Abstract
BackgroundThe optimal patient selection of frail elderly persons undergoing rehabilitation in Geriatric Day Hospital (GDH) programs remains uncertain. This study was done to identify potential predictors of rehabilitation outcomes for these patients.MethodsThis study is a retrospective cohort analysis of patients admitted to the rehabilitation program of our GDH, in Montreal, Canada, over a five year period. The measures considered were: Barthel Index, Older Americans Resources and Services, Folstein Mini Mental Status Exam, Timed Up & Go (TUG), 6-minute walk test (6 MWT), Gait speed, Berg Balance, grip strength and the European Quality of life - 5 Dimensions. Successful improvement with rehabilitation was defined as improvement in three or more tests of physical function. Logistic regression analysis using the Bayesian Information Criterion (BIC) was employed to select the optimal model for making predictions of rehabilitation success.ResultsA total of 335 patients were studied, but only 233 patients had a complete data set suitable for the predictive model. Average age was 81 years and patients attended the GDH an average of 24 visits. Significant changes were found in several measures of physical performance for many patients ranging from improved gait speed in 21.3% to improved TUG in 62.7% of the cohort. Fifty-eight percent of patients attained successful improvement with rehabilitation by our criteria. This group was characterized by lower test scores on admission. Using BIC, the best predictor model was the 6 MWT [OR: 0.994 per meter walked (95% CI: 0.990-0.997)].ConclusionsThe GDH rehabilitation program is effective in improving patients' physical performance. Although no single measure was found to be sufficiently predictive to help target candidates appropriately, the 6 MWT showed a trend to significance. Further research will be done to elucidate the utility of a composite 'rehab appropriateness index' and the role of International Classification of Function concepts for targeting frail elderly to GDH rehabilitation services.
Highlights
The optimal patient selection of frail elderly persons undergoing rehabilitation in Geriatric Day Hospital (GDH) programs remains uncertain
Some authors have suggested that a Geriatric Day Hospital (GDH) rehabilitation program can prevent inappropriate acute admissions, facilitate earlier discharge from hospital, improve clinical symptoms, promote functional recovery and allow for longer maintenance at home [1,2]
We found a positive effect of the GDH rehabilitation program on our patient population from admission to discharge when we considered multiple functional measures
Summary
The optimal patient selection of frail elderly persons undergoing rehabilitation in Geriatric Day Hospital (GDH) programs remains uncertain. This study was done to identify potential predictors of rehabilitation outcomes for these patients. Some authors have suggested that a Geriatric Day Hospital (GDH) rehabilitation program can prevent inappropriate acute admissions, facilitate earlier discharge from hospital, improve clinical symptoms, promote functional recovery and allow for longer maintenance at home [1,2]. The GDH typically provides multidisciplinary assessment and rehabilitation in an ambulatory setting and has a pivotal position between hospital and home-based services [3]. A meta-analysis reviewing 12 clinical trials of GDH concluded that there was no clear advantage over other forms of care, but that patients attending GDH tended to have better outcomes than those receiving no comprehensive care[3]
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