Functional trajectory 6 months posthospitalization: A cohort study of older hospitalized patients in Taiwan

Background: Although it is well-recognized that hospitalization often precipitates functional decline in older patients, there have been few studies to examine these functional changes carefully over multiple points in time. Objective: To describe functional trajectory during and 6 months posthospitalization and to ascertain the predictors that signal different classes of functional trajectory, using latent class analysis. Methods: A cohort study was conducted on 286 older hospitalized patients who were admitted to five surgical-medical units at a tertiary medical center in Northern Taiwan. Results are reported of 241 participants who completed all four scheduled assessments during hospitalization (within 48 hr after admission and before discharge) and 3 and 6 months postdischarge. Functional trajectory was measured using the Barthel index over four time points, and decline was defined as a reduction on the Barthel index scores. Demographics, comorbidities, visual impairment, medications taken, cognitive status, nutritional status, oral health, depressive symptoms, social support, surgical diagnosis, and length of stay were assessed as the predictors of functional trajectory classes. Results: Most (74.3%) participants developed functional decline during hospitalization, and 32.0% had persistent functional impairment at 6 months posthospitalization. Three functional trajectory classes (good, moderate, and poor) were identified, and gender, age, comorbidities, cognitive status, nutritional status, oral health status, and length of stay were associated with different trajectory classes. Conclusion: Visualizing different classes of functional trajectory and studying predictors that signal such differences during and posthospitalization help practitioners understand how function changed and the possible ways to intervene.