Abstract
ObjectiveTo identify functional performance trajectories and the characteristics of people who receive inpatient geriatric rehabilitation after hospital admissions.Design, setting, participantsREStORing health of acutely unwell adulTs (RESORT) is an observational, prospective, longitudinal inception cohort study of consecutive patients admitted to geriatric rehabilitation wards at the Royal Melbourne Hospital. Recruitment commenced on 15 October 2017.Main outcome measuresFunctional performance, assessed with the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales two weeks before acute hospitalisation, on admission to and discharge from geriatric rehabilitation, and three months after discharge from geriatric rehabilitation.ResultsA total of 618 rehabilitation patients were included in our analysis. For each of the two scales, three distinct functional performance trajectories were identified by latent class growth modelling: poor at baseline and 3‐month follow‐up (remained poor: ADL, 6.6% of patients; IADL, 42%), good at baseline but poor recovery (deteriorated: ADL, 33%; IADL, 20%), and good at baseline and good recovery (recovered: ADL, 60%; IADL, 35%). Higher Clinical Frailty Scale (CFS) score (v recovered, per point: odds ratio [OR], 2.51; 95% CI, 1.64–3.84) and cognitive impairment (OR, 6.33; 95% CI, 2.09–19.1) were associated with greater likelihood of remaining poor in ADL, and also with deterioration (CFS score: OR, 1.76; 95% CI, 1.45–2.13; cognitive impairment: OR, 1.87; 95% CI, 1.24–2.82). Higher CFS score (OR, 1.64; 95% CI, 1.37–1.97) and cognitive impairment (OR, 3.60; 95% CI, 2.31–5.61) were associated with remaining poor in IADL, and higher CFS score was also associated with deterioration (OR, 1.63; 95% CI, 1.33–1.99).ConclusionsBased on ADL assessments, most people who underwent inpatient geriatric rehabilitation regained their baseline functional performance. As higher CFS score and cognitive impairment were associated with poorer functional recovery, assessing frailty and cognition at hospital admission could assist intervention and discharge planning.
Highlights
Main outcome measures: Functional performance, assessed with the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales two weeks before acute hospitalisation, on admission to and discharge from geriatric rehabilitation, and three months after discharge from geriatric rehabilitatio
Higher Clinical Frailty Scale (CFS) score (v recovered, per point: odds ratio [odds ratios (ORs)], 2.51; 95% confidence intervals (CIs), 1.64–3.84) and cognitive impairment (OR, 6.33; 95% CI, 2.09–19.1) were associated with greater likelihood of remaining poor in ADL, and with deterioration (CFS score: OR, 1.76; 95% CI, 1.45–2.13; cognitive impairment: OR, 1.87; 95% CI, 1.24– 2.82)
Higher CFS score (OR, 1.64; 95% CI, 1.37–1.97) and cognitive impairment (OR, 3.60; 95% CI, 2.31–5.61) were associated with remaining poor in IADL, and higher CFS score was associated with deterioration (OR, 1.63; 95% CI, 1.33–1.99)
Summary
Of the 693 rehabilitation inpatients, 11 died during geriatric rehabilitation and 64 within three months of discharge from rehabilitation; 618 patients were included in our analysis (online Supporting Information, figure). Higher age, higher Cumulative Illness Rating Scale, CFS, and Hospital Anxiety and Depression Scale depression scores, cognitive impairment, and lower quality of life score were each associated with greater likelihood of deterioration than recovery; higher CFS score, being male, cognitive impairment, and lower quality of life score were associated with greater likelihood of remaining poor (Supporting Information, table 2). Higher age, being male, higher Charlson Comorbidity Index, Cumulative Illness Rating Scale, CFS, and Hospital Anxiety and Depression Scale depression scores, cognitive impairment, and lower quality of life score were each associated with greater likelihood of remaining poor than recovering; higher age, being male, and higher Charlson Comorbidity Index and CFS scores were associated with greater likelihood of deteriorating (Supporting Information, table 2). Higher CFS score (v recovered, per point: OR, 1.64; 95% CI, 1.37–1.97) and cognitive impairment (OR, 3.60; 95% CI, 2.31–5.61) were associated with remaining poor, and higher CFS score was associated with deterioration (OR, 1.63; 95% CI, 1.33–1.99) (Box 5)
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