{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T11:25:40Z","timestamp":1773746740782,"version":"3.50.1"},"reference-count":38,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T00:00:00Z","timestamp":1639180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002924","name":"FEDER","doi-asserted-by":"publisher","award":["0499_4IE_PLUS_4_E"],"award-info":[{"award-number":["0499_4IE_PLUS_4_E"]}],"id":[{"id":"10.13039\/501100002924","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Aim: To evaluate the evolution of the functional profile of older adults admitted to a health unit in Portugal; to relate the functional profile of these individuals with age, sex, education level and emotional state; and to evaluate the probability of the degree of dependence as a function of age and sex. Methods: longitudinal, retrospective study with a sample of 59,013 older adults admitted to convalescence units of the National Network of Integrated Continuous Care of Portugal. Results: In the first 75 days of hospitalization, activities of daily living, mobility and cognitive state improved, but there was a decline after 75 days of hospitalization. The ability to perform instrumental activities of daily living improved in the first 15 days of hospitalization, stabilized until 45 days and then began to worsen. Women had a higher probability of having a severe\/complete dependence three years earlier than men (88 years to 91 years). A higher education level and stable emotional state were protective factors against functional decline. Conclusions: The functional profile of older adults improved during the length of stay recommended for hospitalization in convalescence units (30 days). It is critical for health systems to adopt strategies to prevent declines in the emotional state of frail individuals.<\/jats:p>","DOI":"10.3390\/jpm11121350","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T01:29:33Z","timestamp":1639358973000},"page":"1350","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Functional Profile of Older Adults Hospitalized in Convalescence Units of the National Network of Integrated Continuous Care of Portugal: A Longitudinal Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4661-0731","authenticated-orcid":false,"given":"Ana","family":"Ramos","sequence":"first","affiliation":[{"name":"Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6975-612X","authenticated-orcid":false,"given":"C\u00e9sar","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Escola Superior de Enfermagem de S\u00e3o Jo\u00e3o de Deus, Universidade de \u00c9vora, 7000-801 Evora, Portugal"},{"name":"Comprehensive Health Research Centre (CHRC), Universidade de \u00c9vora, 7000-801 Evora, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1174-0744","authenticated-orcid":false,"given":"Lara","family":"Pinho","sequence":"additional","affiliation":[{"name":"Escola Superior de Enfermagem de S\u00e3o Jo\u00e3o de Deus, Universidade de \u00c9vora, 7000-801 Evora, Portugal"},{"name":"Comprehensive Health Research Centre (CHRC), Universidade de \u00c9vora, 7000-801 Evora, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7554-8041","authenticated-orcid":false,"given":"Manuel","family":"Lopes","sequence":"additional","affiliation":[{"name":"Escola Superior de Enfermagem de S\u00e3o Jo\u00e3o de Deus, Universidade de \u00c9vora, 7000-801 Evora, Portugal"},{"name":"Comprehensive Health Research Centre (CHRC), Universidade de \u00c9vora, 7000-801 Evora, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8687-4291","authenticated-orcid":false,"given":"Henrique","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Instituto de Telecomunica\u00e7\u00f5es, 1049-001 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0288-6653","authenticated-orcid":false,"given":"Adriana","family":"Henriques","sequence":"additional","affiliation":[{"name":"Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal"},{"name":"Instituto de Sa\u00fade Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,11]]},"reference":[{"key":"ref_1","unstructured":"European Pathway Association (2021, July 31). Care Pathways. Available online: http:\/\/e-p-a.org\/care-pathways\/."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Lopes, M.J. (2021). Desafios de Inova\u00e7\u00e3o em Sa\u00fade: Repensar os Modelos de Cuidados, Universidade de \u00c9vora.","DOI":"10.24902\/uevora.24"},{"key":"ref_3","unstructured":"World Health Organization (2016). Integrated Care Models: An Overview: WHO Regional Office for Europe, World Health Organization. Available online: https:\/\/www.euro.who.int\/en\/health-topics\/Health-systems\/health-services-delivery\/publications\/2016\/integrated-care-models-an-overview-2016."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15171\/ijhpm.2016.111","article-title":"Integrated Care: A Pill for All Ills?","volume":"6","author":"Goddard","year":"2016","journal-title":"Int. J. Health Policy Manag."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1016\/j.healthpol.2016.04.002","article-title":"Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: A systematic literature review","volume":"120","author":"Hopman","year":"2016","journal-title":"Health Policy"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"22","DOI":"10.5334\/ijic.5505","article-title":"Impact of Integrated Care on the Rate of Hospitalization for Ambulatory Care Sensitive Conditions among Older Adults in Stockholm County: An Interrupted Time Series Analysis","volume":"21","author":"Agerholm","year":"2021","journal-title":"Int. J. Integr. Care"},{"key":"ref_7","first-page":"S299","article-title":"Best practices to reduce the risk of drug-drug interactions: Opportunities for managed care","volume":"17","author":"Fanciullo","year":"2011","journal-title":"Am. J. Manag. Care"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Baxter, S., Johnson, M., Chambers, D., Sutton, A., Goyder, E., and Booth, A. (2018). The effects of integrated care: A systematic review of UK and international evidence. BMC Health Serv. Res., 18.","DOI":"10.1186\/s12913-018-3161-3"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Lopes, M., and Sakellaridesm, C. (2021). A Rede Nacional de Cuidados Continuados Integrados em Portugal. Os Cuidados de Sa\u00fade Face Aos Desafios do Nosso Tempo: Contributos para a Gest\u00e3o da Mudan\u00e7a, Universidade de \u00c9vora.","DOI":"10.24902\/uevora.21"},{"key":"ref_10","unstructured":"World Health Organization (2001). The International Classification of Functioning, Disability and Health (ICF), World Health Organization."},{"key":"ref_11","unstructured":"Garc\u00eda-Alonso, J., and Fonseca, C. (2021). Components of Care Models that Influence Functionality in People Over 65 in the Context of Long-Term Care: Integrative Literature Review BT Gerontechnology III, Springer International Publishing."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e022377","DOI":"10.1136\/bmjopen-2018-022377","article-title":"Functional decline and associated factors in patients with multimorbidity at 8 months of follow-up in primary care: The functionality in pluripathological patients (FUNCIPLUR) longitudinal descriptive study","volume":"8","author":"Lesende","year":"2018","journal-title":"BMJ Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"76A","DOI":"10.2471\/BLT.18.228890","article-title":"Implications of self- care for health service provision","volume":"97","author":"Narasimhan","year":"2019","journal-title":"Bull. World Health Organ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"50","DOI":"10.5539\/gjhs.v4n2p50","article-title":"Clinical pathways as instruments for risk and cost management in hospitals\u2014A discussion paper","volume":"4","author":"Romeyke","year":"2012","journal-title":"Glob. J. Health Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"l688","DOI":"10.1136\/bmj.l688","article-title":"Self care interventions to advance health and wellbeing: A conceptual framework to inform normative guidance","volume":"365","author":"Narasimhan","year":"2019","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2158244020914654","article-title":"Ensuring Quality in Interdisciplinary Inpatient Chronic Care","volume":"10","author":"Romeyke","year":"2020","journal-title":"SAGE Open"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Alonso, J., and Fonseca, C. (2021). Sociodemographic Profile of People Aged 65 or Over in Long-Term Care in Portugal: Analysis of a Big Data. Gerontechnology III. IWoG 2020. Lecture Notes in Bioengineering, Springer. Available online: https:\/\/doi.org\/10.1007\/978-3-030-72567-9_40.","DOI":"10.1007\/978-3-030-72567-9_40"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Fonseca, C., Mendes, D., Mendes, F., and Garc\u00eda-Alonso, J. (2020). Developing and Managing Health Systems and Organizations for an Aging Society. Handbook of Research on Health Systems and Organizations for an Aging Society, IGI Global.","DOI":"10.4018\/978-1-5225-9818-3"},{"key":"ref_19","unstructured":"World Health Organization (2020). Decade of Healthy Ageing: Baseline Report, World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240017900."},{"key":"ref_20","unstructured":"ISEG (2015). An\u00e1lise de Dados com IBM SPSS\u00ae: Mix Essencial para Relat\u00f3rios Profissionais e Teses Acad\u00e9micas, M\u00f3dulo I\u2014B\u00e1sico, ISEG."},{"key":"ref_21","unstructured":"Mar\u00f4co, J. (2021). An\u00e1lise Estat\u00edstica com o SPSS Statistics v18\u2013v27, P\u00earo Pinheiro. [8th ed.]."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1007\/s12603-011-0335-7","article-title":"Reducing \u201ciatrogenic disability\u201d in the hospitalized frail elderly","volume":"15","author":"Lafont","year":"2011","journal-title":"J. Nutr. Health Aging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.jamda.2020.07.027","article-title":"Impact of Game-Based Interventions on Health-Related Outcomes in Hospitalized Older Patients: A Systematic Review","volume":"22","author":"Izquierdo","year":"2021","journal-title":"J. Am. Med Dir. Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1001\/jama.2010.1568","article-title":"Change in disability after hospitalization or restricted activity in older persons","volume":"304","author":"Gill","year":"2010","journal-title":"JAMA"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1682\/JRRD.2014.11.0283","article-title":"Impact of Michelangelo prosthetic hand: Findings from a crossover longitudinal study","volume":"52","author":"Luchetti","year":"2015","journal-title":"J. Rehabil Res. Dev."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Fonseca, C., de Pinho, L.G., Lopes, M.J., Marques, M.D.C., and Garcia-Alonso, J. (2021). The Elderly Nursing Core Set and the cognition of Portuguese older adults: A cross-sectional study. BMC Nurs, 20.","DOI":"10.1186\/s12912-021-00623-1"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S464","DOI":"10.1590\/S0102-311X2009001500011","article-title":"Gender and incidence of functional disability in the elderly: A systematic review","volume":"25","author":"Rodrigues","year":"2009","journal-title":"Cad. Saude Publica"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lopes, M.J., Pinho, L.G., de Fonseca, C., Goes, M., Oliveira, H., Garcia-Alonso, J., and Afonso, A. (2021). Functioning and Cognition of Portuguese Older Adults Attending in Residential Homes and Day Centers: A Comparative Study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18137030"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1186\/s12939-017-0673-0","article-title":"Ageing under unequal circumstances: A cross-sectional analysis of the gender and socioeconomic patterning of functional limitations among the Southern European elderly","volume":"16","author":"Perelman","year":"2017","journal-title":"Int. J. Equity Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1093\/gerona\/glaa288","article-title":"Disability Incidence Rates for Men and Women in 23 Countries: Evidence on Health Effects of Gender Inequality","volume":"76","author":"Lee","year":"2021","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s10433-020-00559-6","article-title":"The gender health gap in Europe\u2019s ageing societies: Universal findings across countries and age groups?","volume":"17","author":"Schmitz","year":"2020","journal-title":"Eur. J. Ageing"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1590\/1982-0216201820313417","article-title":"Social communication and functional independence of the elderly in a community assisted by the family health strategy","volume":"20","author":"Coutinho","year":"2018","journal-title":"Rev. CEFAC"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2333721418796663","DOI":"10.1177\/2333721418796663","article-title":"Geographical Differences in Perceived Health Status Among Older Adults in Ghana: Do Gender and Educational Status Matter?","volume":"4","author":"Abalo","year":"2018","journal-title":"Gerontol. Geriatr. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"324","DOI":"10.11648\/j.ajns.20190806.16","article-title":"Influence of Education Level on Mental Health and Medical Coping Modes: A Correlation Analysis in the Elderlies","volume":"8","author":"Cui","year":"2019","journal-title":"Am. J. Nurs. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"419","DOI":"10.18632\/aging.101168","article-title":"Epigenetic clock analysis of diet, exercise, education, and lifestyle factors","volume":"9","author":"Quach","year":"2017","journal-title":"Aging"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Chen, Y.H., Karimi, M., and Rutten-van M\u00f6lken, M.P.M.H. (2020). The disease burden of multimorbidity and its interaction with educational level. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0243275"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"104292","DOI":"10.1016\/j.archger.2020.104292","article-title":"Diabetes multimorbidity combinations and disability in the Mexican Health and Aging Study, 2012\u20132015","volume":"93","author":"McClellan","year":"2021","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1093\/gerona\/glx100","article-title":"Prospective Disability in Different Combinations of Somatic and Mental Multimorbidity","volume":"73","author":"Markwardt","year":"2018","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/12\/1350\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:45:44Z","timestamp":1760168744000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/12\/1350"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,11]]},"references-count":38,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["jpm11121350"],"URL":"https:\/\/doi.org\/10.3390\/jpm11121350","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,11]]}}}