Abstract
Post-acute care (PAC) programmes appear favourable for older adult inpatients too fragile to be discharged home without extensive support, but otherwise not qualifying for specific rehabilitation. Consequently, many Swiss nursing homes have opened PAC wards after a new federal law refined reimbursement in 2012. However, PAC outcomes in this setting have not been well studied. To investigate the functional outcomes of a nursing home-based PAC programme for older adult patients and to evaluate the influences of age, gender and frailty status on these outcomes. This was a prospective cohort study in 135 consecutive patients aged 60 and older admitted to PAC at three nursing homes in Zurich, Switzerland, over a two-month period. Geriatric assessment at admission included mobility, physical performance, cognition, nutrition, frailty, activities of daily living (ADL) and social support. The primary outcomes of the study, Short Physical Performance Battery (SPPB), handgrip strength (HGS) and Barthel Index (BI), were repeated before discharge from PAC. Multivariable linear models were used to analyse differences between these primary outcomes at admission and discharge, adjusting for baseline age, gender, BMI, length of stay (LOS), polypharmacy, cognition, and prior living status. We identified statistically significant improvements between admission and discharge (mean [95% confidence interval]; % change) in BI (69.0 [65.0–72.9] vs 79.6 [75.6–83.6]; +15.4%), gait speed (0.55 [0.48–0.62] vs 0.65 [0.58–0.71] m/s; +18.2%) and SPPB scores (5.5 [5.0–6.1] vs 6.9 [6.3–7.4]; +24%), p-values for all comparisons <0.001. In this real-word sample, PAC resulted in a significant and clinically relevant improvement in physical performance and ADL. However, our study should be replicated with a larger sample. Furthermore, long-term outcomes of PAC warrant additional investigation.
Highlights
The world's aging population is a major challenge to today's healthcare systems
Half the referrals (n = 62, 45.9%) to postacute care (PAC) were from acute care medicine wards
SeematterBagnoud et al investigated the outcomes of 2754 participants aged 65 years and older undergoing geriatric postacute care at Lausanne University Hospital, Switzerland, where the patients’ Barthel Index (BI) scores improved from 62.2 (±20.3) to 79.5 (±18.9) points over a mean length of stay (LOS) of 22 (15–30) days
Summary
The world's aging population is a major challenge to today's healthcare systems This is especially true for Europe and the United States, where the population aged 65 and older is expected to at least double within the four decades [1, 2]. With an increasing proportion of older inpatients and a continuing trend towards shorter lengths of stay in acute care [4], postacute care (PAC) programmes seem to be of growing importance. They are most relevant for the care of frail older adults, who face a very high risk of functional decline and loss of autonomy in the face of acute illness or trauma [5, 6]. There are several approaches to implementing PAC in Switzerland, one of them being a temporary stay at a nursing home [9]
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