Rehabilitation outcomes of older patients at 6 months follow-up after discharged from a geriatric day hospital (GDH)

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Abstract

Whether rehabilitation outcome can be maintained after discharged from GDH has not been thoroughly investigated. This study was conducted to examine the rehabilitation outcome and its predictors 6 months after discharged from GDH. We studied 418 patients attended a GDH in Hong Kong. All of them had post-6-month assessment. Cognitive status was assessed with Cantonese version of mini-mental state examination (C-MMSE). Functional independence measure (FIM) upon GDH admission (FIM-adm), discharge (FIM-dis) and 6 months after discharge (FIM-p6m) were measured. FIM gain was FIM-dis  FIM-adm while FIM efficiency was FIM gain divided by number of GDH visits. Of the study pool, 164 (39.2%) showed a drop of FIM-p6m. There was a significant drop of FIM-p6m as compared with FIM-dis (p < 0.001). However, the FIM-p6m remained significantly higher than FIM-adm (p < 0.001). Multivariate analysis revealed that FIM-dis was a negative predictor (p < 0.001) while Parkinsonism was a positive predictor for drop of FIM-p6m (p = 0.008). A proportion of functional gain can still be maintained 6 months after discharged from GDH. More studies are needed to look for strategies in maintaining functional gain in GDH discharged patients, especially those with Parkinsonism.

Introduction

The first GDH was open in UK in 1952. In Hong Kong, the first GDH was open in 1975 and at present, there are 14 GDHs serving different parts of Hong Kong (Kong, 1991, Lum et al., 1995). Although GDH can play a number of different roles in provision of geriatric services, the most important task of GDH is regarded as in geriatric comprehensive assessment and rehabilitation (Hui et al., 1995, Roderick et al., 2001, Lee et al., 2002, Hershkovitz et al., 2004). To date, there have been many controversies surrounding GDH. First, it has been shown in meta-analysis that GDH has no overall benefit compared to other models of comprehensive care, but is superior to no comprehensive care (Forster et al., 1999). Second, whether the functional gain of GDH can be maintained after discharge is questionable. One study in community-dwelling older patients reported that there was no sustained improvement in mobility or functional status after 3 months following discharge from GDH (Malone et al., 2002). Another study showed that 39% of the older patients deteriorated 6–18 months after discharged from GDH (Crilly et al., 2005). However, none of these studies looked at the factors affecting the drop in functional and motor status after discharged from GDH.

The present study was performed in a large group of Chinese patients to examine whether there was a drop in rehabilitation outcome 6 months after discharged from GDH and if present, its predictors affecting such a drop. We hypothesize that there is a drop of functional and motor rehabilitation outcomes in older patients after discharged from GDH but they can still maintain a proportion of their rehabilitation gain. To our knowledge, it is the first study that has examined this important issue in a large group of Chinese patients in a GDH setting.

Section snippets

Subjects and setting

The study was a retrospective study carried out in the GDH of Tung Wah Group of Hospitals, Fung Yiu King Hospital (FYKH), Hong Kong, SAR, China. We recruited older patients (age ≥65) attended between January 2005 and December 2007. The GDH of FYKH has a daily capacity of 22.

The subjects of this study were all the older patients attended and discharged from FYKH GDH, and had come back for post-6-month assessment. Patients in GDH were from multiple sources. These included patients discharged from

Results

Four hundred and eighteen elderly patients attended GDH between January 2005 and December 2007 with p6m assessment, were included into the study. There were 170 (40.7%) men and 248 (59.3%) women. Their mean age was 80.3 ± 6.8 (range 65–100 years). Table 1 shows the demographic and clinical characteristics of the patients.

Among the 418 patients, 164 (39.2%) showed a drop in FIM-p6m follow-up after discharged from GDH. Fig. 1 shows the FIM-adm, FIM-dis and FIM-p6m. The FIM scores improved

Discussion

Geriatricians who engage in rehabilitation of their GDH patients often have a question in their mind: can the patients’ functional and motor status maintain after discharged from GDH? Their worries are not without ground. The study in Canada showed that motor or functional improvements could not be maintained as short as three months after discharge from GDH (Malone et al., 2002). We believe that a larger study is needed to see if the lost of rehabilitation gain after discharge from GDH is

Conclusion

There was a significant drop in FIM-p6m. However, patients could maintain a significant proportion of their rehabilitation gain 6 months after discharged from GDH. This suggested that GDH training could have a long lasting effect. FIM taken at discharge from GDH (FIM-dis) was a negative predictor for drop of FIM-p6m while Parkinsonism was a positive predictor for the drop of FIM-p6m. More studies are needed in future to look for strategies in maintaining functional gain in GDH discharged

Conflict of interest statement

None.

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