European Geriatric Medicine (2018) 9:321–327
Functional deterioration in the month before hospitalisation
is associated with in‑hospital functional decline: an observational
Danielle Ní Chróinín
· David Basic
· David Conforti
· Chris Shanley
Received: 18 December 2017 / Accepted: 2 March 2018 / Published online: 14 March 2018
© European Geriatric Medicine Society 2018
Introduction Functional deterioration preceding acute hospital admission may be associated with poorer in-hospital out-
comes. We sought to investigate the association between functional decline in the month preceding admission and in-hospital
Materials and methods Consecutive patients admitted under geriatric medicine over 5 years were prospectively included.
Pre-hospital decline was deﬁned as decrease in Modiﬁed Barthel Index (MBI) between pre-morbid status (1 month prior) and
admission. The primary outcome was in-hospital functional decline (decline in MBI and/or new assistance/aid to mobilise).
Secondary outcomes included length-of-stay (LOS; highest quartile), in-hospital falls and death.
Results Amongst 1458 patients (mean age 82.0; 60.91% female), 76.89% (1121/1458) experienced pre-hospital MBI decline.
On univariate logistic regression, pre-hospital MBI decline was associated with in-hospital functional decline (OR 15.83,
p < 0.001). Adjusting for age, nursing home residence, pre-morbid MBI, in-hospital referral source, dementia, adverse drug
reaction and number of active diagnoses, pre-hospital decline was independently associated with in-hospital functional
decline (OR 15.22, CI 10.89–21.26, p < 0.001). On univariate analysis, those with pre-hospital decline had more in-hospital
falls (OR 2. 91, p = 0.02). Adjusting for age, sex, dementia, number of active diagnoses, and ambulation, no strong associa-
tion was observed between pre-hospital decline and in-hospital falls (OR 1.86, p = 0.08). Prolonged LOS ≥ 20 days was more
common amongst patients with pre-hospital decline on univariate (OR 1.95, p < 0.001) but not adjusted analyses (p = 0.14).
No association was observed with in-hospital death.
Conclusion Pre-hospital functional decline was associated with poorer in-hospital functional outcomes. Exploration of early
interventions to optimise function in such patients is needed.
Keywords Function · Frail elderly · Hospitalisation · Activities of daily living · Patient outcome assessment
Regrettably, and potentially avoidably, many older patients
experience poor outcomes during acute hospitalisation
[1–5]. Such outcomes may represent the eﬀects of disabling
illnesses and individual patient characteristics , which
increase vulnerability to the stressors encountered soon after
hospitalisation. Functional decline is often multifactorial,
representing a complex interplay of factors, including the
underlying disease processes, underlying frailty or ‘prox-
imity to disability’, and insults related to hospitalisation or
to medications [1, 6]. The acute admission itself leaves a
patient vulnerable to medication errors, polypharmacy, hos-
pital-acquired infection, delirium, falls and related injury,
and pressure injuries [6–8]. Inhibitors of recovery such as
* Danielle Ní Chróinín
* David Basic
Department of Geriatric Medicine, Liverpool Hospital,
Locked Mail Bag 7103, Liverpool 1871, NSW, Australia
UNSW South Western Sydney Clinical School, UNSW,
Centre for Applied Nursing Research, Western Sydney
University, Sydney, Australia
Ingham Institute of Applied Medical Research, Liverpool,