Geriatric Conditions Impair Daily Activities for Patients Following Hospitalization

OCTOBER 14, 2019
Kenny Walter
Geriatric patients face a lot of challenges after they are discharged from the hospital that can be exacerbated by conditions like depression, dementia, and delirium.

Ching-Fu Weng, MD, Hsinchu Cathay General Hospital, recently led a team on a prospective cohort study examining the effects of depression, dementia, and delirium on the daily activities of geriatric patients discharged from tertiary medical center in Taiwan.

The 149-patient study was conducted between 2012-2013 with patients admitted to the geriatric ward. The investigators used the Geriatric Depression Scale Short Form, Mini-Mental State, and Confusion Assessment Method to identify patients with depression, dementia, and delirium on admission.

They also evaluated the patients’ functional status on admission, at discharge, as well as 30-days, 90-days, and 180-days after discharge using the Barthel Index (BI) and used the Generalized Estimating Equation (GEE) to calculate the association between depression, dementia, and delirium and BI.

Some of the daily activities assessed included eating, transferring from bed to wheelchair, toileting, bathing, dressing, ambulation, and urination and defecation control.

The study population included 27 (18.1%) patients with depression, 37 (24.8%) patients with dementia, and 85 (57.0%) patients with delirium. The mean age of the study was 87.6, with 80.5% of the participants older than 81 years old.

Also, 54.7% of the patients in the study experienced a fall within the past year, 11.5% had hearing impairments, and 29.1% had visual impairments.

On average, each participant took 8.5 prescription drugs per day and stayed in the hospital for 13.8 days.

Ultimately, the investigators found that whether depression exists did not substantially impact functional recovery after discharge, but either dementia or delirium could impede geriatric patient’s functional status.

However, the recovery of functional improvement in delirium or dementia was generally irreversible when compared to depression and once delirium or dementia is diagnosed, poorer functional restore was expected.

“In general, patients with delirium or dementia had worse functional status compared with those without, even though (there was) slight improvement after discharge,” the authors wrote.

On the other hand, functional status remained similar to 6 months after discharge, regardless of depressive status.  

The investigators suggest intensive work and strategies for modifying delirium or dementia as early as possible.

“Old, hospitalized patients with depression can recover well after adequate intervention,” the authors wrote. “We emphasize that early detection of dementia and delirium is imperative in subsequent functional outcome, even if at or before admission.”

Recent studies suggest between 34-50% of geriatric patients experience functional decline during hospitalization, commonly due to reasons irrelevant to the patients’ admission diagnoses, but related to the underlying primary illness or iatrogenic complications during hospitalization.

Geriatric syndromes are known to be linked with poor outcomes like readmission, increased length of stay, functional decline, hospitalization, and mortality.

Understanding geriatric patients who are at risk of functional decline during hospitalization is needed before preventative strategies can be properly developed.

The study, “Effects of depression, dementia and delirium on activities of daily living in elderly patients after discharge,” was published online in BMC Geriatrics.
 

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