Hospitalization-associated disability in older adults with valvular heart disease: incidence, risk factors and its association with care processes

Abstract

Background: The aim of this study was to determine the incidence and recovery of hospitalisation-associated disability (HAD), the associated risk factors, and the link with care processes in patients aged 70 years or older hospitalised with valvular heart disease (VHD).

Methods: Prospective cohort study performed on the cardiology and cardiac surgery units of University Hospitals Leuven, Belgium. HAD was defined as the loss of independence to complete one of the Activities of Daily Living (ADLs) between hospital admission and discharge. Recovery of HAD at 30 days post hospital discharge was achieved when patients recovered their baseline ADL status (2 weeks before hospital admission) (ClinicalTrials.gov: NCT02572999).

Results: Eighty patients were enrolled in the study, 77 completed the assessment at discharge and 62 responded at 30 days follow-up. Forty patients (51.9%) developed HAD; 18 of them (45.0%) recovered their baseline ADL status. The risk of HAD increased when patients were physically restrained (relative risk (RR) 1.73, 95% confidence interval (CI) 1.20–2.49), had indwelling catheters (RR 1.80, 95% CI 0.85–3.80) and received preventive pressure ulcer measures (RR 1.71, 95% CI 1.07–2.74). Patients with HAD had longer hospital stays (+3 days, p = .011) and longer use of indwelling catheters (+2 days, p = .024).

Conclusion: Half of the older adults with VHD developed HAD. The results indicate a potential association between HAD and care processes, which could be used as quality measures and intervention targets. Validation in larger cohort studies is recommended.

Keywords:

• Heart valve diseases
• aged
• functional decline
• disability
• activities of daily living

Geolocation information

University Hospitals Leuven, Belgium (50°52’43” N, 4°40’27” E).

Acknowledgements

The authors would like to acknowledge the valuable contribution of Ms. Lindsey De Graeve for her assistance with the data collection, entry and management.

Disclosure statement

No potential conflict of interest was reported by the authors.