Pilot Project on Assessing Physical Performance in Hospitalized Older Patients

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The SPPB is a set of objective measures of lower extremity physical performance (tests of balance, rising from a chair, and gait velocity) that was designed to assess functional limitations in older persons. It has been demonstrated in epidemiologic studies of community-dwelling older persons that performance on this test battery is highly predictive of mortality, institutionalization, health care expenditures, and subsequent disability. Recent work has demonstrated that the SPPB could be performed safely and in a short time in outpatient clinics, that it was acceptable to nurses and patients and that it predicted adverse outcomes similarly to what was found in epidemiological research cohorts. This supports the premise that standardized performance measures of physical functioning may be valuable when employed in routine clinical practice as early warning signs of impending problems. What has not been evaluated is whether a simple battery of performance tests is practical to administer to hospitalized patients and whether it can indicate improvement during the hospitalization and change in function in the immediate period post-hospitalization. It is hypothesized that deterioration of function after hospital discharge indicates a worsening in the clinical picture that may not be appreciated through the normal disease oriented follow-up and predicts a high risk of readmission to the hospital. Patients were considered eligible for the study if admitted for one of the following conditions: congestive heart failure, chronic obstructive pulmonary disease, pneumonia, stroke, diabetes in poor control. These conditions have been selected because they are common causes of hospitalizations in older patients and because are conditions that strongly affect physical function in older frail subjects. Patients were administered the SPPB at 48 hours after hospitalization, just prior to discharge and at home 1 week and 4 weeks after discharge. Telephone followup to assess new hospital admissions, institutionalization and vital status were done at 3, 6, 9 and 12 months. The data collection for the study has now been completed and analyses are under way. A paper describing the methodology of this study and the baseline corrlations of the SPPB has already been published. A definitive paper entitled "Predictive value of the Short Physical Performance Battery following hospitalization in older patients" is in press at the Journal of Gerontology Medical Sciences.