Assessment of physical function of hospitalized older patients in routine clinical practice predicts 1-year mortality; A cohort study of 5,062 medical and surgical patients

METHODS: Adult patients referred for physical function evaluation by physio- or occupational therapists were evaluated with the Cumulated Ambulation Score (CAS) for basic mobility, 30sec-Sit-To-Stand-test (30s-STS) for muscle strength and function in lower extremities, and handgrip strength (HGS) as a proxy for general muscle strength. Results were categorized as normal (mean+/-1SD) or reduced (<-1SD) according to Danish sex- and age-decade reference values. The day of the first CAS assessment was used as an index for 1-year mortality in Cox regression analysis adjusted for age, sex, and multimorbidity (M3-index >1 point).

RESULTS: A total of 5062 unselected patients with a mean±SD age of 74.5±13.9 years (54% women), were evaluated with CAS in an acute (n = 337), surgical (n = 1671) or medical (n = 3054) ward. Of these, the 30s-STS was assessed in 85% (n = 4309) and HGS in 51% (n = 2580) patients, respectively. One-year mortality was 19.3%. The adjusted hazard ratio for 1-year mortality in patients with reduced CAS-mobility (57%), reduced 30s-STS (93%), and reduced HGS (44%) was 1.98 (95%CI, 1.71-2.29), 3.57 (2.21-5.78), and 2.06 (1.66-2.56), respectively, versus those with a normal physical function in respective tests. Correspondingly, hazard ratios for patients ≥85 years of age (n = 1185) were 2.02, 3.34 and 1.98.

CONCLUSIONS: In older medical and surgical hospitalised patients with reduced physical function (CAS, 30s-STS or HGS) 1-year mortality was markedly increased. This simple test battery is rapid and low-cost and can easily be implemented in other hospitals, acute care facilities, and across sectors.