Factors related to Changes of Ambulatory Status in Elderly Nursing Home Residents

ABSTRACT

PURPOSE: To define the events surrounding mobility change in frail ambulatory elderly. METHODS: We retrospectively studied a cohort of 87 ambulatory residents of a chronic care hospital. Demographic data, medication, chronic condition, the Charlson Comorbidity Index(CCI), and ADLs were recorded. Mobility change was measured by the Timed Up & Go Test(TUGT) at baseline in July 1993 and follow-up in July 1996. This study determined the outcome status(dead, mon-ambulatory, ambulatory) and determined the reasons for ambulatory decline in individual subjects. RESULTS: During this period 31(36%) expired; 16(18%) became nonambulatory(wheel-chair dependent or bed-ridden) and 40(46%) remained ambulatory. Of those remaining ambulatory, TUGT performance was maintained in 26(30%), declined by 2X in 10(11%) and 4(5%) could not follow the test due to mental or behavioral problems. In the 16 nobambulatory subjects, 5(31%) lost mobility after an acute event, 11(69%) lost their mobility by slow decline. Factors associated with becoming nonambulatory include baseline CCI(p=0.01), frequency of medication change(p=0.009) and falls(p=0.004). CONCLUSION: CCI, medication change and falls were found to be associated with loss in mobility. The identification of risk factors for mobility change may be useful to target preventive measure.