Investigation of an Elder Abuse Case in a Convalescent Rehabilitation Ward

[Purpose] This study aimed to assess the differences in body composition, including phase angle, extracellular water-to-total body water ratio, and skeletal muscle index, between patients in convalescent rehabilitation and long-term care wards. Understanding these differences is essential for tailoring patient care and rehabilitation strategies given that body composition plays a key role in recovery and functional outcomes. [Participants and Methods] In total, 160 patients (73 males and 87 females) in convalescent rehabilitation wards and 26 patients (9 males and 17 females) in long-term care wards participated in this study. Body composition, height, and weight were measured using an InBody S10 device, which allows measurements in both seated and lying positions. [Results] Significant differences in phase angle, extracellular water-to-total body water ratio, and skeletal muscle index were observed between patients in the convalescent rehabilitation and long-term care wards, with larger differences noted among female participants. Specifically, the skeletal muscle index was lower in the patients from long-term care wards, suggesting reduced muscle mass in this group. [Conclusion] Body composition differed between patients in the convalescent rehabilitation and long-term care wards. These findings highlight the need for personalized care and rehabilitation based on body composition to improve patient outcomes.

To evaluate the feasibility of the International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set for inpatients in a convalescent (Kaifukuki) rehabilitation ward. Overall, 295 inpatients in convalescent rehabilitation wards were rated using the ICF Rehabilitation Set, and the proportion of missing values was investigated. Categories with missing values <10% were selected, and internal construct validity of the total score of the selected categories was examined using Rasch analysis. Missing values were detected in 25 items, of which seven had missing values of ≥10%. No ceiling or floor effects were noted. Rasch analysis of 23 categories with missing values <10% showed a good fit to the model after applying testlet solution and item splitting, which supported the internal construct validity of the ICF Rehabilitation Set. This identified the set of categories of the ICF Rehabilitation Set that could be used for evaluating rehabilitation inpatients. These categories had good internal construct validity based on Rasch analysis.

BackgroundThe economic burden on individuals with stroke is a major concern, and measures to mitigate the negative effects of stroke on labor productivity are imperative. However, few studies have explored the return to work (RTW) of individuals with stroke after their discharge from rehabilitation wards. We therefore aimed to explore the proportion of patients with stroke who returned to work after discharge from a convalescent rehabilitation ward and to explore the characteristics of patients with stroke who achieve RTW compared to those who do not.MethodsThis descriptive study was conducted in a convalescent rehabilitation ward at a university hospital in Japan. It included patients with stroke in the working-age population (15–64 years) who worked before the onset and were discharged from the rehabilitation ward to their homes between January 2018 and April 2022. The participants were required to respond to a questionnaire, which was sent by mail, and the RTW status at 6 months after discharge from the rehabilitation ward was investigated. They were classified into RTW and non-RTW groups, and their characteristics were compared between the groups.ResultsFifty-nine patients [mean (SD) age 53.0 (9.0) years; 42 men] among 125 who met the criteria returned the questionnaire, and their data were included in the analysis. Thirty-nine individuals [66.1%; mean (SD) age 53.0 (8.2) years; 31 men] achieved RTW. Compared to the non-RTW group, the RTW group had significantly higher total functional independence measure (FIM) scores at admission (p = 0.046) and discharge (p < 0.001), a significantly shorter duration of ward stay during hospitalization (p = 0.002), and a significantly smaller proportion of patients with aphasia (p = 0.019).ConclusionTwo-thirds of the patients in this study population had achieved RTW at 6 months after discharge from the convalescent rehabilitation ward. Patients who achieved RTW had better motor function and FIM scores at discharge than those who did not.

ABSTRACTBackground:Advances in cancer treatment have led to an increase in the number of cancer survivors and, likewise, cancer patients in convalescent rehabilitation wards. It is difficult for patients with bone metastases to recover their motor functions and be discharged. However, cancer treatments, such as anti-cancer drug therapy and radiation therapy, are not generally provided in convalescent rehabilitation wards.Cases:This study retrospectively reviewed six cases of bone metastases in our convalescent rehabilitation ward from April 2018 to October 2019. The ages of the patients ranged from 58 to 85 years, and all patients were male. The primary cancers were lung cancer (two cases), renal cancer (one case), esophageal cancer (one case), prostate cancer (one case), and double lung and kidney cancer (one case). Bone metastases were observed in the spine (six cases), pelvis (two cases), and femur (one case). All patients were admitted to our convalescent rehabilitation ward for postoperative management of imminent fracture risk and rehabilitation of pathological fracture or spinal cord compression caused by bone metastasis. None of the patients received treatment for primary cancer or bone metastases during their hospitalization. Two patients had new bone metastases in load-bearing bones. Five patients were transferred to acute care hospitals for the treatment of cancer or infection.Discussion:Before transferring patients with bone metastases to convalescent rehabilitation wards, clinicians should assess the risk of skeletal-related events and the rate of progression of their cancer. Indications for hospitalization should be carefully determined in cooperation with acute care hospitals.

Maeshima S, Osawa A, Nishio D, Hirano Y, Kigawa H. Approaches to hip fractures in convalescent rehabilitation wards – Consideration of length of stay, number of sessions, and discharge destination. Jpn J Compr Rehabil Sci 2012; 3: 72-77. Purpose: Factors that infl uence activities of daily living (ADL) and the discharge destination of hip fracture patients hospitalized in convalescent rehabilitation wards were examined from the viewpoint of the amount of time spent in rehabilitation sessions and the duration of hospitalization. Methods: The study subjects were 50 patients suffering from hip fracture. We evaluated the preinjury condition, cognitive function, uninjured side leg extensor muscle strength, and activities of daily living (ADL) for each patient. The discharge destination was generally divided into a “home” group and a “facility/ hospital transfer” group, and a comparative examination was carried out regarding the relationship between the overall number of rehabilitation sessions conducted, including physiotherapy and occupational therapy, and the daily number of sessions. Results: FIM effi ciency declined greatly from 0.32 (n = 30) for the 4th through 6th weeks after hospitalization to 0.11 (n = 20) for the 6th to 8th weeks, and in a post hoc test, a signifi cant difference (p = 0.0069) was observed in FIM effi ciency between weeks 2�4 and weeks 6�8. Conclusion: The results suggest that for hip fracture patients, about 6 weeks after being admitted to a convalescent rehabilitation ward, post-discharge guidance including nursing care service and family coaching is necessary.

Although appropriate nutrition management could improve rehabilitation outcomes, more than 40 % of patients in a convalescent rehabilitation ward (CRW) suffer from malnutrition. The study was undertaken to investigate whether adequate nutrition for each patient in a CRW could be estimated based on motor scores on the Functional Independence Measure (FIM-M). In 218 patients in our CRW, both basal energy expenditure (BEE) on admission and average energy intake (EI) for 2 weeks were calculated, and EI was divided by BEE to estimate the activity index (e-AI). The patients were classified according to FIM-M to investigate the relationship between the FIM-M and the e-AI. The e-AI tended to increase in proportion to the FIM-M. In the N group, where the increase-decrease rate for body weight was within 2%, the e-AI induced by a FIM-M greater than 60 was significantly higher than that induced by a FIM-M up to 60 (1.3 vs 1.1, p<0.01). Compared to the N group, altering the e-AI caused the same tendency of body weight change in patients with FIM-M greater than 60 and up to 60. The FIM-M could provide a criterial activity index for patients in a CRW when their energy requirement is appropriately estimated, considering the intensity of their physical activity.

Teranishi T, Kondo I, Tanino G, Miyasaka H, Sakurai H, Kaga J, Suzuki Y, Matsushima A, Kawakita M, Sonoda S. An analysis of falls occurring in a convalescence rehabilitation ward — a decision tree classification of fall cases for the management of basic movements —. Jpn J Compr Rehabil Sci 2013; 4:7-13.Purpose: A simple and discriminative method for evaluating the ability to maintain balance, the Standing test for Imbalance and DisEquilibrium (SIDE), was developed for fall risk management. As a preliminary step toward clinical application of the SIDE, this study aimed to determine a method of assessing the expected fall risk by analyzing fall cases using a decision tree classification for the management of basic movements. Subjects and method: The subjects of this study were 513 patients who had been discharged from a convalescence rehabilitation ward over a one-year period (from January 1, 2010 to December 31, 2010). In cases when a fall occurred, we investigated the period from hospitalization and the classification of the patient, which was made with a decision tree describing the permitted activities of the patient and the management of the activities. The frequency of fall occurrence was determined by considering the number of patients who fell during every 15-day period during hospitalization.Results: One hundred twenty patients fell during hospitalization. In total, 163 falls occurred. The incidence of falls was 4.65‰. Thirty patients suffered multiple falls. The falls occurred significantly more frequently during the first 15 days after admission. From classification by the decision tree, 62 falls occurred while the patients were being managed using physical restraints and/or sensors, 55 falls occurred during unpredictable actions of patients when the patients were not using physical restraints or sensors, and 26 falls occurred during permitted activities of patients.Conclusion: Simple assessments of balance and adherence are necessary to reduce the occurrence of patient falls during the early period after admission.

This study clarified the changes in respiratory condition, and physical and mental functions pertaining to them, of patients with the coronavirus disease 2019 ("COVID-19") who were admitted to our convalescent rehabilitation ward. It also examined the conditions remaining after the disease (long-COVID). We focused on 16 moderate and severe patients with COVID-19 who were transferred to our convalescent rehabilitation ward and discharged home between March and September 2021. We evaluated the patients' respiratory, physical, and mental conditions at the time of admission, four weeks after admission, and at the time of discharge. We confirmed an improvement in the shortness of breath in those with respiratory conditions, and a significant improvement in the walking distance related to physical function before the time of discharge, but anxiety and depression remained. Patients with moderate to severe COVID-19 can be discharged home after convalescent rehabilitation. Despite improved dyspnea and walking distance, the patients tend to have incomplete recovery, including physical deconditioning, mood disorders, and other long-COVID conditions at discharge.

There is a notable lack of evidence regarding the long-term effects of rehabilitation services, particularly concerning functional recovery and daily living activities of patients following discharge from convalescent rehabilitation wards. This study aimed to clarify the longitudinal changes in activities of daily living and instrumental activities of daily living of patients after discharge from a convalescent rehabilitation ward and the association between the use of rehabilitation services and clinical outcomes. Patients discharged from Japanese convalescent rehabilitation wards in August 2021 were included. They were classified into two groups (rehabilitation and nonrehabilitation services use) based on whether they used rehabilitation services (outpatient rehabilitation, older adult day care, or home-based rehabilitation) after discharge. The primary outcomes, including the Barthel Index, functional independence measure, Frenchay Activities Index, and life-space assessment scores at 6months after discharge, were analyzed by multivariate analysis. A total of 293 patients (median age: 75years; 148 females) were included in the analysis. The use of rehabilitation services was independently associated with the Barthel Index (partial regression coefficient [B]: 7.224; 95% confidence interval [CI]: [1.760, 12.688]), functional independence measure (B: 2.659; 95% CI: [0.194, 5.125]), Frenchay Activities Index (B: 2.351; 95% CI: [0.5088, 4.192]), and life-space assessment at 6months after discharge (B: 8.226, 95% CI: [3.902, 12.550]). The use of rehabilitation services was independently associated with patients' Barthel Index, functional independence measure, Frenchay Activities Index, and life-space assessment after discharge from a convalescent rehabilitation ward. This study emphasizes crucial role of postdischarge interventions for improved patient outcomes.

The effect of partially hydrolyzed guar gum on preventing influenza infection.

This retrospective cohort study investigated the relationship between sarcopenia and Activities of Daily Living capacity after discharge from convalescent rehabilitation wards. We included consecutive patients discharged from three convalescent rehabilitation wards in a hospital in Japan between December 2018 and October 2020. Sarcopenia was diagnosed based on the criteria of the 2019 Asian Working Group for Sarcopenia, utilizing skeletal muscle mass index and handgrip strength. Statistical analyses were carried out separately for men and women. The primary outcome was a higher motor domain (motor Functional Independence Measure [mFIM]) and a higher cognitive domain (cognitive Functional Independence Measure [cFIM]) of the FIM score 1 month after discharge. The secondary outcomes were higher mFIM and cFIM scores 6 months after discharge, analyzed using binary logistic regression. Among 305 participants (mean age 70.0 years, 148 men), 93 were identified as having sarcopenia. The prevalence of sarcopenia was 16% for outpatient rehabilitation services, 59% for home-visit rehabilitation services and 50% for older adult day care. Logistic regression analyses showed that sarcopenia at discharge was not an independent variable for mFIM at 1 month (odds ratio [OR] 20, 95% confidence interval [CI] 0.31-1300 for men, OR 0.51, 95% CI 0.11-2.4 for women) and cFIM (OR 0.63, 95% CI 0.10-3.8 for men, OR 5.3, 95% CI 0.81-34 for women). At 6 months, sarcopenia at discharge was not an independent variable for mFIM (OR 0.30, 95% CI 0.02-3.6 for men, OR 0.40, 95% CI 0.06-2.5 for women) and cFIM (OR 0.16, 95% CI 0.01-2.4 for men, OR 0.00, 95% CI 0.00-1.1 for women). Sarcopenia at the time of discharge from convalescent rehabilitation wards does not independently predict FIM 1 month or 6 months after discharge. Geriatr Gerontol Int 2024; 24: 715-721.

Implementation of nutritional screening tools, nutritional assessment tools, and diagnostic criteria for malnutrition in convalescent rehabilitation wards: A nationwide survey

Background and purpose: Early prediction of clinical outcomes in stroke patients is socioeconomically important. The aim of this study was to clarify whether Functional Independence Measure (FIM) scores on admission can predict their discharge destinations and future self-care levels required for post-acute stroke patients classified by the Long-Term Care Insurance (LTCI) system, the national insurance plan for care in Japan. Methods: We enrolled post-acute stroke patients admitted to 12 convalescent rehabilitation wards (CRW) from 9 acute stroke centers. A CRW was defined as a specialized ward for intensive rehabilitation to prevent a bedridden state and to promote home rehabilitation by improving ability to perform activities of daily living. We evaluated self-care abilities using FIM scores and modified Rankin Scale (mRS) scores as traditional assessment scales and compared with certified self-care levels within the LTCI system (seven levels; slight impairment to bedridden). We divided patients into those who were discharged home from a CRW and all others. Results: Among 1261 patients (47% female, mean age 75 years), 984 (78%) were discharged home. FIM scores at discharge were significantly correlated with both mRS scores at discharge and certified self-care levels within the LTCI system (P &lt; .001). The cut-off values for home discharge were a FIM score on admission of 50 points and an age of 75 years. On multivariate analysis, FIM scores ≥50 on admission [odds ratio (OR), 95% confidence interval (95% CI); 5.80, 4.30-7.91] and age &lt;75 years (2.16, 1.60-2.95) were independently associated with home discharge. Conclusions: FIM scores in post-acute stroke patients can predict self-care levels within the LTCI system. Early prediction of self-care levels may promote careful preparation of healthcare planning and improve the efficiency of stroke management.

Background Polypharmacy or potentially inappropriate medications negatively affect the functional recovery of rehabilitation. However, limited research exists regarding the effect of decreasing in potentially inappropriate medications use on functional improvement of rehabilitation in geriatric Japanese patients. Objective To elucidate whether decreasing PIM during hospitalization could be a predictor of rehabilitation outcomes among geriatric patients in a convalescent rehabilitation setting. Setting This study was conducted at the convalescent rehabilitation ward in the Hitachinaka General Hospital in Japan. Methods This retrospective observational cohort study included consecutive geriatric patients admitted at the convalescent rehabilitation ward between 2010 and 2018. Participants were divided based on presence or absence of decreasing in potentially inappropriate medications use during hospitalization. A multiple linear regression analysis was performed to analyze whether decreasing potentially inappropriate medications use during hospitalization could be a predictor of Functional Independence Measure-Motor at discharge. Main outcome measures The primary outcome was the Functional Independence Measure-Motor at discharge. Results In total, 569 participants (interquartile range 73-85years; 33.6% men) were included in the present study. A multiple linear regression analysis of Functional Independence Measure-Motor at discharge, adjusting for confounding factors, revealed that decreasing in potentially inappropriate medications use was independently correlated with Functional Independence Measure-Motor at discharge. In particular, the use of first-generation antihistamines, antipsychotics, benzodiazepines, and non-steroidal anti-inflammatory drugs among potentially inappropriate medications decreased significantly during hospitalization. Conclusion Decreased potentially inappropriate medications use during hospitalization may be a predictor of improvement of rehabilitation outcomes in geriatric patients.

In-Hospital Physical Activity Predicts Swallowing Function at Discharge in Patients With Hip Fracture: A Prospective Study in Convalescent Rehabilitation Wards.