POST-HOSPITALIZATION FUNCTION IN OLDER ADULTS: SUPPORTS FOR RECOVERY AND INDEPENDENCE

Background: For older patients, hospitalization is an established predictor of functional decline. After hospitalization, the ability to perform basic activities of daily living (ADL) declines in at least one third of older patients. and can lead to adverse health outcomes, such as nursing home placement and mortality. Supports for functional decline after hospitalization can impact the ability to function in the community. Objective: To provide information about determinants of functional decline after hospitalization, the determinants of functional recovery in those that utilize rehabilitative surveys, and the association of cognitive frailty with functional decline in a nationally representative study of Medicare beneficiaries in a post-hospitalization context. Methods: This study used data from the National Health and Aging Trends study, a nationally representative study of Medicare beneficiaries in the United States. Logistic regression examined the association of demographic and health characteristics with new use of assistive devices for activities of daily living (ADL) and functional decline. Logistic models were used to assess the association of demographic, health and rehabilitation characteristics on rehabilitation outcomes. Regression models were used to assess the association of the co-occurrence of mild cognitive impairment and physical frailty with function decline and hospitalization. Results: Among Medicare beneficiaries that reported a hospitalization, new use of assistive devices and functional decline was associated with older age, pre-hospital functional decline, cognitive status and functional decline. Low pre-hospital physical capacity, compared to high pre-hospital physical capacity, was associated with higher odds of using rehabilitative services after hospitalization. Those with low pre-hospital physical capacity and utilized rehabilitative services had the highest odds of recovery to pre-hospitalization status for all functional outcomes. In the adjusted regression model, cognitive frailty was not associated with worse functioning in those hospitalized compared to those with cognitive impairment only or physical frailty only. Conclusion: These findings suggest that older adults with low pre-hospital functioning and dementia are in greater need of supports for independence and recovery in function. These findings can help inform the needs of patients, especially those with lower levels of pre-hospital physical function and dementia, and interventions to promote functional recovery and independence in vulnerable older persons