FEATURE ARTICLE
Functional Decline in
Hospitalized Older Adults: Can
Nursing Make a Difference?
Function-focused care (FFC) is an approach to
care in which nurses help patients engage in
activities of daily living (ADL) and physical ac-
tivity, with the goal of preventing avoidable
functional decline. This prospective, observa-
tional study, conducted with hospitalized
older adults (N 5 93) examined: 1) the demo-
graphic and clinical characteristics of patients
who were provided FFC activity, and 2) the
relationship between change in physical
activity and FFC activities. Patients who re-
ceived FFC were more likely: to be younger
(P 5 .028); had one or more falls during the
hospitalization (P 5 .048); had demonstrated
better functional performance at admission
(P 5 .004) and better physical capability, mea-
sured by the Tinetti gait and balance scale
(P 5 .004). FFC was associated with less
decrement in ADL function, admission to
discharge, while considering patient charac-
teristics (t 5 7.6; P \ .008). Results suggest
that hospitalized older persons can benefit
from FFC. (Geriatr Nurs 2012;33:272-279)
lder adults are admitted to acute care
O hospitals at rates as high as 3 times those
of younger individuals.1 It is estimated
that up to 50% lose the ability to conduct activi-
ties of daily living (ADLs) while hospitalized,2
with profound implications for their health.
The consequences of functional decline include
decreased functional recovery3 and increased
morbidity and mortality.4 The immobility
associated with functional decline results in iat-
rogenic infections, pressure ulcers, falls, and non-
elective rehospitalizations.5,6 Moreover, lack of
attention to functional health predisposes the
older adult to prolonged, costly rehabilitative
care with limited guarantee of return to
prehospitalization function.7 This shortfall in
272
Marie Boltz, PhD, CRNP
Barbara Resnick, PhD, CRNP, FAAN, FAANP
Elizabeth Capezuti, PhD, RN, FAAN
Joseph Shuluk, BA
Michelle Secic, MS
care delivery is inconsistent with the basic tenet
of gerontological nursing that emphasizes preser-
vation of function and with the older persons ex-
pectation that the hospitalization improve not
worsen health and functioning.8 This study be-
gins to address this gap by examining the interac-
tion between nurses and hospitalized older adults
during ADL performance and the relationship
with functional outcomes.
The etiology of functional decline is considered
to be a combination of intrinsic (i.e., demographic
and health-related) and extrinsic factors (envi-
ronmental conditions and care processes). The
social-ecological model provides an overarching
framework for understanding the interrelations
among diverse personal and environmental fac-
tors that contribute to patient outcomes, includ-
ing functional measures,9 and has been used in
other studies that focus on physical function.10
Thus, a social-ecological framework provides
a lens to view the factors that influence change
in physical function in hospitalized older medical
patients and thus guided the selection of vari-
ables for this study.
Advanced age, baseline and admission function,
the presence of multiple comorbidities, impaired
cognition, delirium, depression, and polyphar-
macy place the older adult at increased risk for
functional loss.11,12 Additionally, fear of falling
may contribute to self-limiting of activity level
and time out of bed when hospitalized.13 Restric-
tive care processes including bedrest, the use of
tethering and restrictive devices, and limited
physical activity14,15 have also been identified
as culprits, often contributing to a cascade of
dependency that includes functional decline in
the hospitalized elder.16 Furthermore, the older
adult is typically compromised by an architectural
design in the hospital environment that is not
adapted to age-related changes and functional
Geriatric Nursing, Volume 33, Number 4
limitations. Inadequate lighting, glare, cluttered
hallways, lack of furniture, and beds in high posi-
tion encourage low mobility and inactivity.8,13
Function-Focused Care in the Acute
Care Hospital
Interventions to support functional integrity
receive low priority in the acute care setting,
where the older adults baseline capability and
potential are typically not integrated into a treat-
ment plan.17 Despite the known benefit of staying
engaged in function and physical activity when
hospitalized, a 2007 Cochrane review concluded
that, in general, patient participation in exercise
programs has been poor.18 Challenges to imple-
menting exercise interventions include the illness
severity of the patient, competing care demands
(e.g., test schedules), short hospital stays, and
a general unwillingness of patients to consent
to or actively participate.18,19 Consequently,
there is a growing awareness of the advisability
of integrating a function-focused approach into
care interactions to support functional restoration
and prevent avoidable complications of functional
decline such as delirium, falls, and nutritional
problems.20
Function-focused care (FFC) is a philosophy of
care in which nursing staff members help pa-
tients engage in care activities (e.g., eating, taking
medication, bathing, dressing, turning in bed, or
ambulating) versus simply performing the tasks
for the patient or limiting the amount of activity
that patients perform.21 Examples of FFC include
encouraging the patient to stand and walk to the
bathroom to urinate rather than automatically
providing a bedpan or urinal and supporting
self-care in the person with dementia through
the use of physical cues or the hand-over-hand
technique. Nursing care practices that acknowl-
edge the older persons capabilities and potential
while promoting physical activity and self-care
may prevent avoidable functional decline.22
Although the bulk of acute care nursing focuses
on medication administration and indirect care
activities such as documentation and care coordi-
nation,23 the nurse continues to play a key role in
providing and/or supervising direct care activi-
ties, including those related to activities of daily
living and physical activity. An understanding of
the contribution of nursing practice is necessary
to develop interventions to prevent functional
Geriatric Nursing, Volume 33, Number 4
decline. Emerging evidence indicates that FFC
in the acute care setting is possible24 and that it
may mitigate functional decline in the hospital-
ized older adult.25 An examination of the charac-
teristics of older patients who are actually
involved in FFC may also identify those individ-
uals who are less likely to receive this approach
to care and identify opportunities to meet individ-
ualized needs through modified FFC interven-
tions and adaptations in the care environment.
Thus, the purpose of this study was to examine
the characteristics of older medical patients
who were engaged in FFC and to explore the rela-
tionship of FFC with functional outcomes.
Methods
Site and Setting
A prospective descriptive design was used in
2 medical units in an urban academic medical
center. Older medical patients, aged 70 and
above, who could speak, understand, and read
English were invited to participate. Patients
who had a terminal illness (i.e., life expectancy
of 6 months or less), were discharged from the
study units, or had surgery were excluded.
Ninety-three participants were enrolled in the
study. The institutional review board of the spon-
soring hospital approved the study procedures.
Data Sources and Procedures
Study participants were enrolled within
24 hours of admission to the hospital unit. After
explaining the study and obtaining the patients
informed consent, the data collectors acquired
sociodemographic and health status data (diag-
noses and medications). The 30- to 45-minute ini-
tial assessment on Day 1 included evaluation of
baseline function and the following observed
measures: current functional performance, func-
tional capability, sensory and hearing ability,
cognition, affective status, fear of falling, and an
assessment of person-environment fit (PE fit).
ADL performance and nurse behavior were ob-
served over a 3-hour period within 48 hours of
admission to evaluate whether FFC was included
in the care interactions. Follow-up assessment of
ADLs was conducted within 72 hours of admis-
sion and the day of discharge. Discharge informa-
tion was also acquired from the medical records.
Data collectors underwent training and interrater
273
reliability checks of their assessments, with inter-
rater reliability ranging from .93 to .98. Subse-
quently, interrater reliability of observational
measures was conducted by the research nurse
every 4 weeks on at least 25% of enrolled patients
for the studys 11-month duration with a range
of .95 to .99.
Measures
Patient Characteristics. Medical records were
used to extract sociodemographics (age, gender,
race/ethnicity, highest type of formal education,
marital status, primary language, type of resi-
dence), date of admission, and clinical character-
istics including diagnoses and number of
medications. Additional clinical characteristics
that were evaluated included hearing and vision,
fear of falling, affective status, cognition, physi-
cal function and capability, illness severity, and
person-environment fit.
The presence of uncorrected hearing loss was
measured using the whisper test, and the hand-
held Snellen was used to measure vision (with
correction when possible). Participants were
asked to rate their fear of falling on a scale of
0 to 4 (4 5 very afraid). Affective status was
assessed using the single-item Yale Depression
Scale, which asked, Do you often feel sad or
depressed?26 calculated as a dichotomous vari-
able yes or no. Cognition was assessed using
the Mini-Cog,27 which comprises a 3-item recall
and the Clock Drawing Test (CDT). For the
CDT portion, we asked the person undergoing
testing to draw a clock, put in all the numbers
of the clock, and set the hands at 10 past 11. We
differentiated patients with cognitive impairment
from those without impairment. A score of 0 (can-
not recall any words) or a score of 1 or 2 (cor-
rectly recalls 1 or 2 words) with an abnormal
CDT indicates positive screen for cognitive im-
pairment. A score of 1 or 2 (correctly recalls
1 or 2 words) with a normal CDT indicates nega-
tive screen for cognitive impairment or a score of
3 (correctly recalls 3 words) indicates negative
screen for cognitive impairment. Cognition was
calculated as a dichotomous variable, yes (pres-
ence of cognitive impairment) or no. The Mini-
Cog has sensitivity ranging from 76% to 99% and
specificity ranging from 89% to 93% with 95% con-
fidence interval.27
Measures of functional ability included hand
grip (measured by dyanonmeter) and the Tinetti
274
Gait and Balance Instrument,28 with a maximum
total score of 28 points. P-E fit was measured us-
ing the Housing Enabler Instrument, which
includes an assessment of the patients functional
limitations, dependence on mobility devices, and
a detailed assessment of environmental barriers
to engaging in functional activities.29 For each
environmental barrier item, the instrument com-
prises predefined severity ratings and is scored
from 1 (potential accessibility problem) to 4
(very severe accessibility problem). The assess-
ment of the individuals limitations is matched
with the environment and a score calculated
using Housing Enabler software. Higher scores
are indicative of more barriers to function, that
is, less desirable P-E fit, compared with lower
scores. The use of physical restraints (including
restrictive side rails), tethering devices (medi-
cally prescribed tubing/lines), and bedrest orders
were extracted from the record and dichoto-
mized as used (yes/no) during hospital stay.
Comorbidities were measured using the Charl-
son Comorbidity Index, with ranges from 0 to 33,
with higher scores indicating a more severe
burden of comorbidity.30 The index has well-
established validity and reliability.31 The pres-
ence of delirium and a fall occurrence at any
time during the hospital stay was also noted
(yes/no); the medical record was the source of
this information, given that data collection was
intermittent (i.e., not daily). Length of stay,
defined as the number of inpatient hospital days
including the day of admission and the day of dis-
charge; a discharge plan for post-hospitalization
utilization of rehabilitation services (yes/no);
and new institutionalization (yes/no), were also
collected.
Provision of Function-Focused Care and
care processes. Function-focused care (FFC)
was measured by the Restorative Care Behavior
Checklist (RCBC), a continuously scaled ob-
served measure of patient involvement in activi-
ties associated with functional independence
and physical activity.32 Observed activities
included the following: bed mobility, transfers,
ambulation, bathing, dressing, hygiene, eating,
use of personal assistive devices, communica-
tion, and exercise. The RCBC is scored by calcu-
lating the total number of activities in which
functional or physical activity was promoted by
nursing staff, divided by the total number of activ-
ities that were observed (e.g., 5/10 or 50%). It has
demonstrated very good person separation
Geriatric Nursing, Volume 33, Number 4
reliability (.77) and interrater reliability, with 83%
to 100% agreement on each of the care activi-
ties.32 The RCBC was measured during a 3-hour
observation of care activities based on estab-
lished descriptions of FFC behavior.
Physical Function. Physical function was mea-
sured at key time points: 1) baseline, defined as
2 weeks before admission (self-reported or
caregiver-reported if cognitive impairment pres-
ent); 2) admission performance; and 3) discharge
performance. The main outcome of interest was
change in ADL function, calculated from admis-
sion to discharge, measured with the Barthel In-
dex (BI). The BI is a 10-item scale that evaluates
bowel status, bladder status, grooming, toilet
use, feeding, transfer, mobility, dressing, stairs,
and bathing.33 It contains ADL dimensions cap-
tured by the RCBC and is an efficient tool for
the acute care setting. The BI has been used
repeatedly to measure physical function in older
adults in other studies21,25 and has been found
to be reliable when administered by face-to-
face interview and by telephone (intraclass corre-
lation coefficient [ICC] 0.89) and on testing by
different observers (ICC 0.95-0.97), including
trained research assistants.34 Change in BI, from
baseline (2 weeks before admission) to admis-
sion was also calculated for descriptive purposes.
Statistical Analysis
All data were entered using double-data entry
verification and analyzed using IBM SPSS 20. A
P \ .05 level of significance was used. Descrip-
tive statistics were used to create a profile of
patient demographic and clinical characteristics,
FFC and care processes, and change in physical
function. Means were reported for continuous
measures and percentages were reported for
categorical measures. We examined the demo-
graphic and clinical characteristics of patients
who received FFC (provided vs. not provided)
using 1-way analysis of variance for continuous
variables and chi-square tests for nominal
variables.
Analysis of variance methods were used to ex-
amine the influence of FFC behaviors on change
in physical function from admission to discharge.
Bivariate Pearsons correlations between demo-
graphic and clinical characteristics and of change
in physical function from admission to discharge
were examined to assess for covariates to be in-
cluded in the model.35
Geriatric Nursing, Volume 33, Number 4
Findings
Patient Characteristics
Table 1 shows the demographic and clinical
characteristics of the sample. Mean age was
80.8  7.2; 63.4% were women; 89.2% were non-
Hispanic white; and 90.3% lived in a noninstitu-
tional setting. A majority (55.9%) reported that
they used assistive devices for mobility before ad-
mission. The most common reason for admis-
sions was an infectious condition (28%),
including pneumonia. The mean Charlson Co-
morbidity score was 2.8  2.8 with a mean base-
line BI of 93.5  12.9; 15.0% had cognitive
impairment, and 34.4% reported depression. The
mean number of medications ordered at admis-
sion was 7.1  4.6.
The mean admission BI score was 82.0  12.9;
34.4% demonstrated hearing impairment, and
24.7% had visual impairment. Almost half (47%)
the patients demonstrated a P-E fit as measured
by the Housing Enabler that was above the median,
indicating poor fit. Tinetti balance and gait scores
ranged from 1 to 29 (mean 19.8  7.9). The majority
(n 5 57, 61%) were tethered with medical lines,
and 5 (5.4%) were physically restrained at some
point during the hospital stay. Nine (9.7%) patients
had a medical order for bedrest. Mean length of
hospital stay was 7.0  5.4 days.
The majority of patients (n 5 54, 58%) experi-
enced loss of ADL function before admission;
46 (85%) of these same older adults did not return
to baseline function. Most had plans for posta-
cute rehabilitation (63.4%), and 30 community-
residing older adults (32.3%) were discharged to
another setting other than their home (i.e., new
institutionalization) for postacute care.
The mean for FFC was .76  .35, indicating that
76% of all possible activities were performed us-
ing FFC (i.e., patients were engaged in activities
associated with functional independence). FFC
[skewness of e1.1 (SE 5 . 28) and kurtosis of
2.89 (SE)] was highly skewed and explorations
of transformations were unsuccessful toward
normalizing. Therefore, FFC was dichotomized
as FFC (RCBC 5 1, or full support of indepen-
dence) or not (\1; all others).
Factors Associated with FFC
Fear of falling and P-E fit were not normally
distributed and efforts at transformation were
275
 Table 1.
Patient (N 5 93) Characteristics: FFC versus Non-FFC
N (%) Combined FFC Non-FFC P Value

Female 59.0 (63.4) 35 (59.3) 24 (40.7) .277

White, non-Hispanic 88.0 (94.6) 55 (37.5) 33 (62.5) .657
Currently married 22.0 (23.7) 12 (54.5) 10 (45.5) .717
Education: college or above 46.0 (49.5) 26 (56.5) 20 (43.5) .465
Primary language English 78.0 (83.9) 46 (58.9) 32 (41.1) .411
Living situation: noninstitutional 84.0 (90.3) 55 (65.5) 29 (34.5) .114
Use of mobility device 52.0 (55.9) 29 (55.8) 23 (44.2) .191
Depression 32.0 (34.4) 20 (62.5) 12 (37.5) .891
Cognitive impairment 14.0 (15.0) 7 (50.0) 7 (50.0) .257
Hearing impaired 32.0 (34.4) 17 (53.1) 15 (46.1) .135
Visual impairment 23.0 (24.7) 12 (52.2) 11 (47.8) .073
Reason for admission .348
Infection 26.0 (28)
Cancer complications 22.0 (23.7)
Cardiopulmonary 18.0 (19.4)
Respiratory conditions 15.0 (16)
Gastrointestinal 12.0 (12.9)
Delirium during hospital stay 14.0 (15.0) 7 (50.0) 7 (50.0) .568
Fear of falling 60.0 (64.5) 59 (63.4) 34 (36.6) .636
Falls 14.0 (15.0) 5 (35.7) 9 (64.3) .048
Person-Environment Fit $33 44.0 (47.0) 29 (61.8) 15 (38.2) .640
Bedrest 9.0 (9.7) 58 (62.4) 35 (37.6) .296
Use of medical lines (tethers) 57.0 (61.0) 35 (61.4) 22 (38.6) .608
Use of restrictive devices (restraints) 5.0 (5.4) 4 (80.0) 1 (20.0) .429
Postacute new institutionalization 30.0 (32.3) 11 (36.7) 19 (63.3) .0001
Postacute rehabilitation 59.0 (63.4) 34 (57.6) 25 (42.4) .126

x (SD) Combined FFC 5 1 FFC \ 1 P Value

Age 80.8 (7.2) 79.5 (6.8) 82.9 (7.5) .028

Charlson Comorbidity 2.8 (2.8) 2.6 (2.4) 3.2 (3.5) .317
Total medications at admission 7.1 (4.6) 7.1 (4.9) 6.9 (4.3) .847
Tinetti Gait and Balance Score 19.8 (7.9) 21.5 (7.3) 15.8 (7.7) .003
Hand grip 7.5 (2.7) 7.7 (2.6) 7.2 (2.8) .398
Barthel Index at baseline 93.5 (12.9) 93.9 (12.6) 92.8 (13.5) .676
Barthel Index at admission 82.0 (19.4) 86.3 (18.4) 74.5 (19.1) .004
Barthel Index at discharge 80.2 (22.6) 88.5 (16.9) 65.6 (24.0) .000
Length of stay 7.0 (5.4) 6.9 (4.8) 7.2 (6.30) .460
Function-focused Care (FFC) x 5 .76, S.D. 5. 35 (range 0-1.0; median 1.0; skewness 1.1; kurtosis .289).

unsuccessful. They were therefore categorized
using the median as the cutpoint before subse-
quent analysis: fear of falling ($2), and P-E fit
($33). As indicated in Table 1, the following char-
acteristics were associated with FFC: younger
participant age (P 5 .028), at least 1 fall during
the hospital stay (P 5 .048), a higher BI score
on admission (P 5 .004), and higher performance
on the Tinetti Gait and Balance scale (P 5 .004).
Additionally, patients who were discharged to
home versus an institutional setting were more
likely to receive FFC (P \ .0001). Table 1 shows
that care processes (bedrest, use of medical lines,
physical restraints) were not significantly differ-
ent between patients who received FFC and
those who did not.
FFC and Change in Physical Function
Bivariate Pearsons correlations between pa-
tient characteristics, care processes, and change
in physical function, admission to discharge,

276 Geriatric Nursing, Volume 33, Number 4

 Table 2.
Factors influencing change in physical function, admission to discharge
n (%)
Baseline Barthel Index x 93.5  12.9
Admission Baseline Barthel Index x 82.0  19.4
Fear of falling* 60 (64.5)
Delirium 14 (15)
Function-Focused Care* 34 (36.6)
*Variables without normal distributions were categorized using the median as the cutpoint before analysis.
yielded 4 covariates to be included in the model
examining change in physical function, admis-
sion to discharge: baseline BI (r 5 .24, P 5
.022); admission BI (r 5 .39, P \ .0001); delirium
(r 5 e.22, P 5 .04); and fear of falling (r 5 .26,
P 5 .014). Table 2 results show that FFC, ad-
justed for these covariates is associated with
change in BI, admission to discharge (t 57.6,
P \ .008). Patients with FFC \1 demonstrated
a decrease in BI from baseline to discharge
(mean e7.9), whereas FFC 5 1 was not associ-
ated with decrement (mean 5 0.24; P \ .0001).
Discussion
The purpose of this study was to examine the
characteristics of patients who were provided
FFC and to examine the relationship between
FFC and change in physical activity in older medi-
cal patients. Consistent with previous findings,25,36
FFC was associated with less decrement in
physical function, admission to discharge, in
a sample of 93 medical patients aged 70 to 97
with a range of functional abilities. The results
suggest that nursing interventions that support
functional independence and physical activity
may mitigate risk for hospital-acquired functional
decline. Providing nursing staff with education
and support to integrate FFC into care interactions
may not only prevent functional decline during the
hospital stay but may also facilitate carryover of re-
habilitative interventions in the postacute setting.
Additionally, there is a need to examine alternate
ways of deploying human resources, including
well-defined roles and areas of accountability for
function-promoting activities.13
Findings emphasize that baseline function
(i.e., ADL function before the onset of the admit-
ting problem) is a salient benchmark to be used
Geriatric Nursing, Volume 33, Number 4
Type III SS Mean Square F P Value
4505.6 321.8 3.7 .0001
9864.3 352.3 4.0 .000
227.9 227.9 2.6 .114
589.1 589.1 6.7 .013
668.5 668.5 7.6 .008
when developing treatment plans, including dis-
charge goals. A significant number (58%) of
patients experienced a decline in functional sta-
tus immediately before admission to the hospi-
tal, consistent with other studies.37 This group
can be viewed as particularly vulnerable given
that most (85%) did not return to baseline func-
tion. Both baseline and admission functional sta-
tus demonstrated an association with the
trajectory of change in physical function during
the hospital stay. These findings suggest that
the acute care stay, beginning at admission, is
a critical opportunity to initiate interventions
aimed at promoting functional recovery and pre-
venting avoidable decline. This will require a par-
adigm shift in a care delivery system that
traditionally focuses on only correcting the acute
problem that led to admission to one that also
supports older adults resuming their roles and
activities. The practice of bedrest during hospital
stay (10%) warrants close examination. In addi-
tion, policies that limit mobility, such as manda-
tory use of wheelchairs without clinical
indication, were not examined in this study but
warrant future investigation.14
The evidence of barriers to functional and
physical activities in the sample underscores
the need to adapt the physical environment to
older adults with functional limitations while pro-
viding function-focused approaches that support
physical activity and ADL performance. Previous
research demonstrated that FFC is ideally sup-
ported with simple, cost-neutral but nonetheless
critical environmental approaches. Appropriate
bed and toilet height, furniture, handrails, sign-
age, and written information for patients and fam-
ilies are important to engage patients in function
and physical activity throughout the course of the
hospitalization.17
277
 Older adults who received FFC were more
likely to be discharged back to their home, rather
than an institution. Nurses were more likely to
provide FFC to patients who were younger and
demonstrated better physical capability and func-
tional performance upon admission. This finding
suggests that older adults with functional limita-
tions, even prior to admission, may not receive
the same degree of exposure to FFC than those
who are higher functioning. There may, therefore,
be missed opportunities to restore baseline func-
tional performance. Thus, this finding is an area
that warrants closer investigation, including eval-
uation of the clinical assessment and decision-
making associated with this functional cohort of
patients to maximize function in varying levels
of patient ability. Treating older adults within
the context of their functional capability and
potential may prevent unnecessary institutionali-
zation, cost, and diminished quality of life.
Patients who had fallen during the hospital stay
received less FFC, perhaps reflective of efforts to
decrease fall risk by limiting physical activity.
The role of nursing interventions to minimize
fall risk through function-promoting activities,
as opposed to mobility restriction, is an under-
studied area and one that warrants closer
attention in the acute care setting. Cognitive im-
pairment did not appear to be a factor influencing
the level of engagement in FFC. This is consistent
with the work of Galik et al.,10 who demonstrated
that older adults with dementia can benefit from
efforts to promote physical activity and engage-
ment in ADL self-care.
Limitations
Study findings are not meant to be interpreted
as demonstrating causal relationships. This study
was limited by a single setting, limiting generaliz-
ability. In addition, the observation of FFC was
limited to only 1, albeit extensive, 3-hour observa-
tion. There were additional limitations related to
measurement. It is possible that cognitive status,
which was evaluated on admission, changed over
the hospital stay. The presence of delirium, eval-
uated through chart audit, may have been under-
reported,38 and therefore its relationship with
physical function may not have been accurately
appraised. Finally, self-efficacy and the interper-
sonal dynamics between staff and patients,
which could possibly have influenced engage-
ment in FFC and response to treatment in
278
general,39,40 were not examined. Future
research would ideally consider these factors as
well as other known stresses: demanding
diagnostic studies, interrupted sleep,12,41 and
nutritional problems.42
Conclusion
There is growing awareness that much of the
functional decline experienced by hospitalized
older adults is avoidable7,14 FFC is predicated on
the philosophy that for hospitalized older adults,
physical function is an important treatment goal
to be considered in addition to correcting the
acute admitting problem. Despite limitations, our
findings suggest that FFC can have a positive
influence on the functional trajectory of
hospitalized older adults. There appears to be
sufficient evidence to investigate the effectiveness
of FFC in patients with diverse functional abilities
and health characteristics.
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MARIE BOLTZ, PhD, CRNP, is an Assistant Professor, New
York University College of Nursing, New York, NY. BAR-
BARA RESNICK, PhD, CRNP, FAAN, FAANP, is a Professor
and the Sonya Ziporkin Gershowitz Endowed Chair in
Gerontology, University of Maryland School of Nursing,
Baltimore, MD. ELIZABETH CAPEZUTI, PhD, RN, FAAN,
is the Dr. John W. Rowe Professor in Successful Aging, New
York University College of Nursing, New York, NY. JOSEPH
SHULUK, BA, is a Research Coordinator and Assistant
Research Scientist, New York University College of Nurs-
ing, New York, NY. MICHELLE SECIC, MS, is President
and Biostatistician, Secic Statistical Consulting, Inc.,
Chardon, OH.
ACKNOWLEDGMENTS
This work was supported by the John A. Hartford Founda-
tions Building Academic Geriatric Nursing Capacity
Award Program, and the Rehabilitation Nurses Foundation.
0197-4572/$ - see front matter
2012 Mosby, Inc. All rights reserved.
doi:10.1016/j.gerinurse.2012.01.008
279