Rehabilitation Outcomes in a Population of Nonagenarians and Younger Seniors With Hip Fracture, Heart Failure, or Cerebral Vascular Accident

Abstract

Conner D, Barnes C, Harrison-Felix C, Reznickova N. Rehabilitation outcomes in a population of nonagenarians and younger seniors with hip fracture, heart failure, or cerebral vascular accident. Objectives To compare rehabilitation characteristics and patient outcomes between nonagenarians and younger seniors with hip fracture (HFx), heart failure (HF), or cerebral vascular accident (CVA). Design Data only, retrospective cohort. Setting Seven skilled nursing facilities providing rehabilitation services to a managed care organization. Participants Subjects (N=2563; age, ≥65y) with HFx, HF, or CVA receiving rehabilitation services. Interventions Not applicable. Main Outcome Measures Patient and rehabilitation characteristics influencing FIM score at discharge and the proportion of patients discharged to the community were compared between nonagenarians and younger seniors with HFx, HF, or CVA. Results Patients with higher admission FIM scores were discharged with better function. Different patient characteristics were important for successful rehabilitation for different conditions and outcomes. Except for HFx, nonagenarians had admission and discharge characteristics similar to those of younger seniors, although fewer were discharged to the community. Nonagenarians and younger seniors with CVA were most similar for all measures. Conclusions Fewer nonagenarians were admitted from the community and fewer were discharged to the community, even if admitted from the community. Nonagenarians with HFx differed most strikingly from their younger counterparts in admission and discharge measures, as well as total discharge FIM score and discharge to the community. Nonagenarians and younger seniors with CVA were most similar for all measures. Our results suggest that a large proportion of the nonagenarian population can benefit from rehabilitation efforts for these 3 conditions; however, more rehabilitation resources may be required for some conditions to achieve similar outcomes.