Predictors and Prognostic Models for Early Discharge Planning of Hospitalized Acute Geriatric Patients, A Retrospective Study

Abstract

Motivation: When treated for an acute disorder, older adults are vulnerable for functional losses and the need of care after discharge. In a specialised geriatric ward, patients get a comprehensive treatment complementary to medical care in order to maintain and improve mobility and activities of daily living (ADL) to facilitate the return to domesticity. The aim of this paper is to identify the relevant predictors for the impact of geriatric treatment on the status at discharge, which are then used in logistic models to predict a patient’s potential to reach a certain level of independence during treatment.Method: In a retrospective cohort study with 580 patients, we analysed the impact of acute geriatric early rehabilitation on the functional outcome after treatment. As a sufficient improvement of ADLs and mobility we defined as a suitable endpoint at least 60 Barthel Points (ADL) and the ability for „Timed-Up-and-Go-Test“(TUG) when discharged from acute hospital care. To identify relevant predictors in the set of the screening assessments at admission we used linear and logistic regressions as well as odds-ratios. Multivariate logistic models are used to predict the probability that at patient reaches the endpoint. Their predictive quality is tested on additional 120 test patients from a different cohort. Results: Statistical analysis shows that all patients improved during early rehabilitation significantly in ADLs and the physical function (TUG). Barthel-Score, walking distance and handgrip on admission are the strongest predictors for the outcome after geriatric treatment. Logistic models predict the outcome correctly in 70% to 80% of the cases. These models once established for a certain cohort of patients can be applied with similar accuracy to different sets of patients as well. Clinical condition, the medical treatment before admission, length of hospitalization, age or gender have no predictive quality.Discussion: We were able to show that all patients benefit significantly from early rehabilitation in an acute geriatric ward. Only a few assessments on admission related to physical function are sufficient to indicate the functional outcome after geriatric treatment. Logistic models based on these predictors are reliable with a generic predictive quality for the expected level of independence at discharge. This facilitates early discharge planning.Trial registration: The study was retrospectively registered on 2nd July 2018 by the ethic commission of the hospital und filed under registration number (MG1/569/770/2019).