Functional status change in older adults undergoing coronary artery bypass surgery
Keywords:
Aged, Disabled persons, Coronary disease, Coronary artery bypass, Patient admission, HospitalizationAbstract
CONTEXT AND OBJECTIVE: Increased life expectancy has resulted in growing numbers of elderly patients undergoing heart surgery. This study aimed to identify changes in functional status among older adults undergoing coronary artery bypass grafting. DESIGN AND SETTING: Prospective observational cohort study conducted at a level IV private hospital in Brazil. METHODS: Patients were assessed using the Katz and Lawton scales and the Functional Independence Measure before admission, at hospital discharge and one month after discharge. Repeated-measurement analysis of variance was used. RESULTS: Two patients died during hospitalization. Among the 31 patients included, the Functional Independence Measure ranged from 121.7 ± 7.4 (pre-admission) to 91.1 ± 20.5 (discharge) and 109.0 ± 21.7 (one month after discharge); the Katz scale from 5.92 ± 0.32 to 4.18 ± 1.04 and 5.13 ± 1.30; and the Lawton scale from 24.3 ± 4.6 to 12.8 ± 2.0 and 16.5 ± 4.6 (P = 0.0001). When subgroups with (18) and without (13) complications were compared, the Functional Independence Measure (P = 0.085) showed a trend, although not significantly, toward recovery one month after discharge. Delirium and blood transfusion were the intercurrent events found. There was a correlation between the scales and age (P = 0.008), APACHE II (P = 0.051), EuroSCORE (P = 0.064), intensive care unit stay (P = 0.024) and overall hospital length of stay (P = 0.040). CONCLUSION: The Functional Independence Measure proved to be a promising tool for monitoring the functional status of elderly patients undergoing coronary artery bypass grafting, especially in the subgroup with complications.
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Lotufo PA. Mortalidade precoce por doenças do coraçäo no Brasil. Comparaçäo com outros países [Premature mortality from heart diseases in Brazil. An international comparison]. Arq Bras Cardiol. 1998;70(5):321-5.
Viana FP, Lorenzo AC, Oliveira EF, Resende SM. Medida de independência funcional nas atividades de vida diária em idosos com seqüelas de acidente vascular encefálico no Complexo Gerontológico Sagrada Família de Goiânia [Functional independence measure in daily life activities in elderly with encephalic vascular accident sequels in the Sagrada Família Gerontologic Complex of Goiania]. Rev Bras Geriatr Gerontol. 2008;11(1):17-28.
Loures DRR, Carvalho RG, Mulinari L, et al. Cirurgia cardíaca no idoso [Cardiac surgery in elderly patients]. Rev Bras Cir Cardiovasc. 2000;15(1):1-5.
Covinsky KE, Palmer RM, Counsell SR, et al. Functional status before hospitalization in acutely ill older adults: validity and clinical importance of retrospective reports. J Am Geriatr Soc. 2000;48(2):164-9.
Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Geronto- logist. 1970;10(1):20-30.
Lawton MP, Moss M, Fulcomer M, Kleban MH. A research and service oriented multilevel assessment instrument. J Gerontol. 1982;37(1):91-9.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental acti- vities of daily living. Gerontologist. 1969;9(3):179-86.
Solway S, Brooks D, Lacasse Y, Thomas S. A qualitative systematic overview of the mea- surement properties of functional walk tests used in the cardiorespiratory domain. Chest. 2001;119(1):256-70.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS sta- tement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-7.
Enright PL, McBurnie MA, Bittner V, et al. The 6-min walk test: a quick measure of functional status in elderly adults. Chest. 2003;123(2):387-98.
Camara FM, Gerez AG, Miranda MLJ, Velardi M. Capacidade funcional do idoso: formas de avaliação e tendências [Elderly functional capacity: types of assessment and trends]. Acta Fisiátrica. 2008;15(4):249-56.
Jassal SV, Chiu E, Hladunewich M. Loss of independence in patients starting dialysis at 80 years of age or older. N Engl J Med. 2009;361(16):1612-3.
Arnold RM, Zeidel ML. Dialysis in frail elders--a role for palliative care. N Engl J Med. 2009;361(16):1597-8.
Kurella Tamura M, Covinsky KE, Chertow GM, et al. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med. 2009;361(16):1539-47.
Smith P, Hamilton BB, Granger CV. Functional independence measure decision tree: the FONE FIM. New York: State University of New York Research Foundation; 1989.
Riberto M, Miyazaki MH, Jorge Filho D, Sakamoto H, Battistella LR. Reprodutibilidade da versão brasileira da medida de independência funcional [Reproductivity brazilain version of functional independence measure]. Acta Fisiátrica. 2001;8(1):45-52.
Riberto M, Miyazaki MH, Jucá SSH, et al. Validação da versão brasileira da Medida de Independência Funcional [Validation of the brazilian version of Functional Independence Measure]. Acta Fisiátrica. 2004;11(2):72-6.
Paixão Júnior CM, Reichenheim ME. Uma revisão sobre instrumentos de avaliação do esta- do funcional do idoso [A review of functional status evaluation instruments in the elderly]. Cad. saúde pública = Rep. public health. 2005;21(1):7-19.
Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil. 1996;77(12):1226-32.
Brasil. Ministério da Saúde. Portaria no 2.224/GM em 5 de dezembro de 2002. Estabelecer o sistema de Classificação Hospitalar do Sistema Único de Saúde. Available from: http:// dtr2001.saude.gov.br/sas/PORTARIAS/Port2002/Gm/GM-2224.htm. Accessed in 2011 (Mar 28).
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classifica- tion system. Crit Care Med. 1985;13(10):818-29.
Nashef SA, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999;16(1):9-13.
World Health Organization. WHO Age-Friendly Environments Programme. Available from: http://www.who.int/ageing/age_friendly_cities/en/index.html. Accessed in 2011 (Mar 28).
World Health Organization. Ageing. Available from: http://www.who.int/topics/ageing/en/. Accessed in 2011 (Mar 28).
Abramson JH. WINPEPI (PEPI-for-Windows): computer programs for epidemiologists. Epide- miol Perspect Innov. 2004;1(1):6.
Hollander M, Wolde DA. Nonparametric statistical methods. New Yor: John Wiley & Sons; 1973.
Mahoney FI, Barthel DW. Functional evaluation: the barthel index. Md State Med J. 1965;14:61-5.
Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke. 1999;30(8):1538-41.
Giaquinto S, Giachetti I, Spiridigliozzi C, Nolfe G. Quality of life after stroke in a rehabilitation setting. Clin Exp Hypertens. 2010;32(7):426-30.
Monteiro CR, Faro ACM. Avaliação funcional de idoso vítima de fraturas na hospitalização e no domicílio [Functional evaluation of aged with fractures at hospitalization and at home]. Rev Esc Enferm USP. 2010;44(3):719-24.
Semel J, Gray JM, Ahn HJ, Nasr H, Chen JJ. Predictors of outcome following hip fracture rehabilitation. PM R. 2010;2(9):799-805.
Gitlin LN, Winter L, Dennis MP, Hodgson N, Hauck WW. A biobehavioral home-based in- tervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial. JAMA. 2010;304(9):983-91.
Luk JK, Chan CF, Chan FH, Chu LW. Rehabilitation outcomes of older Chinese patients with different cognitive function in a geriatric day hospital. Arch Gerontol Geriatr. 2010 Aug 21. [Epub ahead of print].
Araújo F, Ribeiro JLP, Oliveira A, Pinto C. Validação do índice de Barthel numa amostra de idosos não institucionalizados. Revista Portuguesa de Saúde Pública. 2007;25(2):59-66. Available from: http://www.ensp.unl.pt/dispositivos-de-apoio/cdi/cdi/sector-de-publica-coes/revista/2000-2008/pdfs/05_02_2007.pdf. Accessed in 2011 (Mar 28).
Mathisen L, Lingaas PS, Andersen MH, et al. Changes in cardiac and cognitive function and self-reported outcomes at one year after coronary artery bypass grafting. J Thorac Cardio- vasc Surg. 2010;140(1):122-8.
Rebellato JR, Morelli JGS. Fisioterapia geriátrica: a prática da assistência ao idoso. Barueru: Manole; 2004.
Paúl MC. Lá para o fim da vida: idosos, família e meio ambiente. Coimbra: Edições Almedi- na; 1997.
Girard TD, Jackson JC, Pandharipande PP, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38(7):1513-20.
Santos FS, Velasco IT, Fráguas R Jr. Risk factors for delirium in the elderly after coronary artery bypass graft surgery. Int Psychogeriatr. 2004;16(2):175-93.
Institute for Healthcare Improvement. Daily assessment form for urinary catheter. Available from: http://www.ihi.org/IHI/Topics/HealthcareAssociatedInfections/InfectionsGeneral/Tools/DailyAssessmentFormforUrinaryCatheter.htm. Accessed in 2011 (Mar 28).
Institute for Healthcare Improvement. Final project report: blood transfusion improvement collaborative. Available from: http://www.ihi.org/IHI/Topics/Improvement/Improvement-Methods/Literature/FinalProjectReportBloodTransfusionImprovementCollaborative.htm. Accessed in 2011 (Mar 28).
