Physical Performance Measures in the Prediction of Long-term Outcomes after Hospitalization in Older Patients: Preliminary Results from the CAPE HORN Study

Background. Hospital admission may cause prolonged worsening of functional status in older patients. In this preliminary analysis of the Comprehensive Assessment of Prognosis in Elderly HOspitalized patients ReturNing home (CAPE HORN) Study, we compared the ability of the Short Physical Performance Battery (SPPB) and handgrip strength (HS) test to predict short- and long-term outcomes in older patients discharged from Acute Care for the Elderly (ACE) hospital units. Methods. Subjects aged 75+ years admitted to ACE units in Florence, Italy, able to walk pre-admission and with a Mini-Mental State Examination (MMSE) score ≥18, were assessed pre-discharge (T0) and 1 (T1, in-person examination) and 6 months (T2, phone interview) after discharge. Data recorded included SPPB, HS, BADL, IADL and mobility disability, MMSE, Clock Drawing Test (CDT), Geriatric Depression Scale (GDS) and comorbidity (Disease Count, DC). Results. 101 participants (52% men, mean age 83) were enrolled. In multiple regression models, HS was associated with SPPB (p<0.001) at T0 and T1, controlling for age, gender, MMSE, CDT, GDS, DC and number of drugs. BADL, IADL, and mobility disability worsened in 38, 55, and 43% of the 82 participants assessed at T1, in whom SPPB was the only independent predictor (p=0.003) of mobility decline, with adjusted OR (95% CI) of 1.34 (1.10-1.63). In the 66 T2 participants, SPPB predicted decline in IADL and mobility with ORs of 1.22 (1.00-1.50), p=0.051, and 1.30 (1.04-1.62), p=0.019, respectively. By T2 follow-up, 29% of subjects had fallen, 42% were re-hospitalized, and 12% died (60% incidence of the combined outcome). SPPB was the only independent predictor (p=0.034) of the combined outcome, with an OR of 1.19 (1.01-1.39). The re-admission risk was separately predicted by SPPB and HS with ORs of 1.40 (1.07-1.82), p=0.013, and 1.06 (1.00-1.13), p=0.049, respectively.Conclusions. In older patients discharged from ACE units, SPPB and HS were well correlated. However, SPPB was a better predictor of functional decline and hard outcomes short- and longterm post-discharge.