Abstract
BackgroundThe objective of the present study was to investigate 1) the role of different admission diagnoses and 2) the degree of functional loss, on the rate of recovery of older patients after acute hospitalization. Furthermore, to compare the predictive value of simple assessments that can be carried out in a hospital lacking geriatric service, with assessments including geriatric screening tests.MethodsProspective, observational cohort study, including 961community dwelling patients aged ≥ 70 years, transferred from medical, cardiac, pulmonary and orthopedic acute hospital departments to intermediate care in nursing home. Functional assessment with Barthel index (BI) was performed at admission to the nursing home and further geriatric assessment tests was performed during the first week. Logistic regression models with and without geriatric assessment were compared concerning the patients having 1) slow recovery (nursing home stay up to 2 months before return home) or, 2) poor recovery (dead or still in nursing home at 2 months).ResultsSlow recovery was independently associated with a diagnosis of non-vertebral fracture, BI subgroups 50–79 and <50, and, in the model including geriatric assessment, also with cognitive impairment. Poor recovery was more complex, and independently associated both with BI < 50, receiving home care before admission, higher age, admission with a non-vertebral fracture, and in the geriatric assessment model, cognitive impairment.ConclusionsGeriatric assessment is optimal for determining the recovery potential of older patients after acute hospitalization. As some hospitals lack geriatric services and ability to perform geriatric screening tests, a simpler assessment based on admission diagnoses and ADL function (BI), gives good information regarding the possible rehabilitation time and possibility to return home.
Highlights
The objective of the present study was to investigate 1) the role of different admission diagnoses and 2) the degree of functional loss, on the rate of recovery of older patients after acute hospitalization
Infection Heart disease COPD Other medical Injury/Contusions Vert comp fr Other fr Pelvic fr Humerus fr Hip fr Patient characteristics Of 1085 patients who were admitted to the intermediate care (IC) unit during the period 2011–2014, 112 were not asked to participate in the study at times when the geriatrician in charge was absent, 5 patients refused to participate, 4 patients had delirium and 3 patients had language problems
Slow recovery was more often observed for patients with non-vertebral fractures, while the influence of diagnoses was not so pronounced for the groups of patients that had a poor recovery
Summary
The objective of the present study was to investigate 1) the role of different admission diagnoses and 2) the degree of functional loss, on the rate of recovery of older patients after acute hospitalization. To compare the predictive value of simple assessments that can be carried out in a hospital lacking geriatric service, with assessments including geriatric screening tests. No studies have analysed a Comprehensive geriatric assessment, CGA, is considered the optimal way to assess older people admitted acutely to hospital [7]. CGA predicts mortality and adverse outcomes in hospitalized geriatric patients [8], and there is strong evidence in the literature that comprehensive geriatric care (CGC) improves outcomes for older people after acute hospitalization [9, 10]. Focus on simple assessments tools, like the Barthel Index sumscore (hereafter called BI), is still important to elaborate on
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