Events that lead to disability among the elderly

Illnesses and injuries leading to either hospitalization or restricted activity are strongly associated with the development of disability for older persons living in the community, regardless of their physical condition, according to a study in the November 3 issue of JAMA.

The authors provide as background information that while the prevalence of disability is decreasing, there are currently more than 7 million chronically disabled individuals aged 65 years or older in the United States. “Disability is associated with increased mortality and leads to additional adverse outcomes, such as nursing home placement and greater use of formal and informal home services, all of which place a substantial burden on older persons, informal caregivers, and health care resources. In the aggregate, the additional cost of medical and long-term care for newly disabled U.S. elderly individuals is estimated to be $26 billion per year.”

Thomas M. Gill, M.D., and colleagues from Yale University School of Medicine, New Haven, Conn., assessed 754 people aged 70 years or older, who were not disabled (not requiring personal assistance) in four essential activities of daily living: bathing, dressing, walking inside the house, and transferring from a chair. Participants were categorized into 2 groups according to the presence of physical frailty and were followed up with monthly telephone interviews for up to 5 years to determine exposure to intervening events (illnesses or injuries) and the occurrence of disability.

“During the 5-year follow-up period, disability developed among 417 (55.3 percent) participants, 372 (49.3 percent) were hospitalized and 600 (79.6 percent) had at least one episode of restricted activity,” the authors found. “… participants who developed disability were significantly more likely to have been hospitalized or to have had restricted activity than those who did not develop disability.”

“In absolute terms, illnesses and injuries leading to hospitalization accounted for about 50 percent to 80 percent of the disability outcomes. Another 5 percent to 19 percent of the disability outcomes were attributable to illnesses and injuries leading to restricted activity but not to hospitalization. Depending on the specific disability outcome, the risk of disability was elevated more than 5-fold in the setting of restricted activity.” The authors add that “falls and fall-related injuries resulting in hospitalization or restricted activity conferred the highest risk of disability…”

“The results of the current study highlight the importance of intervening events as a potential target for the prevention of disability, regardless of the presence of physical frailty,” the authors write. “In the setting of an acute illness or injury leading to hospitalization, functional outcomes are improved by management of older persons on specialized inpatient services and, posthospitalization, by highly coordinated gerocentric care provided in the home.”