WEDNESDAY, Nov. 3, 2004 (HealthDayNews) -- A new study verifies what doctors have long known -- an illness or injury that requires an older person to be hospitalized often results in a permanent disability.
Yet that finding underscores a major weakness in the U.S. health-care system, the Yale University study contends.
Medicare now pays the cost of rehabilitation for an older person after hospitalization for an illness or injury, said study author Dr. Thomas M. Gill, an associate professor of medicine at Yale. But the federal government is only now starting to finance "prehabilitation" measures that could help prevent such hospitalizations, he said.
It's well known that an illness or injury -- particularly due to a fall -- that requires a hospital stay for an older person can lead to permanent disability, Gill said. "What may be surprising is the magnitude of the effect," he said. "In our study, the risk was increased 60-fold by an injury and sixfold by a period of restricted activity."
The findings appear in the Nov. 3 issue of the Journal of the American Medical Association.
The five-year study followed 754 people 70 and older who were not disabled at the start of the study. During that time, 372 of the participants were hospitalized, and 600 -- or 79.6 percent -- had at least one episode of restricted activity, such as an illness requiring a stay in bed. In that five-year span, 417 people -- 55.3 percent -- developed a permanent disability, such as an inability to walk.
"In absolute terms, illnesses and injuries leading to hospitalization accounted for about 50 percent to 80 percent of the disability outcomes," the study said. "Another 5 percent to 19 percent of the disability outcomes were attributable to illnesses and injuries leading to restricted activity but not hospitalization."
When those older people came out of the hospital, Medicare was ready to help. It will pay for a nursing-home stay that includes physical and occupational therapy of at least 30 days, and sometimes for up to 90 days, Gill said.
For the older people who return home after a hospital stay, Medicare also pays for a visiting nurse service that can identify potential risk factors in the home that can cause a fall. Such services also offer physical or occupational therapy that can reduce the risk of another injury by providing training in gait, balance and muscle strength.
But "Medicare wasn't structured for prevention," Gill said. "Several strategies have been identified in reducing the likelihood and severity of falls, but there is no Medicare payment for fall prevention."
Only recently has federal legislation provided payment for a comprehensive geriatric examination that can identify individual physical problems that increase the risk of disabling injuries, Gill said. "I hope it leads to expansion of preventive programs for this population," he said.
But there has been a step backward in after-hospital care, Gill said. "Medicare has cut back dramatically on such care," he said. "Now typically it pays for just a few [visiting nurse service] visits, which is not enough to permit proper follow-up."
The study was done "to better understand how disability develops, with the hope and expectation that by understanding that, we can design better intervention strategies," Gill said.
One finding of the study is that steps can be taken during a hospital stay to reduce the chance of permanent disability. They include "minimizing the number of things that keeps someone almost chained to a bed, such as catheters, minimizing the use of medications that decrease levels of consciousness, and having intensive efforts to maintain mobility by getting people out of bed onto a chair or walking in the corridor," Gill said.
But in-home measures are very important, he said, and they are being neglected.
"We know how to prevent falls," Gill said. "But I don't think we do a good job at it."
More information
The U.S. Centers for Disease Control and Prevention offers advice on reducing the risk of falls.
