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A Tailored Discharge Program Improves Frailty and Mood in Patients Undergoing Usual Rehabilitative Care: A Randomized Controlled Trial

  • Anna Maria Meyer
    Affiliations
    Aging Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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  • Malte P. Bartram
    Affiliations
    Aging Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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  • Philipp Antczak
    Affiliations
    Center for Molecular Medicine, University of Cologne, Cologne, Germany
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  • Ingrid Becker
    Affiliations
    Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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  • Author Footnotes
    † Contributed equally.
    Thomas Benzing
    Footnotes
    † Contributed equally.
    Affiliations
    Aging Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany

    CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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  • Author Footnotes
    † Contributed equally.
    M. Cristina Polidori
    Correspondence
    Address correspondence to M. Cristina Polidori, MD, PhD, FRCP, Aging Clinical Research, Department II Internal Medicine, University Hospital of Cologne, Herderstrasse 52, 50931 Cologne, Germany.
    Footnotes
    † Contributed equally.
    Affiliations
    Aging Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany

    CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
    Search for articles by this author
  • Author Footnotes
    † Contributed equally.
Published:October 10, 2022DOI:https://doi.org/10.1016/j.jamda.2022.09.003

      Abstract

      Objective

      To investigate whether a tailored intersectoral discharge program (TIDP) impacts on multidimensional frailty, rehospitalization days, and patient-related outcome measures in older in-patients undergoing acute care and usual rehabilitative care.

      Design

      Randomized controlled trial of TIDP vs usual rehabilitative care with a 6-month follow-up, 2019–2020, and historical control with a 6-month follow-up, 2016–2019.

      Setting and Participants

      Geriatric co-managed internal medicine ward of a metropolitan university hospital. One hundred-twelve multimorbid patients older than age 60 years were consecutively assessed for eligibility and inclusion (age ≥60 years, multimorbidity, admitted for treatment of acute disease, at least 2 geriatric syndromes requiring usual rehabilitative care, and able to consent) and signed informed consent, with 110 recruited and randomized to either TIDP or usual rehabilitative care. At discharge, 104 patients were alive in the intention-to-treat group, the 6-month follow-up was completed for 91 patients. A historical control group of 468 patients was included for comparison.

      Intervention

      TIDP as intervention included contact with treating general practitioner to discuss the further treatment plan, a structured medical and lifestyle counseling to patients and caregivers at admission as well as a discharge program with internist, geriatrician, and general practitioner in shared decision making with patients.

      Methods

      Fifty-four patients underwent TIDP, 53 patients underwent usual rehabilitative care only. Rehospitalization days at follow-up as primary endpoint; multidimensional frailty and prognosis (Multidimensional Prognostic Index, Geriatric Depression Scale, Rosenberg Self-Esteem Scale, quality of life, falls, mortality, home care service need, and need of long-term care at 1-, 3- and 6-month follow-up as secondary endpoints.

      Results

      TIDP (median age 76.0 years, 56% female) showed significantly improved Multidimensional Prognostic Index scores at discharge compared with usual rehabilitative care (median age 78.5 years, 58% female) (0.43 vs 0.49, P = .011). Compared with usual rehabilitative care, TIDP improved self-confidence (Rosenberg Self-Esteem Scale 13.9 vs 12.4, P = .009) and mood (Geriatric Depression Scale 4 vs 5, P = .027) at follow-up. Compared with historical control (median age 77.0 years, 39 % female), usual rehabilitative care patients showed significantly lower rehospitalization rates (53% vs 70%, P = .002) and lower mortality rates (13% vs 32%, P < .001).

      Conclusions and Implications

      A feasible TIDP improves frailty and mood in advanced age. In older patients undergoing potentially disabling acute treatments, usual rehabilitative care significantly reduces rehospitalization rates. Therefore, implementing geriatric treatment in general is useful to improve outcomes in older in-patients and a tailored discharge program can further increase the benefit for this frail population.

      Keywords

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