The Importance of Identifying Indicators of Increased Risk for Hospitalization

Among older adults, even short hospital stays can significantly increase risks of functional decline and disability. Hospitalizations can result in pressure ulcers, polypharmacy, deconditioning, and increased likelihood of potentially disabling or fatal falls and fractures. Recognizing and addressing indicators of increased risk for hospitalization can reduce related morbidity and mortality.

A recent study published in the Journal of the American Geriatrics Society offers insights into doing just this. The authors, Peggy M. Cawthon, PhD, MPH, and colleagues identify four indicators of increased risk for hospitalization in the elderly—including one that clinicians could easily check for in the office.

The study followed more than 3000 community-dwelling, black and white men and women, age 70-80, who were free of disability at baseline. All underwent a baseline exam that measured, among other things, grip strength, knee extension strength, lean mass, walking speed, and chair-stand pace. Thigh computer tomography scans were used to assess muscle and density, which served as a proxy for muscle fat infiltration.

At follow-up, which averaged 4.7 years, roughly 56% of participants had had at least one hospitalization. Those with weak grip strength, poor knee strength, slow chair-stand pace, and slow walking speed were significantly more likely to experience a hospitalization, the researchers found. Older adults in the slowest quartile for walking speed, for example, had a 70% higher risk of hospitalization during follow-up than participants with the fastest walking speed, after adjustment for age, body mass index, health status, and coexisting medical conditions. The mean speed for black women, white women, black men, and white men, respectively, in the slowest quartile was: 0.8, 0.93, 0.87, and 1.01 meters per second. By contrast, the mean speed for the same groups in the fastest quartile was 1.29, 1.46, 1.40, and 1.5 meters per second.

“Assessment of walking speed is inexpensive and simple to implement. Thus, walking speed alone may be an ideal measure for identifying individuals at risk of poor outcomes, including hospitalizations,” write Cawthon and colleagues, noting that these findings are consistent with other published results.

“[U]pper extremity strength was also associated with risk of hospitalizations,” they add. Therefore, “poor upper extremity strength (even with robust lower extremity function) should be considered a possible risk factor for future adverse health outcomes.”

Given the risks and costs associated with hospitalization, further research in this area is certainly warranted.

“Interventions to improve muscle strength and physical performance may reduce not only future disability but might also reduce the large economic burden associated with hospitalizations should poor muscle strength and function be causally related to subsequent hospitalizations,” the authors conclude.

We agree.

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