Abstract

BackgroundOlder patients often have multiple comorbidities and are susceptible to develop intercurrent diseases during rehabilitation. This study investigates intercurrent diseases and associated factors in patients undergoing geriatric stroke rehabilitation, focussing on pre-existing comorbid conditions, overall comorbidity and baseline functional status.Materials and methodsThis multicentre prospective cohort study included 15 skilled nursing facilities. Data were collected at baseline and at discharge. The primary outcome measures were presence and number of intercurrent diseases. Furthermore, their impact on change in rehabilitation goals or length of stay was examined. Comorbidity was assessed with the Charlson index, and functional status with the Barthel index (BI).ResultsOf the 175 included patients, 51% developed an intercurrent disease. A lower baseline BI, a higher Charlson index, presence of diabetes mellitus (DM) and kidney disease were related to the occurrence of an intercurrent disease (p < 0.05). Moreover, a lower BI, a higher Charlson index, and particularly the presence of DM were independently associated. If both comorbidity and a lower baseline functional status were present, the odds ratio (95% CI) of developing intercurrent diseases was 6.70 [2.33–19.2], compared to 1.73 [0.52–5.72] (comorbidity only) and 1.62 [0.53–4.94] (only BI ≤ 14).ConclusionsOn admission, functional impairments and comorbidity, particularly diabetes, independently contribute to developing intercurrent diseases during geriatric stroke rehabilitation. Therefore, routine evaluation of comorbidity integrated with functional status at the start of rehabilitation is essential to identify patients at risk. Finally, particular attention should be paid to patients with DM to prevent intercurrent diseases and support optimal functional recovery .

Highlights

  • IntroductionRehabilitation helps patients to regain functional independency that enables them to be discharged home

  • Following acute hospitalisation, rehabilitation helps patients to regain functional independency that enables them to be discharged home

  • To better understand the relations between comorbidity, functional impairment and intercurrent diseases, and to identify associated pre-existing comorbid conditions, this study explores: (i) the presence, and number of intercurrent diseases and their impact on older patients admitted to an skilled nursing facility (SNF), recovering after stroke, and (ii) factors associated with the presence and number of intercurrent diseases, focusing on functional status and comorbidity

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Summary

Introduction

Rehabilitation helps patients to regain functional independency that enables them to be discharged home. Few studies have investigated associations with intercurrent diseases in the older, vulnerable group of patients receiving geriatric stroke rehabilitation [5, 13]. This study investigates intercurrent diseases and associated factors in patients undergoing geriatric stroke rehabilitation, focussing on pre-existing comorbid conditions, overall comorbidity and baseline functional status. A lower BI, a higher Charlson index, and the presence of DM were independently associated If both comorbidity and a lower baseline functional status were present, the odds ratio (95% CI) of developing intercurrent diseases was 6.70 [2.33–19.2], compared to 1.73 [0.52–5.72] (comorbidity only) and 1.62 [0.53–4.94] (only BI ≤ 14). Conclusions On admission, functional impairments and comorbidity, diabetes, independently contribute to developing intercurrent diseases during geriatric stroke rehabilitation. Particular attention should be paid to patients with DM to prevent intercurrent diseases and support optimal functional recovery

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