Article

OBJECTIVES: To ascertain
trends in function and mortality after admission to a medicine for the elderly
rehabilitation unit, and to analyze factors associated with these outcomes.
DESIGN: Retrospective cohort analysis of routinely collected clinical data during
the period from January 1, 1999, to December 31, 2008. SETTING: Hospital-based
medicine for the elderly rehabilitation unit. PARTICIPANTS: Patients (N=4449)
admitted for rehabilitation after medical and surgical illness, stroke, and
fractured neck of the femur. INTERVENTIONS: Not applicable. MAIN OUTCOME
MEASURES: Analysis of routinely collected clinical data: admission and discharge
Barthel scores; indices of cognitive impairment, mental illness, swallowing and
feeding difficulties. Discharge diagnoses, place of discharge, date of death, and
discharge medications were analyzed, along with length of stay. Regression
analysis of factors associated with improvement in Barthel score, place of
discharge, and postdischarge mortality. RESULTS: Length of stay and admission
Barthel scores were unchanged over the study period, but discharge Barthel scores
improved from 13.5 (maximum score, 20) in 2002 to 14.8 in 2008 (P=.002 for
trend). Discharge to home increased from 290 (61%) of 472 patients in 2001 to 290
(76%) of 382 patients in 2007 (P<.001 for trend). Age, admission Barthel score,
cognitive impairment, problems with understanding, and problems with expression
were independent predictors of the change in Barthel score between admission and
discharge. The adjusted hazard ratio for postdischarge mortality in 2007 to 2008
compared with 1999 to 2000 was .76 (95% confidence interval, .63-.93).
CONCLUSIONS: Functional and mortality outcomes improved over a 10-year period in
this rehabilitation unit, despite similar Barthel scores on admission and
equivalent lengths of stay.
CI - Copyright (c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS