Performance-based functional assessment in older hospitalized patients: feasibility and clinical correlates

Background: Functional evaluation is a cornerstone of multidimensional geriatric assessment, however, little is known on the clinical value of standardized performance-based assessment in the acute care setting. The aim of this study was to evaluate the clinical correlates and short-term predictive value of the Short Physical Performance Battery (SPPB) in older patients admitted to the hospital for an acute medical event. Methods: We enrolled 92 women and men aged 65 and older able to walk and with a Mini Mental State Examination (MMSE) score  18, admitted to the hospital with a clinical diagnosis of congestive heart failure, pneumonia, chronic obstructive pulmonary disease, or minor stroke. The SPPB was assessed at hospital admission and discharge. Self-report functional assessment included basic activities of daily living (ADL) and instrumental activities of daily living (IADL). Spearman’s rank correlation coefficients and multivariable linear regression analyses were used to study the association of SPPB score and functional and clinical characteristics, including length of hospital stay. Results: The mean age was 77.7 (range 65-94), 49% were female, 64.1% had congestive heart failure, 16% COPD, 13.1% pneumonia, and 6.5% minor stroke. At hospital admission the mean SPPB score was 6.02.7. SPPB scores were inversely correlated with age, the severity of the index disease, IADL and BADL difficulty 2 weeks before hospital admission (p <0.01), and directly correlated with MMSE score (p=0.002). On average, SPPB score increased 1 point (+0.97, SEM=0.2; p for paired t-test<0.001) from baseline to hospital discharge assessment. After adjustment for potential confounders baseline SPPB score was significantly associated with the length of hospital stay (p