Gerontological Nursing Interventions Research Center (GNIRC)

Title: Preventing Functional Decline in Hospitalized Elderly
Principal Investigator: Bonnie Wakefield, PhD, RN
Study Sites: The University of Iowa and Veterans Affairs Medical Center, Iowa City, IA

Abstract
The project proposes Phase I of a multi-phase research agenda that will examine nursing interventions to maintain, improve, or prevent deterioration in functional status in hospitalized patients, determine effective staff development mechanisms to care for at-risk elderly hospitalized patients, and examine use of evidence-based guidelines to ensure cost-effective and optimal continuity of care for high risk frail elderly. The goal is to develop a better understanding of the natural history, clinical profiles, and trajectories of functional decline in hospitalized elderly veterans (HEV), and clinical and resource importance in HEV. Risk profiles will be developed so that evidence-based interventions to prevent and treat this phenomenon can be developed and tested. The immediate objective of the proposed study is to describe patterns and trajectories of functional decline associated with different chronic illnesses and comorbid conditions. The long term objectives of this program of research are to test evidence-based guidelines and identify the organizational structures necessary to support care for high risk frail elderly both in the hospital and after discharge.

Specific Aim 1 : Characterize the natural history and trajectory of functional decline associated with hospitalization in elderly veterans. Research questions to be addressed are: 1) What is the prevalence and type of functional limitations present on admission to the hospital?' 2) What is the incidence of functional decline in hospitalized elderly?; and 3) What is the nature, magnitude, and trajectory of change in functional status during hospitalization? Specific Aim 2: Identification of the subset of patients who are at high risk for decline during hospitalization. The primary research question to be addressed in this aim is: Can subgroups of hospitalized patients who experience decline and increased resource use after hospitalization be identified using a combination of risk factors? Research questions to be addressed are: 4) What are the risk factors for functional decline during hospitalization? And 5) Is functional decline during hospitalization associated with new admission to a long term care setting?