PREDICTIVE VALUE OF PERFORMANCE-BASED FUNCTIONAL ASSESSMENT IN OLDER HOSPITALIZED PATIENTS

Background: Functional evaluation is a cornerstone of multidimensional geriatric assessment, however, little is known on the clinical value of standardized performance-based assessment in the acute care setting. Objective: The aim of this study was to assess the ability of the Short Physical Performance Battery (SPPB), a three-item lower extremity performance test including gait speed, 5 repeated chair stands, and tandem balance tests, to predict rates of hospitalization, death and functional decline (basic activities of daily living, ADL) in older patients in the 12 months after discharge from the hospital. Methods: We enrolled 92 women and men aged 65 and older able to walk and with a Mini Mental State Examination (MMSE) score >= 18, admitted to the hospital with a clinical diagnosis of congestive heart failure, pneumonia, chronic obstructive pulmonary disease, or minor stroke. Participants were evaluated with SPPB (range 0-12, with higher scores indicating better lower body function) at hospital admission, were re-evaluated the day of hospital discharge, then one week and one month after hospital discharge by in-home visits. Subsequently, they were followed-up for ADL, new hospitalization, and vital status every three months by telephone interviews. Eighty-six patients with complete follow-up data were included in the analysis. Results: the mean age of the sample was 77.2 /6.3 years; 51.2% were women. Mean SPPB score at discharge was 7.12/3.0. After adjustment for age, gender, comorbidity level, cognitive status, and ADL functional status before hospital admission, the SPPB score at hospital discharge was inversely correlated with the rate of decline in ADL performance over the 12-month follow-up (p=0.022). Forty-eight (55.8%) patients were re-admitted to the hospital and 11 (12.8%) have died over the follow-up. In multivariable logistic regression analysis adjusted for potential confounders, patients with better SPPB score at hospital discharge (score:8-12) had a lower risk of hospitalization or death (Odds Ratio: 0.19, I.C. 95% 0.06-0.62) compared to patients with the lowest SPPB score (0-4). Patients with intermediate score (score 5-7) had intermediate likelihood of new hospitalization or death (Odds Ratio: 0.52, I.C. 95% 0.19-1.37). Conclusion: In older acute geriatric patients the SPPB provides important prognostic information. Lower-extremity performance-based functional assessment might identify older patients at high risk of poor outcomes after hospital discharge.