Measuring frailty in the hospitalized elderly: Concept of functional homeostasis

John E. Carlson, Kent A. Zocchi, Donna M. Bettencourt, Michele L. Gambrel, Jean L. Freeman, Dong Zhang, James Goodwin

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

Functional homeostasis is the ability of an individual to withstand illness without loss of function. We investigate whether the level functional homeostasis predicts adverse outcomes in the 6 months posthospital discharge in older men and women. A prospective cohort study was conducted in an acute care geriatric inpatient unit of a university hospital. Subjects included a consecutive series of patients admitted to the unit. The Functional Independence Measure (FIM(TM)) instrument was used to assess patients at four time points: preillness, hospital admission, hospital discharge, and 6 months postdischarge. Of the 122 subjects available for analysis, 64 (52%) experienced a decline in functional level from preillnes to hospital discharge and were defined as having poor functional homeostasis, whereas 58 (48%) experienced no change or an increase in functional status and were defined as having good functional homeostasis. Those with poor functional homeostasis had a higher 6-months readmission rate to the hospital (59.4 v 39.7%; P = 0.03) and a higher rate of any adverse outcome (78.1 v 50%; P = 0.001) than those with good functional homeostasis. In logistic regressive analyses, functional homeostasis remained a significant and powerful predictor of adverse outcomes independent of actual level of function at discharge, age, gender, living status, and other factors that might influence outcomes. Charge in functional status associated with an acute illness is an independent predictor of adverse outcomes and, in this study, a better predictor than actual level of function at discharge. Functional homeostasis to the quantification of the important but elusive concept of frailty in the elderly.

Original languageEnglish (US)
Pages (from-to)252-257
Number of pages6
JournalAmerican Journal of Physical Medicine and Rehabilitation
Volume77
Issue number3
DOIs
StatePublished - May 1998
Externally publishedYes

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Homeostasis
Geriatrics
Inpatients
Cohort Studies
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • Frailty
  • Function
  • Homeostasis
  • Hospital Readmission
  • Outcomes

ASJC Scopus subject areas

  • Rehabilitation
  • Health Professions(all)
  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Measuring frailty in the hospitalized elderly : Concept of functional homeostasis. / Carlson, John E.; Zocchi, Kent A.; Bettencourt, Donna M.; Gambrel, Michele L.; Freeman, Jean L.; Zhang, Dong; Goodwin, James.

In: American Journal of Physical Medicine and Rehabilitation, Vol. 77, No. 3, 05.1998, p. 252-257.

Research output: Contribution to journalArticle

Carlson, John E. ; Zocchi, Kent A. ; Bettencourt, Donna M. ; Gambrel, Michele L. ; Freeman, Jean L. ; Zhang, Dong ; Goodwin, James. / Measuring frailty in the hospitalized elderly : Concept of functional homeostasis. In: American Journal of Physical Medicine and Rehabilitation. 1998 ; Vol. 77, No. 3. pp. 252-257.
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