Original study
Outcomes at 12 Months in a Population of Elderly Patients Discharged From a Rehabilitation Unit

https://doi.org/10.1016/j.jamda.2007.09.009Get rights and content

Objectives

This study investigates the cognitive, functional, and clinical variables associated with the risk of institutionalization, rehospitalization, and death at 12 months among a population of elderly discharged from a Rehabilitation and Aged Care Unit (RACU) within a 1-year period (May 1, 2004 to April 30, 2005). The RACU is a relatively new setting of care providing intensive rehabilitation and clinical support to elderly with highly heterogeneous reasons for admission.

Methods

There were 1303 patients (≥65 years old) contacted 12 months after discharge from the RACU. We obtained information about institutionalization, rehospitalization, and death. Predictors were all the demographic and clinical variables potentially related to these outcomes. The relationship among predictors and outcomes was tested with multiple stepwise logistic regression models.

Results

Among the 1072 patients alive at the 12-month follow-up, 90 (8.4%) were institutionalized (3.4% early at discharge and 4.9% within the next period). The logistic regression analysis showed that 2 ranges of age (78 to 83 years and 84 years or more), living alone, occurrence of delirium, cognitive impairment (Mini Mental State Examination lower or equal to 20/30), and poor functional status at discharge (Barthel Index scores ranging from 69 to 85 and Barthel Index scores lower than 68/100) were independently and significantly associated with the risk of institutionalization during the 12 months following discharge from the RACU. Three hundred and twenty-three (30.1%) patients had been rehospitalized once and 86 (8.0%) patients twice at the 12-month follow-up. In the multivariate analysis, comorbidity (Charlson Index scores ranging from 2 to 3 and Charlson Index scores higher than 4) and delirium were significantly and independently associated with this outcome. One hundred and thirty-six (11.3%) patients had died by the 12-month follow-up. The stepwise logistic regression analysis showed that age greater than 83 years, poor functional status (Barthel Index lower than 60/100 at discharge), high comorbidity (Charlson Index scores ranging from 3 to 4 and Charlson Index scores higher than 4, respectively), and albumin serum levels ranging from 3.2 to 2.9 mg/dL and lower than 2.9 mg/dL independently and significantly predicted the 12-month risk of death. Absence of depressive symptoms (Geriatric Depression Scale <2/15) had instead a protective effect.

Conclusion

Variables related to the sociodemographic, cognitive, functional, and health status predicted, with different degree of association, the 12-month risk of institutionalization, rehospitalization, and death among a population of elderly patients discharged from a RACU. Accordingly, various clinical and organizational approaches may be planned for prevention.

Section snippets

Study Population and Setting

This study included all elderly (aged 65 years or older) patients consecutively and newly discharged from the RACU between May 1, 2004, and April 30, 2005. The RACU is an intermediate-care setting that offers a rehabilitative and clinical approach for patients requiring specialized care not routinely available in hospitals or nursing homes (NH). In particular, our RACU is a 60-bed ward devoted to the rehabilitation of postacute and chronic disabilities of frail and nonfrail elderly patients.

Results

During the study period, 1330 patients were discharged from the RACU consecutively and for the first time. Of these, 7 patients who were residents in a NH before RACU admission were excluded from further analyses. At the 12-month follow-up, 115 (8.7%) patients were untraceable at the telephonic interview and 136 (10.2%) had died; of the 1072 remaining, 90 (8.3%) were institutionalized (3.4% at discharge and 4.0% within the next l2 months) and 409 (8.0%) had 2 or more rehospitalizations.

Discussion

The main aim of this study was to identify the cognitive, functional, and clinical variables associated with the 12-month risk of institutionalization, rehospitalization, and death in a population of patients discharged from a RACU.

With regard to the risk of 12-month institutionalization, our rate is lower than those of other international studies.32, 33, 34, 35 Winograd et al,32 in a prospective cohort study of male veterans aged 65 years and older, found that 1 year after hospital discharge

Conclusion

This study was undertaken to assess the variables predicting 1-year rates of institutionalization, rehospitalization, and mortality among a population of elderly patients first and consecutively discharged from a RACU. Our purpose was to investigate factors susceptible of an intervention study performable in our area to organize preventive health care programs and home services. The findings clearly suggest that both modifiable and unmodifiable variables strongly impact outcomes (Table 8).

Acknowledgments

Sincere appreciation is due to Drs. Emanuela Barisione, Fabio Guerini, Elena Lucchi, Alessandra Marrè, Marco Pagani, Salvatore Speciale, and Renato Turco for their support in collecting data and to Elena Davelli for her revision of the manuscript in the English language.

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    This study was supported by a grant from the ONLUS Foundation “Socialità e Ricerche,” Bergamo, Italy.

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