According to the World Health Organization (WHO), disability is a reduction in function in one of three domains that include body function or structure, activity and participation. Approximately 30% of older adults will experience a new ADL disability by hospital discharge, with little recovery observed. ADL disability captures only one of the three disability domains, activity limitation. The UAB Life-Space Assessment (LSA) is a validated tool that measures community mobility and reflects participation in society based on the distance through which a person reports moving during the four weeks preceding the assessment. Life-space "levels" range from within one's dwelling to beyond one's town. A life-space composite score is calculated based on life-space level, degree of independence in achieving each level, and the frequency of attaining each level. Based on preliminary data, recovery of participation as measured by life-space, to pre-admission levels does not appear to occur for many older hospitalized adults. Methods: Using a prospective cohort study design, participants will be recruited during hospitalization and followed for 6-months after discharge. Assessments will be made regularly during the hospital stay, and once a month by telephone after hospitalization.
Specific Aim 1 : To describe changes in life-space mobility after hospitalization in older veterans. While ADL disability is common after hospitalization, our preliminary population-based research shows mobility restrictions are also apparent. No study to date has examined what changes in participation occur during the initial 6 months after hospitalization at the individual level.
Specific Aim 2 : To compare changes in life-space mobility with changes in basic and instrumental activities of daily living after hospitalization in older adults. As with specific aim 1, given the dynamic process of disability, additional data regarding the changes in ADLs, IADLs and life-space each month would allow improved assessment of the inter-relationship between these three important components of disability.
Specific Aim 3 : To determine predictors of recovery of life-space mobility after hospitalization, as measured by the Life-Space Assessment. At the level of the individual, a variety of factors might be expected to predict who will recover life-space. These factors may include patient-related, hospital- related and post-hospitalization factors. The major goal of this study is to identify potentially modifiable predictors of recovery of life-space mobility that could be future targets for intervention. Potential Impact on Veterans Health Care: According to NSV 2001 data, approximately 21% of hospitalized veterans were e 65 years, and this number is expected to increase as the US population ages. Activity and participation disability appear to be a frequent consequence of hospitalization, which may be amenable to intervention. Ultimately, our goal is to improve recovery after hospitalization and reduce disability in our older veterans. The VA medical center system is well suited for this type of research as the population of older patients admitted to the hospital is high and results of future studies can be disseminated nationally through the VA system.

Public Health Relevance

After hospitalization, 30-60% of older adults experience more difficulty performing one or more of their basic activities of daily living (ADLs) like bathing or dressing. Our has shown community mobility, measured by the UAB Life-Space Assessment, also decreases after hospitalization and does not improve even after up to two years of follow-up. The Life-Space Assessment (LSA) is a validated tool that measures community mobility and reflects participation in society based on the distance through which a person reports moving during the four weeks before the assessment. Life-space levels range from within one's dwelling to beyond one's town. A life-space composite score is calculated based on life-space level, degree of independence in achieving each level, and the frequency of attaining each level. We plan to recruit veterans e 65 years of age during hospitalization and followed them with monthly telephone calls for 6-months after discharge. A variety of assessments of their functional ability, cognitive ability and general health will be done. The major goal of this study is to identify potentially modifiable predictors of recovery of life-space mobility that could be future targets for intervention. Ultimately, our goal is to improve recovery after hospitalization and reduce disability in our older veterans. The VA medical center system is well suited for this type of research as the population of older patients admitted to the hospital is high and results of future studies can be disseminated nationally through the VA system.

Agency
National Institute of Health (NIH)
Type
Non-HHS Research Projects (I01)
Project #
5I01RX000198-03
Application #
8837540
Study Section
Musculoskeletal/Orthopedic Rehabilitation (RRD2)
Project Start
Project End
Budget Start
Budget End
Support Year
3
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Birmingham VA Medical Center
Department
Type
DUNS #
City
Birmingham
State
AL
Country
United States
Zip Code
35233