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Geriatr Nurs. 2016 May-Jun;37(3):192-9. doi: 10.1016/j.gerinurse.2016.01.001. Epub 2016 Feb 16.

Hospital-acquired functional decline in older patients cared for in acute medical wards and predictors: Findings from a multicentre longitudinal study.

Author information

1
Udine University, Viale Ungheria 20, 33100, Italy. Electronic address: alvisa.palese@uniud.it.
2
Verona University, Italy.
3
Udine University, Viale Ungheria 20, 33100, Italy.
4
Azienda per i Servizi Sanitari Provincia Trento, Italy.
5
Azienda Ospedaliera Verona, Italy.
6
Fondazione Poliambulanza Brescia, Italy.
7
Azienda Unità Sanitaria Locale n. 9 Treviso, Italy.
8
Azienda per i Servizi Sanitari n. 2 "Isontina", Gorizia, Italy.
9
Azienda Unità Sanitaria Locale n. 6 Vicenza, Italy.
10
Azienda per i Servizi Sanitari n.4 "Medio Friuli", Italy.
11
Azienda Ospedaliera. S.Orsola - Malpighi, Italy.
12
Fondazione Zancan, Padova, Italy.
13
Bologna University, Italy.
14
Azienda Ospedaliero-Universitaria, Padua, Italy.

Abstract

Describing the trajectories of hospital-associated functional decline in older patients admitted to acute medical units and identifying predictors at the individual, nursing, and hospital levels, were the aims of the study. A longitudinal survey among 12 acute medical units in which 1464 patients were consecutively enrolled and evaluated using the Barthel Index (BI), was performed. Functional decline was defined as a decrease in the BI of at least 5 points from admission to discharge. In all, 17.1% participants (n = 251) demonstrated functional decline. In accordance with multiple logistic regression analysis, 28.8% (R(2)) of the variance in the functional decline was explained by: confusion/disorientation (RR = 4.684; 95% CI = 3.144-6.978), admission from nursing homes (RR = 2.464; 95% CI = 1.642-3.697), daily care expressed in minutes offered by nursing aides (RR = 1.535; 95% CI = 1.275-1.849), higher workforce skill-mix (RR = 2.221; 95% CI = 1.763-2.797), bladder catheter insertion (RR = 1.599; 95% CI = 1.128-2.268), and higher BI score at admission (RR = 1.019; 95% CI = 1.014-1.024). Increasing the amount of care delivered by competent nurses-having a bachelors degree-providing and supervising direct-care activities, may reduce the occurrence of functional decline in older patients admitted to medical units.

KEYWORDS:

Functional dependence; Functional recovery; Functional stability; Hospital; Longitudinal study; Medical units; Nursing care; Predictors

PMID:
26895646
DOI:
10.1016/j.gerinurse.2016.01.001
[Indexed for MEDLINE]

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