About one older inpatient in four leaves hospital with new disability

Design

Systematic review and meta-analysis of prevalence

Population

46 studies, 439,406 hospitalised older adults from 15 regions

Primary outcome

Prevalence of hospitalisation-associated disability

Effect

27% (95% CI 24% to 31%); prediction interval 7% to 48%

This meta-analysis, published 4 September in Age and Ageing, pooled 46 studies of 439,406 older adults to estimate hospitalisation-associated disability — a new loss of independence in activities of daily living between before admission and discharge.

Pooled prevalence was 27% (95% CI 24% to 31%), but individual studies ranged from 5% to 57% and the prediction interval was 7% to 48%. Rates were higher in patients aged 75–89, those admitted with lower respiratory tract infection, when pre-admission rather than admission function was the baseline, and when the modified Barthel index was used.

The variation largely reflects how disability is measured. Studies that asked about function before the acute illness found more of it — which is the measure that matters to the patient. Recording that baseline on admission is the first step to noticing and preventing the loss.

• Record each older patient's function two weeks before admission, not only on arrival.
• Mobilise older inpatients early and daily unless there is a clear reason not to.
• Pay particular attention to patients aged 75–89 and those admitted with chest infections.
• Compare discharge function with pre-admission function and plan rehabilitation for any loss.

Why it matters

Makes the harm of hospital stay visible where it is usually recorded only as length of stay.

Don't overread it

Prevalence varied widely with measurement method; this does not compare interventions.

The statistics, in plain English

A 95% prediction interval of 7% to 48% means a new hospital could see anywhere in that range; the pooled 27% is an average across very different settings.

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