Assessment tools and incidence of hospital-associated disability: a rapid systematic review

Background During hospitalization older people have a high risk of developing functional impairments unrelated to the reasons for their admission. This is termed hospital-associated disability. This systematic review aimed to assess the incidence of hospital-associated disability among older patients admitted to acute care, to identify the tools used to assess activities of daily living in these patients, and evaluate which functional task is most sensitive for detecting changes in disability among older hospitalized patients. Methods A rapid systematic review was performed according to the recommendations of the Cochrane Rapid Reviews Methods Group and the PRISMA statement. A literature search was performed in Medline (via Ovid), EMBASE, and Cochrane Central Register of Controlled Trials databases on 26 August 2021. Inclusion criteria: older people, assessment of activities of daily living at baseline and discharge. Exclusion criterion: diseases affecting functional decline. Results Eleven studies were included in the final review. Incidence of hospital-associated disability (overall score) was 37% (95% CI 0.31–0.42). Insufficient data prevented meta-analysis of the individual items. The most sensitive measure for detecting changes in disability was the overall score of assessment of activities of daily living. Conclusions Incidence of hospital-associated disability in older patients might be overestimated, due to the combination of disease-related disability and hospital-associated disability. The tools used to assess these patients presented some limitations. These results should be interpreted with caution, as a limited number of studies reported adequate information to assess the incidence of hospital-associated disability. Risk of bias in the included studies raised some concerns.