Failure to Regain Function at 3 months After Acute Hospital Admission Predicts Institutionalization Within 12 Months in Older Patients

Portegijs, Erja; Buurman, Bianca M.; Essink‐Bot, Marie‐Louise; Zwinderman, Aeilko H.; Rooij, Sophia E. de

doi:10.1016/j.jamda.2012.04.003

Cited by 68 publications

(54 citation statements)

References 42 publications

(37 reference statements)

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“…39 This finding is of concern given the recent evidence of increased incidence of comorbidities among hip fracture patients. 40 This may influence prefracture functional status, which in turn may put individuals at increased risk for poor outcomes after discharge from inpatient rehabilitation. 41 Finally, although there is evidence to suggest that pre-hip fracture status is more important than cognitive impairment for the prediction of regaining functional mobility after rehabilitation, both of these variables have been identified as important predictors of regaining functional independence.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture

McGilton

Chu

Naglie

et al. 2016

J American Geriatrics Society

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Objectives To determine the contribution of cognitive impairment, prefracture functional impairment, and treatment as predictors of functional status and mobility 6 months after discharge from rehabilitation for older adults with hip fracture. Design Longitudinal. Setting Inpatient rehabilitation units of two community hospitals. Participants Adults with hip fractures aged 65 and older who were discharged from a rehabilitation unit and had been living in the community before the fracture (N = 133). Measurements Mini‐Mental State Examination ( MMSE ) score at discharge from rehabilitation was used to identify the presence and severity of cognitive impairment. Outcomes were measured using questions from two subscales of the Functional Independence Measure (Self‐Care Function and Functional Mobility) and the New Mobility Scale ( NMS ). Measurements were made at discharge from a rehabilitation setting and 3 and 6 months after discharge. Results Prefracture functional impairment was associated with worse outcomes throughout the 6 months after discharge and with lower rates of improvement, or in some cases decline, after discharge. Cognitive impairment was associated with worse outcomes throughout the 6 months after discharge but was only weakly associated with lower rates of improvement or decline. The Patient Centered Rehabilitation Model of care targeting persons with cognitive impairment ( PCRM ‐ CI ) intervention group had higher NMS scores after discharge than a usual care group. Conclusion Although cognitive impairment and prefracture functional impairment contribute to poor outcomes, prefracture functional impairment was more strongly associated with poor outcomes than cognitive impairment. There is evidence to show that individuals with cognitive impairment are able to regain their mobility, which suggests a need for postdischarge targeted interventions that include a focus on activities of daily living for older adults with cognitive impairment and functional impairment to stabilize gains from inpatient rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture

McGilton

Chu

Naglie

et al. 2016

J American Geriatrics Society

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“…Additionally, patients are at risk of decreased physical function, [6–8] new injurious falls and fractures, [9,10] and increased need of supportive care. [11] …”

Section: Discussionmentioning

confidence: 99%

The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture

Yang

Ning

Zhang³

et al. 2016

Medicine

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The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery.We collected medical records of elderly patients aged ≥ 60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n = 80). During the postoperative period, the intervention group received lower limb rehabilitation gymnastics treatment for 3 months, but the control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month, after surgery. The clinical rehabilitation effect was evaluated by checking lower limb action ability, detecting the lower limb deep venous thrombosis (DVT), scoring muscle strength of quadriceps and visual analog scale (VAS) score, and performing satisfaction survey.At the 1st week and 2nd week after surgery, the clinical rehabilitation effect in the intervention group was better regarding lower limb action ability, lower limb DVT, muscle strength of quadriceps, VAS score, and patient satisfaction, as compared with the control group. However, there was no significant difference at the 1st month and the 3rd month after surgery when comparing the intervention group to the control group.In the early postoperative stage, lower limb rehabilitation gymnastics can effectively improve the recovery of lower limb function, beneficial to reducing postoperative complications such as lower limb DVT and muscle atrophy, and increasing patient satisfaction rate.

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“…In general, patients with elective procedures have better disability outcomes than those who are acutely hospitalized. The development of new disabilities during hospitalization is associated with higher health care utilization (5), mortality (3, 6, 7) and institutionalization (8, 9). …”

Section: Introductionmentioning

confidence: 99%

Trajectories of Disability Among Older Persons Before and After a Hospitalization Leading to a Skilled Nursing Facility Admission

Buurman

Han

Murphy

et al. 2016

Journal of the American Medical Directors Association

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Objectives To identify distinct sets of disability trajectories in the year before and after a Q-SNF admission, evaluate the associations between the pre- and post-Q-SNF disability trajectories, and determine short-term outcomes (readmission, mortality). Design, setting and participants Prospective cohort study including 754 community-dwelling older persons, 70+ years, and initially nondisabled in their basic activities of daily living. The analytic sample included 394 persons, with a first hospitalization followed by a Q-SNF admission between 1998–2012. Main outcomes and measures Disability in the year before and after a Q-SNF admission using 13 basic, instrumental and mobility activities. Secondary outcomes included 30-day readmission and 12-month mortality. Results The mean (SD) age of the sample was 84.9(5.5) years. We identified three disability trajectories in the year before a Q-SNF admission: minimal disability (37.3% of participants) mild disability (44.6%), and moderate disability (18.2%). In the year after a Q-SNF admission, all participants started with moderate to severe disability scores. Three disability trajectories were identified: substantial improvement (26.0% of participants), minimal improvement (36.5%), and no improvement (37.5%). Among participants with minimal disability pre-Q-SNF, 52% demonstrated substantial improvement; the other 48% demonstrated minimal improvement (32%) or no improvement (16%) and remained moderately to severely disabled in the year post-Q-SNF. Among participants with mild disability pre-Q-SNF, 5% showed substantial improvement, whereas 95% showed little to no improvement. Of participants with moderate disability pre-Q-SNF, 15% remained moderately disabled showing little improvement, whereas 85% showed no improvement. Participants who transitioned from minimal disability pre-Q-SNF to no improvement post-Q-SNF had the highest rates of 30-day readmission and 12-month mortality (rate/100 person days 1.3 [95% CI 0.6–2.8] and 0.3 [95% CI 0.15–0.45], respectively). Conclusions Among older persons, distinct disability trajectories were observed in the year before and after a Q-SNF admission. The likelihood of improvement in disability was greatly constrained by the pre-Q-SNF disability trajectory. The majority of older persons remained moderately to severely disabled in the year following a Q-SNF admission.

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Failure to Regain Function at 3 months After Acute Hospital Admission Predicts Institutionalization Within 12 Months in Older Patients

Cited by 68 publications

References 42 publications

Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture

Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture

The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture

Trajectories of Disability Among Older Persons Before and After a Hospitalization Leading to a Skilled Nursing Facility Admission

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