Abstract
Self-rated health is a valuable outcome in geriatric rehabilitation besides objective results. The present work aims at measuring and analyzing overall health as it is perceived at admission into and at discharge from a geriatric rehabilitation ward. Overall health was self-appraised through a visual-analogue scale (VAS), spanning from 0 (worst) to 10 (best). We studied 1997 patients (70% females), aged 79 (standard deviation, s.d. 8.7) years; most were frail, either functionally, clinically and cognitively. 80% of patients were discharged to home after a length of stay lasting 47.5 (s.d. 22.7) days. At admission, 3/5 patients appraised favorably their overall health (VAS ≥ 6/10): at discharge, the proportion rose to 3/4, with a mean (s.d.) gain = 2 (2) points. The improvement in self-perceived health score positively correlates with the grade expressing clients’ overall satisfaction for the stay (p 0.001), and with discharge versus admission differences in: Barthel Index (BI) total score (p items GDS), pain (VAS 0 to 10). A Linear regression model predicting the changes in self-perceived health included changes in BI, MMSE, GDS, pain, dropping Tinetti test. Changes in self-rated health were positively correlated to functional gain adjusted for pre-morbid level, and to relative functional gain. By analysis of variance, health self-appraisal changed more favorably in patients discharged to home than for other social outcomes (all p
Highlights
Geriatric rehabilitation wards face the complexity of different clinically important goals
Functional state was assessed through the Barthel Index (BI) [11], balance and gait performances by Tinetti test [12,13,14], general cognition by the Mini Mental State Examination (MMSE) [15,16], mood by 5 items Geriatric Depression Scale (GDS) [17, 18]
After a length of stay lasting 47.5 (s.d. 22.7) days, 80% of patients were discharged to home, 8.5% to nursing homes, 4% to hospital, 7% to other rehabilitative settings; 0.5% of patients died
Summary
Geriatric rehabilitation wards face the complexity of different clinically important goals. Health-related quality of life is quoted as a reference outcome measure in clinical trials. It is best used in older persons to capture the global burden of multiple, simultaneous and interactive chronic conditions on physical, psychological and social function. In diseases like stroke, Parkinson’s disease or chronic coronary artery disease, the relationship between clinical measures of disease severity and health-related quality of life is nonlinear [5]. Core issues of geriatric rehabilitation like ambulation difficulties and depression heavily impinge on perceived health and functioning in community living older bearing “geriatric syndromes” like sleep disturbances, falls and urinary incontinence [7]. Rehabilitation interventions which focused on restoring independence in basic activi-
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