Basic self-care in older acute medical in-patients: a retrospective cohort study

Background: Older patients hospitalized for acute illness are vulnerable to decline in basic self-care. This functional decline determines future health needs and can lead to negative health outcomes. Aim: To compare basic self-care needs in older acute medical in-patients between admission and discharge using the Nursing Patient Classification System data. Design: Single-center, observational, and retrospective cohort study. Methods: Data were collected between April 2015 and April 2016 and included 384 patients aged 65 or older admitted to a medical ward of a 580-bed teaching hospital in Portugal. Significant differences between groups of patients were assessed by analysis of variance and Kruskal–Wallis for continuous variables and by chi-squared test for categorical variables. Significant changes in the level of dependence were analyzed using McNemar–Bowker test. Results: The mean age of the patients was 79.93 years (SD = 7.49) and the majority were women (57.3%). There were no gender differences in length of stay. Oldest-old patients presented higher percentages of dependence on basic self-care, both at admission and at discharge. Younger-old patients improves in hygiene and personal care, toilet use, and movement (P < .01). However, it is also this group of patients who have the highest percentages of deterioration in eating (P = .129), toilet use, and movement (P < .001). Conclusion: All patients are vulnerable to decline in basic self-care regardless their age. Use Nursing Patient Classification Systems to track progress in basic self-care between admission and discharge in older acute medical patients is an innovative and valid methodology. Based on the needs of nursing care, we were able to characterize older patients’ needs and achieve health outcomes