Current status and influencing factors of hospitalization-related disability in elderly individuals: a scoping review

LIAO Dongxia; YU Xuemei; ZHANG Cuicui; ZHOU Mijuan; DEND Yinyi; CHEN Luying; GONG Xiyan; WANG Min; LIAO Changju

doi:10.16460/j.issn2097-6569.2025.11.038

PDF(869 KB)

Journal of Nursing ›› 2025, Vol. 32 ›› Issue (11) : 38-44. DOI: 10.16460/j.issn2097-6569.2025.11.038

Current status and influencing factors of hospitalization-related disability in elderly individuals: a scoping review

LIAO Dongxia^1,2,3, YU Xuemei³, ZHANG Cuicui³, ZHOU Mijuan³, DEND Yinyi¹, CHEN Luying³, GONG Xiyan³, WANG Min^1,2, LIAO Changju³

Author information +

History +

Abstract

Objective To conduct a scoping review of the current status and influencing factors of hospitalization-associated disability in elder individuals, and to provide insights for clinical nursing practice and research. Methods A scoping review was conducted. Systematic searches were performed for literature in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Database, and China Biology Medicine (CBM) up to April 10, 2024. Thematic analysis was used to integrate and analyze the literature. Results Twenty-three articles were included. The results showed that the assessment tools included the Barthel index, the Katz index, the modified Barthel index, 21 daily activities and physical tasks, SPPB and HAD-FREE. The incidence of hospitalization-associated disability in elder individuals ranged from 3.7% to 67.4%. The influencing factors were integrated and refined into two themes: individual factors including age, frailty, diseases, and cognitive and psychological state and hospitalization-related factors including activity restrictions, malnutrition, urinary incontinence care, and delirium. Conclusion The incidence of hospitalization-associated disability in elder individuals varies widely. More sensitive and objective measurement tools are needed to identify high-risk groups for hospitalization-associated disability early. Timely personalized interventions should be provided to reduce the incidence and improve patients' quality of life.

Key words

elderly individual / hospitalization-associated disability / incidence / influencing factors / scoping review

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

LIAO Dongxia, YU Xuemei, ZHANG Cuicui, ZHOU Mijuan, DEND Yinyi, CHEN Luying, GONG Xiyan, WANG Min, LIAO Changju. Current status and influencing factors of hospitalization-related disability in elderly individuals: a scoping review[J]. Journal of Nursing. 2025, 32(11): 38-44 https://doi.org/10.16460/j.issn2097-6569.2025.11.038

References

[1] Covinsky KE, Pierluissi E, Johnston CB.Hospitalization-associated disability: "She was probably able to ambulate, but I’m not sure"[J]. JAMA, 2011, 306(16):1782-1793. DOI: 10.1001/jama.2011.1556.
[2] 国家卫生健康委员会.2020中国卫生健康统计年鉴[M].2020版.北京:中国协和医科大学出版社,2020.
[3] Loyd C, Markland AD, Zhang Y, et al. Prevalence of hospital-associated disability in older adults: a Meta-analysis[J]. J Am Med Dir Assoc, 2020, 21(4):455-461.e5. DOI: 10.1016/j.jamda.2019.09.015.
[4] Takahashi T, Iwata K, Morisawa T, et al.Incidence of hospitalization-associated disability in older patients with heart failure[J]. Circ J, 2024, 88(5):672-679. DOI: 10.1253/circj.CJ-23-0722.
[5] Chen Y, Almirall-Sánchez A, Mockler D, et al. Hospital-associated deconditioning: not only physical, but also cognitive[J]. Int J Geriatr Psychiatry, 2022, 37(3):10.1002/gps.5687. DOI: 10.1002/gps.5687.
[6] Daudt HM, van Mossel C, Scott SJ. Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’ Malley’s framework[J]. BMC Med Res Methodol, 2013(13):48. DOI: 10.1186/1471-2288-13-48.
[7] Zisberg A, Shadmi E, Gur-Yaish N, et al.Hospital-associated functional decline: the role of hospitalization processes beyond individual risk factors[J]. J Am Geriatr Soc, 2015, 63(1):55-62. DOI: 10.1111/jgs.13193.
[8] Sourdet S, Lafont C, Rolland Y, et al.Preventable iatrogenic disability in elderly patients during hospitalization[J]. J Am Med Dir Assoc, 2015, 16(8):674-681. DOI: 10.1016/j.jamda.2015.03.011.
[9] Reichardt LA, Aarden JJ, van Seben R, et al. Unravelling the potential mechanisms behind hospitalization-associated disability in older patients; the hospital-associated disability and impact on daily Life (Hospital-ADL) cohort study protocol[J]. BMC Geriatr, 2016(16):59. DOI: 10.1186/s12877-016-0232-3.
[10] Palese A, Gonella S, Moreale R, et al.Hospital-acquired functional decline in older patients cared for in acute medical wards and predictors: findings from a multicentre longitudinal study[J]. Geriatr Nurs, 2016, 37(3):192-199. DOI: 10.1016/j.gerinurse.2016.01.001.
[11] Fimognari FL, Pierantozzi A, De Alfieri W, et al.The Severity of acute illness and functional trajectories in hospitalized older medical patients[J]. J Gerontol A biol Sci Med Sci, 2017, 72(1):102-108. DOI: 10.1093/gerona/glw096.
[12] Jonckers M, Van Grootven B, Willemyns E, et al.Hospitalization-associated disability in older adults with valvular heart disease: incidence, risk factors and its association with care processes[J]. Acta Cardiol, 2018(4):1-7. DOI: 10.1080/00015385.2017.1421300.
[13] Saarela M, Ryynänen OP, Äyrämö S.Predicting hospital associated disability from imbalanced data using supervised learning[J]. Artif Intell Med, 2019(95):88-95. DOI: 10.1016/j.artmed.2018.09.004.
[14] Van Grootven B, Jeuris A, Jonckers M, et al.Predicting hospitalisation-associated functional decline in older patients admitted to a cardiac care unit with cardiovascular disease: a prospective cohort study[J]. BMC Geriatr, 2020, 20(1):112. DOI: 10.1186/s12877-020-01510-1.
[15] Huang CH, Hsu CC, Yu PC, et al.Hospitalization-associated muscle weakness and functional outcomes among oldest old patients: a hospital-based cohort study[J]. Exp Gerontol, 2021(150):111353. DOI: 10.1016/j.exger.2021.111353.
[16] Park CM, Kim W, Rhim HC, et al.Frailty and hospitalization-associated disability after pneumonia: a prospective cohort study[J]. BMC Geriatr, 2021, 21(1):111. DOI: 10.1186/s12877-021-02049-5.
[17] Chou MY, Liang CK, Hsu YH, et al.Developing a predictive model for hospital-associated disability among older patients hospitalized for an acute illness: the HAD-FREE Score[J]. Eur Geriatr Med, 2021, 12(5):963-971. DOI: 10.1007/s41999-021-00497-1.
[18] Hori K, Usuba K, Sakuyama A, et al.Hospitalization-associated disability after cardiac surgery in elderly patients-exploring the risk factors using machine learning algorithms[J]. Circ Rep, 2021, 3(8):423-430. DOI: 10.1253/circrep.CR-21-0057.
[19] Skains RM, Zhang Y, Osborne JD, et al.Hospital-associated disability due to avoidable hospitalizations among older adults[J]. J Am Geriatr Soc, 2023, 71(5):1395-1405. DOI: 10.1111/jgs.18238.Epub 2023 Jan 20.
[20] Kolk D, Melis RJF, MacNeil-Vroomen JL, et al. Physical resilience in daily functioning among acutely ill hospitalized older adults: the hospital-ADL study[J]. J Am Med Dir Assoc, 2022, 23(5):903.e1-903.e12. DOI: 10.1016/j.jamda.2021.08.029.
[21] Nagae M, Umegaki H, Komiya H, et al.Dehydration and hospital-associated disability in acute hospitalized older adults[J]. Eur Geriatr Med, 2023, 14(1):113-121. DOI: 10.1007/s41999-022-00722-5.
[22] Abay RJY, Gold LS, Cawthon PM, et al.Lean mass, grip strength, and hospital-associated disability among older adults in Health ABC[J]. Alzheimers Dement, 2022, 18(10):1898-1906. DOI: 10.1002/alz.12527.
[23] Hirakawa K, Nakayama A, Saitoh M, et al.Physical function examination at intensive care unit as predictive indicators for hospitalization-associated disability in patients after cardiovascular surgery[J]. Rev Cardiovasc Med, 2022, 23(2):77. DOI: 10.31083/j.rcm2302077.
[24] Ogawa M, Yoshida N, Nakai M, et al.Hospital-associated disability and hospitalization costs for acute heart failure stratified by body mass index- insight from the JROAD/JROAD-DPC database[J]. Int J Cardiol, 2022(367):38-44. DOI: 10.1016/j.ijcard.2022.08.044.
[25] Nagae M, Umegaki H, Yoshiko A, et al.Muscle evaluation and hospital-associated disability in acute hospitalized older adults[J]. J Nutr Health Aging, 2022, 26(7):681-687. DOI: 10.1007/s12603-022-1814-8.
[26] Hori K, Nakayama A, Kobayashi D, et al.Exploring the frailty components related to hospitalization-associated disability in older patients after cardiac surgery using a comprehensive frailty assessment[J]. Circ J, 2023, 87(8):1112-1119. DOI: 10.1253/circj.CJ-23-0102.
[27] Freeman H, Martin RC, Whittington C, et al. Delirium mediates incidence of hospital-associated disability among older adults[J]. J Am Med Dir Assoc, 2023, 24(4):533-540.e9. DOI: 10.1016/j.jamda.2023.02.006.
[28] Kono Y, Mukaino M, Ozawa Y, et al.Clinical impact of non-lying time on hospital-associated functional decline in older patients undergoing transcatheter aortic valve implantation[J]. Heart Vessels, 2024, 39(3):266-272. DOI: 10.1007/s00380-023-02326-w.
[29] Tor-Roca A, Mayordomo-Cava J, Andres-Lacueva C, et al.Adherence to mediterranean diet and response to an exercise program to prevent hospitalization-associated disability in older adults: a secondary analysis from a randomized controlled Trial[J]. J Nutr Health Aging, 2023,27(7):500-506. DOI: 10.1007/s12603-023-1929-6.
[30] 吴爽,赵一楠,宁红婷,等.老年患者住院相关性失能的研究进展[J].中南大学学报(医学版), 2023,48(3):455-462. DOI:10.11817/j.issn.1672-7347.2023.220333.
[31] 王玮荻,蔡纯,何梅.老年人住院相关功能下降风险筛查及干预研究进展[J].护理学杂志,2019,34(22):105-109. DOI: 10.3870/j.issn.1001-4152.2019.22.105.
[32] Katz S, Ford AB, Moskowitz RW, et al.Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function[J]. JAMA, 1963(185):914-919. DOI: 10.1001/jama.1963.03060120024016.
[33] Mahoney FI, Barthel DW.Functional evaluation: the barthel index[J]. Md State Med J, 1965(14):61-65.
[34] Guralnik JM, Winograd CH.Physical performance measures in the assessment of older persons[J].Aging (Milano), 1994, 6(5):303-305. DOI: 10.1007/BF03324256.
[35] 刘枝健. 急性缺血性脑卒中患者感知控制变化趋势及其与认知、功能、情绪和生活质量关系的纵向研究[D].上海:中国人民解放军海军军医大学,2022.DOI:10.26998/d.cnki.gjuyu.2022.000288.
[36] Kawasaki T, Tozawa R.Motor function relating to the accuracy of self-overestimation error in community-dwelling older adults[J]. Front Neurol, 2020(11):599787. DOI: 10.3389/fneur.2020.599787.
[37] Kempen GI, Steverink N, Ormel J, et al.The assessment of ADL among frail elderly in an interview survey: self-report versus performance-based tests and determinants of discrepancies[J]. J Gerontol B Psychol Sci Soc Sci, 1996, 51(5):254-260. DOI: 10.1093/geronb/51b.5.p254.
[38] Applegate WB, Blass JP, Williams TF.Instruments for the functional assessment of older patients[J]. N Engl J Med, 1990, 322(17):1207-1214. DOI: 10.1056/NEJM199004263221707.
[39] Chodos AH,Kushel MB,Greysen SR,et al.Hospitalization-associated disability in adults admitted to a safety-net hospital[J]. J Gen Intern Med, 2015, 30(12):1765-1772.
[40] 施杨,顾志娥,朱彤,等.社会网络和自我忽视在老年缺血性脑卒中患者衰弱与认知功能间的链式中介效应[J].护理学报, 2024, 31(17):40-45.DOI:10.16460/j.issn1008-9969.2024.17.040.
[41] Khan KT, Hemati K, Donovan AL.Geriatric physiology and the frailty syndrome[J]. Anesthesiol Clin, 2019, 37(3):453-474. DOI: 10.1016/j.anclin.2019.04.006.
[42] Andrew MK, MacDonald S, Godin J, et al. Persistent functional decline following hospitalization with Influenza or acute respiratory illness[J]. J Am Geriatr Soc, 2021, 69(3):696-703. DOI: 10.1111/jgs.16950.
[43] Davydow DS, Hough CL, Levine DA, et al. Functional disability, cognitive impairment,depression after hospitalization for pneumonia[J]. Am J Med, 2013, 126(7):615-624.e5. DOI: 10.1016/j.amjmed.2012.12.006.
[44] Brown CJ, Redden DT, Flood KL, et al.The underrecognized epidemic of low mobility during hospitalization of older adults[J]. J Am Geriatr Soc, 2009, 57(9):1660-1665. DOI: 10.1111/j.1532-5415.2009.02393.x.
[45] Callen BL, Mahoney JE, Grieves CB, et al.Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital[J]. Geriatr Nurs, 2004, 25(4):212-217. DOI: 10.1016/j.gerinurse.2004.06.016.
[46] Hong X, Yan J, Xu L, et al.Relationship between nutritional status and frailty in hospitalized older patients[J]. Clin Interv Aging, 2019(14):105-111. DOI: 10.2147/CIA.S189040.
[47] 龙艳红. 老年住院患者营养不良的发生及相关因素分析[D].长春:吉林大学,2020.DOI:10.27162/d.cnki.gjlin.2020.004269.
[48] 杨翰,曹国瑞,裴福兴,等.加速康复流程下人工全膝关节置换术后留置尿管的危险因素分析[J].中国修复重建外科杂志,2020,34(3):357-361.DOI:10.7507/1002-1892.201906126.
[49] Shehabi Y, Riker RR, Bokesch PM, et al.Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients[J]. Crit Care Med, 2010, 38(12):2311-2318. DOI: 10.1097/CCM.0b013e3181f85759.
[50] Quinlan N, Rudolph JL.Postoperative delirium and functional decline after noncardiac surgery[J]. J Am Geriatr Soc, 2011, 59(Suppl 2):S301-304. DOI: 10.1111/j.1532-5415.2011.03679.x.