk of death.

Methods. Nine hundred fifty elderly ambulant patients (F = 69.3%; mean age 78.3 ± 8.5 years) were consecutively admitted to a geriatric ward (Poliambulanza Hospital, Brescia, Italy) during a 15-month period. Number and severity of somatic diseases, Charlson Index score, APACHE II score, level of serum albumin, cognitive status (by Mini-Mental State Examination), and depression score (by Geriatric Depression Scale), were assessed on admission and evaluated as potential prognostic factors. Functional status (by Barthel Index) was assessed by self-report on admission. Preadmission function was also assessed by self-report at the time of admission. Impairment of function due to an acute event is measured as the difference between performances on admission and 2 weeks before the acute event. Six-month survival was the main outcome variable.

Results. Factors related to mortality in bivariate analysis were: male sex, age over 80, cancer, congestive heart failure, pulmonary diseases, elevated Charlson Index score, and (independently) dementia (Mini-Mental State Examination < 18), APACHE–Acute Physiology Score , albumin level <3.5 g/dL, and anemia. After controlling for these variables and for Barthel Index score 2 weeks before the acute event, change in function due to the acute disease is independently related to 6-month mortality (minor functional change [<30 Barthel Index Point] relative risk: 1.3, 95% confidence interval, 0.6–3.0 and major functional change [major functional decrement] relative risk: 2.8, 95% confidence interval, 1.3–5.7).

Conclusions. Disease-induced disability may reflect a condition of biological inability to react to acute diseases (i.e., frailty), and should be assessed as a relevant prognostic indicator.

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