Functional status recovery trajectories in hospitalised older adults with pneumoniaopen access
- Authors
- Park, Chan Mi; Dhawan, Ravi; Lie, Jessica J.; Sison, Stephanie M.; Kim, Wonsock; Lee, Eun Sik; Kim, Jong Hun; Kim, Dae Hyun
- Issue Date
- May-2022
- Publisher
- British Thoracic Society | BMJ Publishing Group Ltd
- Keywords
- Pneumonia; Clinical Epidemiology
- Citation
- BMJ Open Respiratory Research, v.9, no.1
- Indexed
- SCIE
SCOPUS
- Journal Title
- BMJ Open Respiratory Research
- Volume
- 9
- Number
- 1
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/60977
- DOI
- 10.1136/bmjresp-2022-001233
- ISSN
- 2052-4439
2052-4439
- Abstract
- Background and objectives
Pneumonia is associated with significant mortality and morbidity in older adults. We investigated changes in functional status over 6 months after pneumonia hospitalisation by frailty status.
Methods and measurements
This single-centre prospective cohort study enrolled 201 patients (mean age 79.4, 37.3% women) who were hospitalised with pneumonia. A deficit-accumulation frailty index (range: 0–1; robust <0.15, pre-frail 0.15–0.24, mild-to-moderately frail 0.25–0.44, severely frail ≥0.45) was calculated on admission. Functional status, defined as self-reported ability to perform 21 activities and physical tasks independently, was measured by telephone at 1, 3 and 6 months after discharge. Group-based trajectory model was used to identify functional trajectories. We examined the probability of each trajectory based on frailty levels.
Results
On admission, 51 (25.4%) were robust, 43 (21.4%) pre-frail, 40 (20.0%) mild-to-moderately frail and 67 (33.3%) severely frail patients. Four trajectories were identified: excellent (14.4%), good (25.4%), poor (28.9%) and very poor (31.3%). The trajectory was more strongly correlated with frailty level on admission than pneumonia severity. The most common trajectory was excellent trajectory (59.9%) in robust patients, good trajectory (74.4%) in pre-frail patients, poor trajectory (85.0%) in mild-to-moderately frail patients and very poor trajectory (89.6%) in severely frail patients. The risk of poor or very poor trajectory from robust to severely frail patients was 11.8%, 25.6%, 92.5% and 100%, respectively.
Conclusions
Frailty was a strong determinant of lack of functional recovery over 6 months after pneumonia hospitalisation in older adults. Our results call for hospital-based and post-acute care interventions for frail patients.
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Collections - 2. Clinical Science > Department of Family Medicine > 1. Journal Articles
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