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For older hospital patients, the inability to perform activities of daily living is a strong indicator of a probability of death within three months to two years, according to a recent study. Researchers say that functional status is of key importance to health outcomes of the elderly. It even surpasses physiological problems. However, the report notes, "current risk adjustment and burden of illness assessment indices do not include these measures."
Such variables include physical, cognitive, and social functioning. Examples of physical variables are basic self-care skills of feeding, bathing, grooming, or walking. Some of the "instrumental" activities vital to functioning were using the telephone, grocery shopping, using transportation, cooking, and taking medications.
The study followed two groups of patients ages 70 years or older. "The contributions of functional and burden of illness measures were substantive and interrelated," write the investigators, some of whom are based at the Yale University School of Medicine in New Haven, CT. The study population comprised 207 men and women with a mean age of 79.
The median length of hospital stay was eight days. Eighty-one patients died during the two-year follow-up, with 17 in-hospital deaths, 29 deaths within 90 days, and 52 within one year. Demographics, including age, sex, race, education, marital status, living arrangements, and admission source, had no statistically significant impact on mortality.
A potential limitation of the study is the difficulty in obtaining information on functional variables. The researchers caution, "A first priority for future work will be to find feasible and practical ways for measuring functional status across health care settings."
(See: Inouye SK, Peduzzi PN, Robison JT, et al. Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 1998; 279:1,187-1,193.)