Referral to geriatric rehabilitation: a scoping review of triage factors in acutely hospitalised older patients

Abstract

Objective Old or frail acutely hospitalised patients can benefit from geriatric rehabilitation but criteria concerning referral decisions are unclear. This review presents an overview of clinical factors associated with referral to geriatric rehabilitation that may further consensus between hospital and rehabilitation professionals on triage. Design Scoping review. Methods A review was conducted following Arksey and O’Malley’s framework. The search included literature concerning a broad spectrum of acutely hospitalised patients and factors associated with their referral to geriatric rehabilitation. Results Selected abstracts were categorised into distinct geriatric rehabilitation care pathways such as stroke, hip fracture, amputation of lower limb, cardiac and oncologic rehabilitation. Abstracts on internal medical patients were further reviewed and 29 studies were included. A total of 13 studies focused on factors identifying rehabilitation needs and 16 on factors associated with outcome of geriatric rehabilitation. Triage factors were diverse and included frailty status, functional decline, cognitive symptoms and multimorbidity. Mood symptoms and living situation further specified post-acute care needs. In overview, triage factors could be characterised as demographic (n = 4), diagnosis-related (n = 8), mental (n = 6), functional (n = 10) or multi-domain (n = 12) and mapped in a transitional care pathway. Conclusions and implications Frailty and functional decline are characteristics frequently associated with referral to geriatric rehabilitation of acutely hospitalised internal medical patients. A comprehensive geriatric assessment or a simpler multi-domain set of tests reveals rehabilitation needs and approximates a functional prognosis. Professional consensus on factors and timing of triage in hospital is within reach.

“Associations between patient characteristics and unplanned or delayed discharges from geriatric rehabilitation: A retrospective chart review”

“…The association between albumin level and the adverse outcome in our study is consistent with existing literature from similar rehabilitation settings showing that lower albumin levels were correlated with nosocomial infections, 28 nursing home placement, 12 and mortality after rehabilitation 29 . Furthermore, given that ADL dependence assistance is associated with unplanned discharge, it is possible that an assessment of a patient’s frailty status may guide clinicians in more accurately ascertaining the most suitable patients for rehabilitation 30 . Finally, it may be of value to investigate chronic illness severity as comorbidities they arise on a patient’s comprehensive geriatrics assessment (eg, confirming a documented diagnosis of COPD with the appropriate investigations or specialist’s opinion).…”

“…29 Furthermore, given that ADL dependence assistance is associated with unplanned discharge, it is possible that an assessment of a patient's frailty status may guide clinicians in more accurately ascertaining the most suitable patients for rehabilitation. 30 Finally, it may be of value to investigate chronic illness severity as comorbidities they arise on a patient's comprehensive geriatrics assessment (eg, confirming a documented diagnosis of COPD with the appropriate investigations or specialist's opinion).…”

“…The majority of patients lived in a house or apartment (n = 198, 78.9%), spoke proficiently (n = 213, 84.9%), and ambulated with a 4-wheeled walker before hospitalization (n = 188, 74.9%). Body mass index was available for 44.6% of patients (n = 112), with a median body mass index of 25 (IQR, [22][23][24][25][26][27][28][29][30].…”

A case vignette study to refine the target group of an intermediate care model: the Acute Geriatric Community Hospital

“…To optimize functional capacities and support societal participation despite impairments, so that frail and/or older individuals can return home and live independently in the community. 33 Goal:…”

Factors Associated with Transfer from an Acute Geriatric Unit to a Post-Acute Care Facility among Community-Dwelling Patients: Results from the DAMAGE Cohort

“…However, such models provide complex results that may be difficult to implement in clinical practice, especially since care structures (eg resources, funding systems, uses, and organizational aspects) differ from one country to another and may change rapidly. [43][44][45]…”