Hospital-acquired functional decline in older patients cared for in acute medical wards and predictors : findings from a multicentre longitudinal study / Alvisa Palese, Silvia Gonella, Renzo Moreale, Annamaria Guarnier, Paolo Barelli, Paola Zambiasi, Elisabetta Allegrini, Letizia Bazoli, Paola Casson, Meri Marin, Marisa Padovan, Michele Picogna, Patrizia Taddia, Daniele Salmaso, Paolo Chiari, Tiziana Frison, Oliva Marognolli, Carla Benaglio, Federica Canzan, Elisa Ambrosi, Luisa Saiani

Describing the trajectories of hospital-associated functional decline in older patients admitted to acute medical units and identifying predictors at the individual, nursing, and hospital levels, were the aims of the study. A longitudinal survey among 12 acute medical units in which 1464 patients were consecutively enrolled and evaluated using the Barthel Index (BI), was performed. Functional decline was defined as a decrease in the BI of at least 5 points from admission to discharge. In all, 17.1% participants (n = 251) demonstrated functional decline. In accordance with multiple logistic regression analysis, 28.8% (R2) of the variance in the functional decline was explained by: confusion/disorientation (RR = 4.684; 95% CI = 3.144-6.978), admission from nursing homes (RR = 2.464; 95% CI = 1.642-3.697), daily care expressed in minutes offered by nursing aides (RR = 1.535; 95% CI = 1.275-1.849), higher workforce skill-mix (RR = 2.221; 95% CI = 1.763-2.797), bladder catheter insertion (RR = 1.599; 95% CI = 1.128-2.268), and higher BI score at admission (RR = 1.019; 95% CI = 1.014-1.024). Increasing the amount of care delivered by competent nurses-having a bachelors degree-providing and supervising direct-care activities, may reduce the occurrence of functional decline in older patients admitted to medical units.

Nursing