Prediction of Mobility Limitations after Hospitalization in Older Medical Patients by Simple Measures of Physical Performance Obtained at Admission to the Emergency Department

Ann Christine Bodilsen, Henrik Hedegaard Klausen, Janne Petersen, Nina Beyer, Ove Andersen, Lillian Mørch Jørgensen, Helle Gybel Juul-Larsen, Thomas Bandholm, Ann Christine Bodilsen, Henrik Hedegaard Klausen, Janne Petersen, Nina Beyer, Ove Andersen, Lillian Mørch Jørgensen, Helle Gybel Juul-Larsen, Thomas Bandholm

Abstract

Objective: Mobility limitations relate to dependency in older adults. Identification of older patients with mobility limitations after hospital discharge may help stratify treatment and could potentially counteract dependency seen in older adults after hospitalization. We investigated the ability of four physical performance measures administered at hospital admission to identify older medical patients who manifest mobility limitations 30 days after discharge.

Design: Prospective cohort study of patients (≥65 years) admitted to the emergency department for acute medical illness. During the first 24 hours, we assessed: handgrip strength, 4-meter gait speed, the ability to rise from a chair (chair-stand), and the Cumulated Ambulation Score. The mobility level 30 days after discharge was evaluated using the de Morton Mobility Index.

Results: A total of 369 patients (77.9 years, 62% women) were included. Of those, 128 (40%) patients had mobility limitations at follow-up. Univariate analyzes showed that each of the physical performance measures was strongly associated with mobility limitations at follow-up (handgrip strength(women), OR 0.86 (0.81-0.91), handgrip strength(men), OR 0.90 (0.86-0.95), gait speed, OR 0.35 (0.26-0.46), chair-stand, OR 0.04 (0.02-0.08) and Cumulated Ambulation Score OR 0.49 (0.38-0.64). Adjustment for potential confounders did not change the results and the associations were not modified by any of the covariates: age, gender, cognitive status, the severity of the acute medical illness, and the Charlson Comorbidity Index. Based on prespecified cut-offs the prognostic accuracy of the four measures for mobility limitation at follow-up was calculated. The sensitivity and specificity were: handgrip strength(women), 56.8 (45.8-67.3), 75.7 (66.8-83.2), handgrip strength(men), 50.0 (33.8-66.2), 80.8 (69.9-89.1), gait speed, 68.4 (58.2-77.4), 81.4 (75.0-86.8), chair-stand 67.8 (58.6-76.1), 91.8 (86.8-95.3), and Cumulated Ambulation Score, 40.2 (31.6-49.2), 92.0 (87.1-95.4), respectively.

Conclusion: Physical performance measures, particularly chair-stand and gait speed assessed at admission to an emergency department, were able to identify mobility limitation in acutely admitted older medical patients 30 days after hospital discharge.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Inclusion of patients in the…
Fig 1. Inclusion of patients in the study (N = 369).
Fig 2. Receiver-operator characteristic (ROC) curves showing…
Fig 2. Receiver-operator characteristic (ROC) curves showing sensitivity and 100-specificity for prediction of mobility status 30 days after discharge, according to varying cut-offs for gait speed and handgrip strength.
To illustrate the range of data and to show how the different cut-offs influence the sensitivity and specificity in the present study, selected absolute values are shown with arrows. Preselected cut-offs are marked with black circles, and cut-off based on Youden Index are shown with open circles. HGSW: handgrip strength (kg), women, HGSM: handgrip strength (kg), men, GS: gait speed (m/s), GSNW: Including patients without walking ability at admission (m/s), AUC: area under the curve

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