Unravelling decline of physical functioning in acutely hospitalized older patients From risk factors to targeted intervention

The number of older adults with chronic diseases and consequent disabilities is increasing and leads to one of the biggest global challenges in healthcare. Older adults are frequently admitted to a hospital for acute illness or falls with 30-60% of the older adults experiencing Hospital Associated Disability (HAD), even when the illness is successfully managed. The loss of activities of daily life (ADLs) after hospitalization reduces self-care, independent living as well as participation in society which are often challenged by a higher dependency of care and/or caregivers. This negative spiral leads to increase in demands for long-term healthcare services and costs for society. This thesis aimed to unravel the mechanisms of HAD and demonstrated the importance of physical factors such as muscle mass, muscle strength, activity, and physical performance. In the development of functional decline after acute hospitalization, physical factors play an important role in combination with other factors such as depressive symptoms, apathy, and nutrition. A thorough analysis of the different factors that play a role in the development of functional decline, in combination with the goals of the patient are required before starting an intervention. This thesis recommends, based on consensus of a group international experts, identifying older adults at risk for functional decline and provide these targeted older adults a tailored-made exercise intervention tuned to the goals of the older adults, as soon as they return home after acute hospitalization.