Researchers from Yale School of Medicine have determined that there is a close association between hospitalization and further progression of disability among older adults.
In an effort to better understand how disabilities progress in patients near the end of their lives, lead author Dr. Thomas Gill and other Yale researchers tracked more than 500 adults, all 70 years old or older, during the last year of their lives.
“These results suggests that the disabling process in the last year of life is strongly influenced by the occurrence of acute hospitalizations,” Gill explained in a news release.
A combination of home-based assessments and monthly telephone interviews allowed the team to collect health information going back nearly 15 years. In addition to asking about disability (expressed as the inability to perform certain daily tasks such as dressing, bathing, standing up and walking), the researchers also asked about hospitalizations.
They found that a full 70% of participants had been hospitalized at least once, with 45% being hospitalized multiple times in their final year of life.
Disability is a complex medical topic that changes based on age, geographic location and numerous other factors. People would probably be surprised to learn, for example, that back pain is the leading cause of disability for Americans under 45. Gill and colleagues had shown in previous studies that the course of disability for people nearer the end of life is even more varied and unpredictable than it is for younger people.
But the research team hopes this new information will better inform doctors and patients as to their options in order to optimize both health and overall wellness — including knowing when it’s better to provide palliative care rather than to continue multiple hospitalizations.
“Our results may help inform decisions about the management of disability and the appropriate level of care at the end of life,” said Gill.
The new study was published May 20 in the British Medical Journal under the title “The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people.”