Hospitalization, Restricted Activity, and the Development of Disability Among Older Persons

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Vol. 292 No. 17, November 3, 2004 From Journal of American Medicine

Hospitalization, Restricted Activity, and the Development of Disability

Among Older Persons

M. Gill, MD; G. Allore, PhD; Theodore R. Holford, PhD;

Zhenchao Guo, MD, PhD

Context: Preventing the development of disability in activities of

daily living is an important goal in older adults, yet relatively little

is known about the disabling process.

Objectives: To evaluate the relationship between 2 types of intervening

events (hospitalization and restricted activity) and the development of

disability and to determine whether this relationship is modified by the

presence of physical frailty.

Design, Setting, and Participants: Prospective cohort study, conducted

in the general community in greater New Haven, Conn, from March 1998 to

March 2003, of 754 persons aged 70 years or older, who were not disabled

(ie, required no personal assistance) in 4 essential activities of daily

living: bathing, dressing, walking inside the house, and transferring

from a chair. Participants were categorized into 2 groups according to

the presence of physical frailty (defined on the basis of slow gait

speed) and were followed up with monthly telephone interviews for up to

5 years to ascertain exposure to intervening events and determine the

occurrence of disability.

Main Outcome Measure: Disability, defined as the need for personal

assistance in bathing, dressing, walking inside the house, or

transferring from a chair.

Results: During the 5-year follow-up period, disability developed among

417 (55.3%) participants, 372 (49.3%) were hospitalized and 600 (79.6%)

had at least 1 episode of restricted activity. The multivariable hazard

ratios for the development of disability were 61.8 (95% confidence

interval [CI], 49.0-78.0) within a month of hospitalization and 5.54

(95% CI, 4.27-7.19) within a month of restricted activity. Strong

associations were observed for participants who were physically frail

and those who were not physically frail. Hospital admissions for falls

were most likely to lead to disability. Intervening events occurring

more than a month prior to disability onset were not associated with the

development of disability. The population-attributable fractions

associated with new exposure to hospitalization and restricted activity,

respectively, were 0.48 and 0.19; 0.40 and 0.20, respectively, for frail

participants and 0.61 and 0.16, respectively, for nonfrail participants.

Conclusions: Illnesses and injuries leading to either hospitalization

or restricted activity represent important sources of disability for

older persons living in the community, regardless of the presence of

physical frailty. These intervening events may be suitable targets for

the prevention of disability.

Author Affiliations: Departments of Internal Medicine (Drs Gill, Allore,

and Guo) and Epidemiology and Public Health (Dr Holford), Yale

University School of Medicine, New Haven, Conn.