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Functional decline and associated factors in patients with multimorbidity at 8 months of follow-up in primary care: the functionality in pluripathological patients (FUNCIPLUR) longitudinal descriptive study.
BMJ Open 2018 July 29
OBJECTIVE: To analyse short-term functional decline and associated factors in over 65-year-olds with multimorbidity.
DESIGN AND SETTING: Prospective multicentre study conducted in three primary care centres, over an 8-month period. During this period, we also analysed admissions to two referral hospitals.
PARTICIPANTS: Of the 241 patients ≥65 years included randomly in the study, 155 were already part of a multimorbidity programme (stratified by 'Adjusted Clinical Groups') and 86 were newly included (patients who met Ollero's criteria and with ≥1 hospital admission the previous year). Patients who were institutionalised, unable to complete follow-up or receiving dialysis were excluded.
OUTCOMES AND VARIABLES: The primary outcome was the decrease in functional status category (Barthel Index or Lawton Scale). Other variables considered were sociodemographic characteristics, comorbidity, medications, number of admissions and functional status on discharge.
RESULTS: Patients had a median age of 82 years (P75 86) and of five selected chronic conditions (IQR 4-6), and took 11 (IQR 9-14) regular medications; 46.9% were women; 38.2% had impaired function at baseline.Overall, 200 persons completed the follow-up; 10.4% (n=25) of the initial sample died within the 8 months. In 20.5% (95% CI 15.5% to 26.6%) of them we recorded a decrease in functionality, associated with older age (OR 1.1, 95% CI 1.0 to 1.2) and with having ≥1 admission during the follow-up (OR 3.6, 95% CI 1.6 to 7.7). There were 133 hospital admissions in total during the follow-up considering all the patients included, and a functional decline was observed in 35.5% (95% CI 25.7% to 46.7%) of the 76 discharges in which functional status was assessed.
CONCLUSIONS: A fifth of patients showed functional decline or loss of independence in just 8 months. These findings are important as functional decline and the increasing care needs are potentially predictable and modifiable. Age and hospitalisation were closely associated with this decline.
DESIGN AND SETTING: Prospective multicentre study conducted in three primary care centres, over an 8-month period. During this period, we also analysed admissions to two referral hospitals.
PARTICIPANTS: Of the 241 patients ≥65 years included randomly in the study, 155 were already part of a multimorbidity programme (stratified by 'Adjusted Clinical Groups') and 86 were newly included (patients who met Ollero's criteria and with ≥1 hospital admission the previous year). Patients who were institutionalised, unable to complete follow-up or receiving dialysis were excluded.
OUTCOMES AND VARIABLES: The primary outcome was the decrease in functional status category (Barthel Index or Lawton Scale). Other variables considered were sociodemographic characteristics, comorbidity, medications, number of admissions and functional status on discharge.
RESULTS: Patients had a median age of 82 years (P75 86) and of five selected chronic conditions (IQR 4-6), and took 11 (IQR 9-14) regular medications; 46.9% were women; 38.2% had impaired function at baseline.Overall, 200 persons completed the follow-up; 10.4% (n=25) of the initial sample died within the 8 months. In 20.5% (95% CI 15.5% to 26.6%) of them we recorded a decrease in functionality, associated with older age (OR 1.1, 95% CI 1.0 to 1.2) and with having ≥1 admission during the follow-up (OR 3.6, 95% CI 1.6 to 7.7). There were 133 hospital admissions in total during the follow-up considering all the patients included, and a functional decline was observed in 35.5% (95% CI 25.7% to 46.7%) of the 76 discharges in which functional status was assessed.
CONCLUSIONS: A fifth of patients showed functional decline or loss of independence in just 8 months. These findings are important as functional decline and the increasing care needs are potentially predictable and modifiable. Age and hospitalisation were closely associated with this decline.
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