Preventable Iatrogenic Disability in Elderly Patients During Hospitalization

Abstract Background In older patients, hospitalization is often associated with new or worsening disability. This hospitalization-associated disability may be explained in part by the cumulative effect of aging, frailty, comorbidities, and illnesses that led to hospitalization but may also result fr...

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Veröffentlicht in:Journal of the American Medical Directors Association 2015-08, Vol.16 (8), p.674-681
Hauptverfasser: Sourdet, Sandrine, MD, Lafont, Christine, MD, Rolland, Yves, MD, PhD, Nourhashemi, Fati, MD, PhD, Andrieu, Sandrine, MD, PhD, Vellas, Bruno, MD, PhD
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container_end_page 681
container_issue 8
container_start_page 674
container_title Journal of the American Medical Directors Association
container_volume 16
creator Sourdet, Sandrine, MD
Lafont, Christine, MD
Rolland, Yves, MD, PhD
Nourhashemi, Fati, MD, PhD
Andrieu, Sandrine, MD, PhD
Vellas, Bruno, MD, PhD
description Abstract Background In older patients, hospitalization is often associated with new or worsening disability. This hospitalization-associated disability may be explained in part by the cumulative effect of aging, frailty, comorbidities, and illnesses that led to hospitalization but may also result from health care management issues and the hospital environment. Our objective was to determine the frequency, causes, and the preventability of disability induced by the processes of care or “iatrogenic disability.” Methods A total of 503 patients, aged 75 years and older, hospitalized in the 105 medical and surgical units of Toulouse University Hospital between October 2011 and March 2012, with a minimal length of stay of 2 days, were included. Hospitalization-associated disability was defined as a loss of 0.5 points or more in the Katz Activity of Daily Living Score between the time of hospital admission and discharge. To determine the iatrogenic component of hospitalization-associated disability, an expert panel in geriatric medicine reviewed each medical chart using a standardized record review and identified precipitating iatrogenic adverse events resulting in functional decline. Results Incidence of iatrogenic disability was 11.9% (95% confidence interval, 9.2%–15.1%). Of the 60 cases of iatrogenic disability, 49 (81.7%, 95% confidence interval, 69.6%–90.5%) were judged to be potentially preventable. The most common health management issues identified in patients with preventable iatrogenic disability were low mobilization [by excessive bed rest (26.5%) and lack of physical therapist intervention (55.1%)], overuse of diapers (49.0%), and transurethral urinary catheterization (30.6%). Conclusions The present study suggests that a significant proportion of hospitalization-associated disability may be induced by iatrogenic events, and that most of them are potentially preventable. Health care professionals need to be educated on the specific needs of elderly hospitalized patients and should consider hospitalization-associated disability as an outcome of care.
doi_str_mv 10.1016/j.jamda.2015.03.011
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This hospitalization-associated disability may be explained in part by the cumulative effect of aging, frailty, comorbidities, and illnesses that led to hospitalization but may also result from health care management issues and the hospital environment. Our objective was to determine the frequency, causes, and the preventability of disability induced by the processes of care or “iatrogenic disability.” Methods A total of 503 patients, aged 75 years and older, hospitalized in the 105 medical and surgical units of Toulouse University Hospital between October 2011 and March 2012, with a minimal length of stay of 2 days, were included. Hospitalization-associated disability was defined as a loss of 0.5 points or more in the Katz Activity of Daily Living Score between the time of hospital admission and discharge. To determine the iatrogenic component of hospitalization-associated disability, an expert panel in geriatric medicine reviewed each medical chart using a standardized record review and identified precipitating iatrogenic adverse events resulting in functional decline. Results Incidence of iatrogenic disability was 11.9% (95% confidence interval, 9.2%–15.1%). Of the 60 cases of iatrogenic disability, 49 (81.7%, 95% confidence interval, 69.6%–90.5%) were judged to be potentially preventable. The most common health management issues identified in patients with preventable iatrogenic disability were low mobilization [by excessive bed rest (26.5%) and lack of physical therapist intervention (55.1%)], overuse of diapers (49.0%), and transurethral urinary catheterization (30.6%). Conclusions The present study suggests that a significant proportion of hospitalization-associated disability may be induced by iatrogenic events, and that most of them are potentially preventable. Health care professionals need to be educated on the specific needs of elderly hospitalized patients and should consider hospitalization-associated disability as an outcome of care.</description><identifier>ISSN: 1525-8610</identifier><identifier>EISSN: 1538-9375</identifier><identifier>DOI: 10.1016/j.jamda.2015.03.011</identifier><identifier>PMID: 25922117</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Activities of Daily Living ; Aged ; disability ; Disability Evaluation ; Elderly ; Female ; France - epidemiology ; Geriatric Assessment ; Hospitalization ; Humans ; Iatrogenic Disease - epidemiology ; Iatrogenic Disease - prevention &amp; control ; iatrogenic event ; Incidence ; Internal Medicine ; Male ; Medical Education</subject><ispartof>Journal of the American Medical Directors Association, 2015-08, Vol.16 (8), p.674-681</ispartof><rights>AMDA – The Society for Post-Acute and Long-Term Care Medicine</rights><rights>2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine</rights><rights>Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c484t-ecb6e0284dfdd58363acf9715d1746f3836b4498886e0a5d7316eb2545767f8d3</citedby><cites>FETCH-LOGICAL-c484t-ecb6e0284dfdd58363acf9715d1746f3836b4498886e0a5d7316eb2545767f8d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jamda.2015.03.011$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25922117$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sourdet, Sandrine, MD</creatorcontrib><creatorcontrib>Lafont, Christine, MD</creatorcontrib><creatorcontrib>Rolland, Yves, MD, PhD</creatorcontrib><creatorcontrib>Nourhashemi, Fati, MD, PhD</creatorcontrib><creatorcontrib>Andrieu, Sandrine, MD, PhD</creatorcontrib><creatorcontrib>Vellas, Bruno, MD, PhD</creatorcontrib><title>Preventable Iatrogenic Disability in Elderly Patients During Hospitalization</title><title>Journal of the American Medical Directors Association</title><addtitle>J Am Med Dir Assoc</addtitle><description>Abstract Background In older patients, hospitalization is often associated with new or worsening disability. This hospitalization-associated disability may be explained in part by the cumulative effect of aging, frailty, comorbidities, and illnesses that led to hospitalization but may also result from health care management issues and the hospital environment. Our objective was to determine the frequency, causes, and the preventability of disability induced by the processes of care or “iatrogenic disability.” Methods A total of 503 patients, aged 75 years and older, hospitalized in the 105 medical and surgical units of Toulouse University Hospital between October 2011 and March 2012, with a minimal length of stay of 2 days, were included. Hospitalization-associated disability was defined as a loss of 0.5 points or more in the Katz Activity of Daily Living Score between the time of hospital admission and discharge. To determine the iatrogenic component of hospitalization-associated disability, an expert panel in geriatric medicine reviewed each medical chart using a standardized record review and identified precipitating iatrogenic adverse events resulting in functional decline. Results Incidence of iatrogenic disability was 11.9% (95% confidence interval, 9.2%–15.1%). Of the 60 cases of iatrogenic disability, 49 (81.7%, 95% confidence interval, 69.6%–90.5%) were judged to be potentially preventable. The most common health management issues identified in patients with preventable iatrogenic disability were low mobilization [by excessive bed rest (26.5%) and lack of physical therapist intervention (55.1%)], overuse of diapers (49.0%), and transurethral urinary catheterization (30.6%). Conclusions The present study suggests that a significant proportion of hospitalization-associated disability may be induced by iatrogenic events, and that most of them are potentially preventable. Health care professionals need to be educated on the specific needs of elderly hospitalized patients and should consider hospitalization-associated disability as an outcome of care.</description><subject>Activities of Daily Living</subject><subject>Aged</subject><subject>disability</subject><subject>Disability Evaluation</subject><subject>Elderly</subject><subject>Female</subject><subject>France - epidemiology</subject><subject>Geriatric Assessment</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Iatrogenic Disease - epidemiology</subject><subject>Iatrogenic Disease - prevention &amp; control</subject><subject>iatrogenic event</subject><subject>Incidence</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical Education</subject><issn>1525-8610</issn><issn>1538-9375</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkctq3DAYhUVpaG59gkDwshs7uliytGih5A4DCSSF7oQs_Q5yNfZUsgPTp6_cSbPIJisJ6Tv60XcQOiG4IpiIs77qzdqZimLCK8wqTMgHdEA4k6ViDf-47CkvpSB4Hx2m1GOcUSU-oX3KFaWENAdodR_hGYbJtAGKWzPF8QkGb4sLn0zrg5-2hR-Ky-Aghm1xbyaf4VRczNEPT8XNmDZ-MsH_yRfjcIz2OhMSfH5Zj9CPq8vH85tydXd9e_59Vdpa1lMJthWAqaxd5xyXTDBjO9UQ7khTi47lk7aulZQyY4a7hhEBLeU1b0TTSceO0Jfdu5s4_p4hTXrtk4UQzADjnDQRStWKq4ZnlO1QG8eUInR6E_3axK0mWC8ada__adSLRo2Zzhpz6vRlwNyuwb1m_nvLwNcdAPmbzx6iTjabseB8BDtpN_p3Bnx7k7fBZ-8m_IItpH6c45ANaqIT1Vg_LE0uRRKeS6T8J_sLiGaZEQ</recordid><startdate>20150801</startdate><enddate>20150801</enddate><creator>Sourdet, Sandrine, MD</creator><creator>Lafont, Christine, MD</creator><creator>Rolland, Yves, MD, PhD</creator><creator>Nourhashemi, Fati, MD, PhD</creator><creator>Andrieu, Sandrine, MD, PhD</creator><creator>Vellas, Bruno, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150801</creationdate><title>Preventable Iatrogenic Disability in Elderly Patients During Hospitalization</title><author>Sourdet, Sandrine, MD ; Lafont, Christine, MD ; Rolland, Yves, MD, PhD ; Nourhashemi, Fati, MD, PhD ; Andrieu, Sandrine, MD, PhD ; Vellas, Bruno, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c484t-ecb6e0284dfdd58363acf9715d1746f3836b4498886e0a5d7316eb2545767f8d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Activities of Daily Living</topic><topic>Aged</topic><topic>disability</topic><topic>Disability Evaluation</topic><topic>Elderly</topic><topic>Female</topic><topic>France - epidemiology</topic><topic>Geriatric Assessment</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Iatrogenic Disease - epidemiology</topic><topic>Iatrogenic Disease - prevention &amp; control</topic><topic>iatrogenic event</topic><topic>Incidence</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical Education</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sourdet, Sandrine, MD</creatorcontrib><creatorcontrib>Lafont, Christine, MD</creatorcontrib><creatorcontrib>Rolland, Yves, MD, PhD</creatorcontrib><creatorcontrib>Nourhashemi, Fati, MD, PhD</creatorcontrib><creatorcontrib>Andrieu, Sandrine, MD, PhD</creatorcontrib><creatorcontrib>Vellas, Bruno, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Medical Directors Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sourdet, Sandrine, MD</au><au>Lafont, Christine, MD</au><au>Rolland, Yves, MD, PhD</au><au>Nourhashemi, Fati, MD, PhD</au><au>Andrieu, Sandrine, MD, PhD</au><au>Vellas, Bruno, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preventable Iatrogenic Disability in Elderly Patients During Hospitalization</atitle><jtitle>Journal of the American Medical Directors Association</jtitle><addtitle>J Am Med Dir Assoc</addtitle><date>2015-08-01</date><risdate>2015</risdate><volume>16</volume><issue>8</issue><spage>674</spage><epage>681</epage><pages>674-681</pages><issn>1525-8610</issn><eissn>1538-9375</eissn><abstract>Abstract Background In older patients, hospitalization is often associated with new or worsening disability. This hospitalization-associated disability may be explained in part by the cumulative effect of aging, frailty, comorbidities, and illnesses that led to hospitalization but may also result from health care management issues and the hospital environment. Our objective was to determine the frequency, causes, and the preventability of disability induced by the processes of care or “iatrogenic disability.” Methods A total of 503 patients, aged 75 years and older, hospitalized in the 105 medical and surgical units of Toulouse University Hospital between October 2011 and March 2012, with a minimal length of stay of 2 days, were included. Hospitalization-associated disability was defined as a loss of 0.5 points or more in the Katz Activity of Daily Living Score between the time of hospital admission and discharge. To determine the iatrogenic component of hospitalization-associated disability, an expert panel in geriatric medicine reviewed each medical chart using a standardized record review and identified precipitating iatrogenic adverse events resulting in functional decline. Results Incidence of iatrogenic disability was 11.9% (95% confidence interval, 9.2%–15.1%). Of the 60 cases of iatrogenic disability, 49 (81.7%, 95% confidence interval, 69.6%–90.5%) were judged to be potentially preventable. The most common health management issues identified in patients with preventable iatrogenic disability were low mobilization [by excessive bed rest (26.5%) and lack of physical therapist intervention (55.1%)], overuse of diapers (49.0%), and transurethral urinary catheterization (30.6%). Conclusions The present study suggests that a significant proportion of hospitalization-associated disability may be induced by iatrogenic events, and that most of them are potentially preventable. Health care professionals need to be educated on the specific needs of elderly hospitalized patients and should consider hospitalization-associated disability as an outcome of care.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25922117</pmid><doi>10.1016/j.jamda.2015.03.011</doi><tpages>8</tpages></addata></record>
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subjects Activities of Daily Living
Aged
disability
Disability Evaluation
Elderly
Female
France - epidemiology
Geriatric Assessment
Hospitalization
Humans
Iatrogenic Disease - epidemiology
Iatrogenic Disease - prevention & control
iatrogenic event
Incidence
Internal Medicine
Male
Medical Education
title Preventable Iatrogenic Disability in Elderly Patients During Hospitalization
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