• Anna H Chodos, Margot B Kushel, S Ryan Greysen, David Guzman, Eric R Kessell, Urmimala Sarkar, L Elizabeth Goldman, Jeffrey M Critchfield, and Edgar Pierluissi.
• Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA. anna.chodos@ucsf.edu.
• J Gen Intern Med. 2015 Dec 1; 30 (12): 176517721765-72.

BackgroundLittle is known about hospitalization-associated disability (HAD) in older adults who receive care in safety-net hospitals.ObjectivesTo describe HAD and to examine its association with age in adults aged 55 and older hospitalized in a safety-net hospital.DesignSecondary post hoc analysis of a prospective cohort from a discharge intervention trial, the Support from Hospital to Home for Elders.SettingMedicine, cardiology, and neurology inpatient services of San Francisco General Hospital, a safety-net hospital.ParticipantsA total of 583 participants 55 and older who spoke English, Spanish, or Chinese. We determined the incidence of HAD 30 days post-hospitalization and ORs for HAD by age group.MeasurementsThe outcome measure was death or HAD at 30 days after hospital discharge. HAD is defined as a new or additional disability in one or more activities of daily living (ADL) that is present at hospital discharge compared to baseline. Participants' functional status at baseline (2 weeks prior to admission) and 30 days post-discharge was ascertained by self-report of ADL function.ResultsMany participants (75.3 %) were functionally independent at baseline. By age group, HAD occurred as follows: 27.4 % in ages 55-59, 22.2 % in ages 60-64, 17.4 % in ages 65-69, 30.3 % in ages 70-79, and 61.7 % in ages 80 or older. Compared to the youngest group, only the adjusted OR for HAD in adults over 80 was significant, at 2.45 (95 % CI 1.17, 5.15).ConclusionsIn adults at a safety-net hospital, HAD occurred in similar proportions among adults aged 55-59 and those aged 70-79, and was highest in the oldest adults, aged ≥ 80. In safety-net hospitals, interventions to reduce HAD among patients 70 years and older should consider expanding age criteria to adults as young as 55.

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