Predictors of Functional Recovery in Patients Admitted to Geriatric Postacute Rehabilitation

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• 作者：Laurence Seematter-Bagnoud ; MD ; MSc^a ; ^b ; ^{Laurence.Seematter-Bagnoud@chuv.ch" class="auth_mail" title="E-mail the corresponding author} ; Estelle Lé ; cureux ; PhD^c ; Sté ; phane Rochat ; MD ; MM(ClinEPi)^a ; Sté ; fanie Monod ; MD^a ; Constanze Lenoble-Hoskovec ; PT^a ; Christophe J. Bü ; la ; MD^a
• 关键词：Aged ; Health services ; Recovery of function ; Rehabilitation
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：94
• 期：12
• 页码：2373-2380
• 全文大小：542 K

文摘

To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation.

Design

Observational study.

Setting

Postacute rehabilitation facility.

Participants

Patients (N=2754) aged ≥65 years admitted over a 4-year period.

Interventions

Not applicable.

Main Outcome Measure

Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement.

Results

Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16–1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01–1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31–1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15–1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19–23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13–2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67–2.93; P<.001, respectively).

Conclusions

Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.