JAMDA
Volume 9, Issue 1 , Pages 55-64 , January 2008

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

  • Giuseppe Bellelli, MD

      Affiliations

    • Rehabilitation and Aged Care Unit, “Ancelle della Carità” Hospital, Cremona, Italy
    • Geriatric Research Group, Brescia, Italy
    • Corresponding Author InformationAddress correspondence to Giuseppe Bellelli, MD, Rehabilitation and Aged Care Unit “Ancelle della Carità” Hospital, via Aselli 14, 26100 Cremona 26100, Italy.
  • ,
  • Francesca Magnifico, PsyD

      Affiliations

    • Rehabilitation and Aged Care Unit, “Ancelle della Carità” Hospital, Cremona, Italy
    • Geriatric Research Group, Brescia, Italy
  • ,
  • Marco Trabucchi, MD

      Affiliations

    • Geriatric Research Group, Brescia, Italy
    • University Tor Vergata, Rome, Italy.

References 

  1. Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59:255–263
  2. Kim H, Lee J. The impact of comorbidity on wealth changes in later life. J Gerontol B Psychol Sci Soc Sci. 2006;61:S307–S314
  3. Hoffman C, Rice D, Sung HY. Persons with chronic conditions: Their prevalence and costs. JAMA. 1996;276:1473–1479
  4. Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74:511–544
  5. Ferrucci L, Guralnik JM, Studenski S, et al. Interventions on Frailty Working Group (Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: A consensus report). J Am Geriatr Soc. 2004;52:625–634
  6. Fried LP, Guralnik JM. Disability in older adults: Evidence regarding significance, etiology, and risk. J Am Geriatr Soc. 1997;45:92–100
  7. Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults: Toward a better understanding of physiology and etiology: Summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006;54:991–1001
  8. Slaets JP. Vulnerability in the elderly: Frailty. Med Clin North Am. 2006;90:593–601
  9. Comette P, D’Hoore W, Malhomme B, et al. Differential risk factors for early and later hospital readmission of older patients. Aging Clin Exp Res. 2005;17:322–328
  10. Winograd CH, Gerety MB, Chung M, et al. Screening for frailty: Criteria and predictors of outcomes. J Am Geriatr Soc. 1991;39:778–784
  11. Satish S, Winograd CH, Chavez C, et al. Geriatric targeting criteria as predictors of survival and health care utilization. J Am Geriatr Soc. 1996;44:914–921
  12. Sullivan DH. Risk factors for early hospital readmission in a select population of geriatric rehabilitation patients: The significance of nutritional status. J Am Geriatr Soc. 1992;40:792–798
  13. Librero J, Peiro S, Ordinana R. Chronic comorbidity and outcomes of hospital care: Length of stay, mortality, and readmission at 30 and 365 days. J Clin Epidemiol. 1999;52:171–179
  14. Fortinsky RH, Covinsky KE, Palmer RM, Landefeld CS. Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J Gerontol A Biol Sci Med Sci. 1999;54:M521–M526
  15. Rudenberg MA, Sager MA, Zhang J. Risk factors for nursing home use after hospitalization for medical illness. J Gerontol A Biol Sci Med Sci. 1996;51:M189–M194
  16. Aditya BS, Sharma JT, Allen SC, Vassallo M. Predictors of a nursing home placement from a non-acute geriatric hospital. Clin Rehabil. 2003;17:108–113
  17. Fogel JF, Hyman RB, Rock B, Wolf-Klein G. Predictors of hospital length of stay and nursing home placement in an elderly medical population. J Am Med Dir Assoc. 2000;1:202–210
  18. Rozzini R, Sabatini T, Trabucchi M. Prediction of 6-month mortality among older hospitalized adults. JAMA. 2001;286:1315–1356
  19. Walter LC, Brand RJ, Counsell SR, et al. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA. 2001;285:2987–2994
  20. Inouye SK, Peduzzi PN, Robison JT, et al. Importance of functional measures in predicting mortality among older hospitalized patients. JAMA. 1998;279:1187–1193
  21. Wells JL, Seabrook JA, Stolee P, et al. State of the art in geriatric rehabilitation (Part II: Clinical challenges). Arch Phys Med Rehabil. 2003;84:898–903
  22. Ottenbacher KJ, Smith PM, Illig SB, et al. Trends in lengths of stay, living setting, functional outcome, and mortality following medical rehabilitation. JAMA. 2004;292:1687–1695
  23. Rozzini L, Cornali C, Vicini Chilovi B, et al. Predictor of institutionalization in demented patients discharged from a rehabilitation unit. J Am Med Dir Assoc. 2006;7:345–349
  24. Bellelli G, Guerini F, Trabucchi M. Geriatric pocket guide and geriatricians in the rehabilitation of older patients. Arch Phys Med Rahabil. 2005;86:846
  25. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40:373–383
  26. Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982–. 1983;17:37–49
  27. Folstein MF, Folstein SE, McHugh PR. “Mini Mental State”: a practical method for grading the cognitive status of patients for the clinician. J Psych Res. 1975;12:189–198
  28. Inouye SK, Van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: The Confusion Assessment Method. Ann Intern Med. 1990;113:941–948
  29. Mahoney FI, Barhel DW. Functional evaluation: the Barthel Index. Mar St Med J. 1965;14:61–65
  30. Tinetti M. Performance-oriented assessment of mobility problems in elderly patient. J Am Geriatr Soc. 1986;34:119–126
  31. Kidd D, Stewart G, Baldry J, et al. The functional independence measure: A comparative validity and reliability study. Disabil Rehabil. 1995;17:10–14
  32. Winograd CH, Lindenberg EC, Chavez CM, et al. Identifying hospitalised older patients at varying risk for physical performance decline: A new approach. J Am Geriatr Soc. 1997;45:604–609
  33. Friedman SM, Steinwachs DM, Rathouz PJ, et al. Characteristics predicting nursing home admission in the program of all-inclusive care for elderly people. Gerontologist. 2005;45:157–166
  34. Miller EA, Weissert W. Incidence of four adverse outcomes in the elderly population: Implications for home care policy and research. Home Health Care Serv Q. 2001;20:17–47
  35. Shen Q, Cordato D, Chan DK, et al. Identifying the determinants of 1-year post-stroke outcomes in elderly patients. Acta Neurol Scand. 2006;113:114–120
  36. Caltagirone C, Bianchetti A, Di Luca M, et al. Italian Association of Psychogeriatrics Guidelines for the treatment of Alzheimer’s disease from the Italian Association of Psychogeriatrics. Drugs Aging. 2005;22(Suppl 1):1–26
  37. Inouye SK. Prevention of delirium in hospitalized older patients: Risk factors and targeted intervention strategies. Ann Med. 2000;32:257–263
  38. Inouye SK, Bogardus ST, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340:669–676
  39. Inouye SK, Rushing JT, Foreman MD, et al. Does delirium contribute to poor hospital outcomes? (A three-site epidemiologic study). J Gen Intern Med. 1998;13:234–242
  40. Guccione AA, Fagerson TL, Anderson JJ. Regaining functional independence in the acute care setting following hip fracture. Phys Ther. 1996;76:818–826
  41. Hoenig H, Rubenstein L, Kahn K. Rehabilitation after hip-fracture: Equal opportunities for all?. Arch Phys Med Rehab. 1996;77:58–63
  42. Bellelli G, Guerini F, Bianchetti A, et al. Medical comorbidity and complexity of the rehabilitative procedures for older patients with functional impairments. J Am Geriatr Soc. 2002;50:2095–2096
  43. Speciale S, Bellelli G, Lucchi E, et al. Delirium and functional recovery in elderly patients. J Gerontol A Biol Sci Med Sci. 2007;62:107–108
  44. Bellelli G, Lucchi E, Magnifico M, et al. Rehospitalization and transfers to nursing facilities in elderly patients after hip fracture surgery. J Am Geriatr Soc. 2005;53:1443–1445
  45. Bellelli G, Frisoni GB, Pagani M, et al. Does cognitive performance affect physical therapy regimen after hip fracture surgery?. Aging Clin Exp Res. 2007;19:119–124
  46. Teri L, McCurry SM, Buchner DM, et al. Exercise and activity level in Alzheimer’s disease: A potential treatment focus. J Rehabil Res Dev. 1998;35:411–419
  47. Nikolaus T, Specht-Leible N, Bach M, et al. A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients. Age Ageing. 1999;28:543–550
  48. Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281:613–620
  49. Halm EA, Magaziner J, Hannan EL, et al. Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture. Arch Intern Med. 2003;163:108–113
  50. Young J, Inouye SK. Delirium in older people. BMJ. 2007;334:842–846
  51. Rigney TS. Delirium in the hospitalized elder and recommendations for practice. Geriatr Nurs. 2006;27:151–157
  52. Lyons WL. Delirium in postacute and long-term care. J Am Med Dir Assoc. 2006;7:254–261
  53. Flaherty JH, Rudolph J, Shay K, et al. Delirium is a serious and under-recognized problem: Why assessment of mental status should be the sixth vital sign. J Am Med Dir Assoc. 2007;5:273–275
  54. Speciale S, Bellelli G, Trabucchi M. Staff training and use of specific protocols for delirium management. J Am Geriatr Soc. 2005;53:1445–1446
  55. Leibson CL, Tosteson AN, Gabriel SE, et al. Mortality, disability, and nursing home use for persons with and without hip fracture: A population-based study. J Am Geriatr Soc. 2002;50:1644–1650
  56. de Jong G, van Raak L, Kessels F, Lodder J. Stroke subtype and mortality (A follow-up study in 998 patients with a first cerebral infarct). J Clin Epidemiol. 2003;56:262–268
  57. Almagro P, Barreiro B, Ochoa de Echaguen A, et al. Mortality after hospitalization for COPD. Chest. 2002;121:1441–1448
  58. Rozzini R, Sabatini T, Cassinadri A, et al. Relationship between functional loss before hospital admission and mortality in elderly persons with medical illness. J Gerontol A Biol Sci Med Sci. 2005;62:1180–1183
  59. Ranieri P, Rozzini R, Franzoni S, Trabucchi M. Combined hypoalbuminemia and hypocholesterolemia as a predictor of mortality in older patients in a short-term period. J Am Geriatr Soc. 1999;47:1386–1387
  60. Rozzini R, Barbisoni P, Frisoni GB, et al. Albumin as a predictor of mortality in elderly patients. J Clin Epidemiol. 1997;50:865–867
  61. Yancik R, Ershler W, Satariano W, et al. Report of the National Institute on Aging Task Force on Comorbidity. J Gerontol A Biol Sci Med Sci. 2007;3:275–280
  62. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders IV (Text Revision). Washington, DC: American Psychiatric Association; 2000;

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

PII: S1525-8610(07)00437-9

doi: 10.1016/j.jamda.2007.09.009

JAMDA
Volume 9, Issue 1 , Pages 55-64 , January 2008