Association of cognition with functional trajectories in patients admitted to geriatric wards: A retrospective observational study

Hartley, Peter; Alexander, Kerry; Adamson, Jennifer; Cunningham, Carol C.; Embleton, Georgina; Romero-Ortuño, Román

doi:10.1111/ggi.12884

Cited by 7 publications

(12 citation statements)

References 26 publications

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“…The response variable in the linear regression model was the changes in either SPPB or gait speed, controlling for sex, age, and respective functional scores at evaluation. Explanatory variables of interest included: comorbidities (FCI), 18 cognition (BIMS), 29 depression (PHQ-9©), 30,31 BI (subjective ADL report), 32 , Braden Score, 21 dementia diagnosis, malnutrition diagnosis, 33 Medicare priority diagnoses (coded as the patient having one or not), 25 pain that impacts sleep or activity, 34,35 falls history in the past month, 36,37 falls history with fracture, 36,38 SNF LOS, hospital LOS, total therapy minutes (physical, occupational, and speech therapy), and BMI. 36 These potential predictors have been thought to impact physical function and ADLs in older adults (as referenced above) and are potentially modifiable risk-factors for poor functional recovery.…”

Section: Statistical Analysesmentioning

confidence: 99%

Predictors of Functional Change in a Skilled Nursing Facility Population

Gustavson¹,

Forster

Stevens-Lapsley³

2019

Journal of Geriatric Physical Therapy

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Poor physical function following an SNF stay places older adult at significant risk for adverse events including rehospitalization, future disability, and institutionalization. Understanding the predictors of functional change from evaluation to discharge may direct efforts toward developing innovative and effective interventions to improve function trajectories for older adults following an acute hospitalization.

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Section: Statistical Analysesmentioning

confidence: 99%

Predictors of Functional Change in a Skilled Nursing Facility Population

Gustavson¹,

Forster

Stevens-Lapsley³

2019

Journal of Geriatric Physical Therapy

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“…older adults with mild cognitive impairments). Our results fill this knowledge gap by suggesting the relevance to apply an occupational therapist-led discharge planning intervention (HOME) to this growing patient population who are at higher risk of poor outcomes [62,63]. Even if the intervention has not been found effective to improve functional outcomes (ADL), our findings suggest that there may be significant cost savings given the reductions of hospitalization.…”

Section: Resultsmentioning

confidence: 76%

Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial

et al. 2020

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Background: Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of "at-risk" older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations. Trial design and methods: This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist; or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telephone follow-up. Characteristics associated with higher risks of adverse outcomes were recorded and at-risk subgroups were created (mild cognitive impairment, walking difficulty, comorbidity, living alone and no support from family). Independence in ADL and participation in life roles were assessed with validated questionnaires. The number of unplanned re-hospitalizations and ED presentations were extracted from medical files. Linear regression models were conducted to detect variation in response to the intervention at 3-months, according to patients' characteristics.

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“…Hoenig et al [ 18 ] considered that rehabilitation potential was better expressed by gaining improvements in quality of life rather than by functional gain alone. Gray et al [ 24 ] and Hartley et al [ 41 ] used place of residence as a proxy for functional ability whereby individuals had rehabilitation potential if they were predicted to be likely to be discharged back to their usual place of residence after an acute episode of ill health.…”

Section: Resultsmentioning

confidence: 99%

“…Assessments took place in outpatient geriatric clinics [ 28 , 55 ], intermediate care units [ 48 , 52 ], acute or subacute geriatric inpatient wards [ 32 , 33 , 41 , 56 , 57 ], inpatient rehabilitation units [ 17 , 20 , 28 , 29 , 36 , 37 , 53 , 58 – 61 ], care homes [ 3 , 28 , 34 , 35 , 38 , 40 , 43 , 44 , 62 ], rehabilitation situated in care homes [ 39 ] and day hospitals [ 42 , 54 ]. Some studies included multiple sites where rehabilitation took place in either the patient’s own home, inpatient setting or nursing homes [ 46 , 48 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

“…The identification of an individual’s rehabilitation potential was said to involve clinical judgement and reasoning [ 17 , 21 , 41 ], but there was limited evidence for the use of formal decision-making frameworks. In one study a Pre-Admission Screening checklist [ 58 ] was developed from a sample of 549 referrals over a six month period with medical charts reviewed for risk factors for readmission to acute care from a rehabilitation unit.…”

Section: Resultsmentioning

confidence: 99%

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Rehabilitation potential in older people living with frailty: a systematic mapping review

et al. 2021

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Background Following periods of acute ill-health and injury, older people are frequently assessed and provided with rehabilitation services. Healthcare practitioners are required to make nuanced decisions about which patients are likely to benefit from and respond to rehabilitation. The clinical currency in which these decisions are transacted is through the term “rehabilitation potential”. The aim of this study was to explore information about rehabilitation potential in older people to inform the development of an evidence-based assessment tool. Methods A systematic mapping review was completed to describe the extent of research and the concepts underpinning rehabilitation potential. We searched Medline, CINHAL, EMBASE, AMED, PsycINFO, PEDro, Cochrane Library, Web of Science, ProQuest, Trip and EThOS from inception to December 2020. We included studies which focused on rehabilitation potential and/or assessing for rehabilitation interventions for older people with comorbidities in the hospital and community setting. Reviewer pairs independently screened articles and extracted data against the inclusion criteria. A descriptive narrative approach to analysis was taken. Results 13,484 papers were identified and 49 included in the review. Rehabilitation potential was found to encompass two different but interrelated concepts of prognostication and outcome measurement. 1. Rehabilitation potential for prognostication involved the prediction of what could be achieved in programmes of rehabilitation. 2. Rehabilitation potential as an outcome measure retrospectively considered what had been achieved as a result of rehabilitation interventions. Assessments of rehabilitation potential included key domains which were largely assessed by members of the multi-disciplinary team at single time points. Limited evidence was identified which specifically considered rehabilitation potential amongst older people living with frailty. Conclusions Current approaches to rehabilitation potential provide a snapshot of an individual’s abilities and conditions which fail to capture the dynamic nature and fluctuations associated with frailty and rehabilitation. New approaches to measures and abilities over time are required which allow for the prognostication of outcomes and potential benefits of rehabilitation interventions for older people living with frailty.

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Association of cognition with functional trajectories in patients admitted to geriatric wards: A retrospective observational study

Cited by 7 publications

References 26 publications

Predictors of Functional Change in a Skilled Nursing Facility Population

Predictors of Functional Change in a Skilled Nursing Facility Population

Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial

Rehabilitation potential in older people living with frailty: a systematic mapping review

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