Mobility of geriatric patients at admission to early post-acute rehabilitation facilities predicts change in living situation after discharge

Objectives: The identification of the problems and characteristics
of geriatric patients at the beginning of post-acute rehabilitation
therapy which predict the worsening of living situation after
hospital discharge and which may be amenable to intensified
rehabilitation interventions. Methods: In a cross-sectional survey
a cohort of 128 elderly patients undergoing early post-acute
rehabilitation was interviewed at the beginning of their
rehabilitation therapy. To identify the patients’ problems the
second level of the ICF (International Classification of
Functioning, Disability and Health) was used. Predictors were
analyzed by conducting a multiple logistic regression model with
worsening of living conditions as the dependent variable and using
age, gender and main diagnosis as forced-in variables. Results: The
mean age of the population was 80.3 years (SD 7.2). Sixty-nine
percent were female. The group of patients with a worse living
situation after discharge from rehabilitation facility compared to
the situation before the acute event which lead to hospital
admission (52.3% of the sample) had more frequently trauma or joint
replacement as main diagnosis and were in the mean one year older
than the group of patients who did not worsen. The only “negative”
predictor for worsening in living situation was the ICF category
d465 “Moving around with equipment” (Odds ratio 2.92, 95%
Confidence interval 1.24 – 6.83). This means that patients who were
not able to move around with equipment at the beginning of
rehabilitation therapy had a 2.9fold higher risk of being more
dependent on assistance after their discharge. When using age,
gender and main diagnosis as forced-in variables this result did
not change. Conclusions: The use of the ICF to identify potential
predictors for discharge destination provided the possibility of
investigating a broad spectrum of patients’ functioning. The
findings of the underlying study suggest that assistive
technologies, especially those enhancing mobility, demand special
attention in a geriatric inpatient rehabilitation setting. Use of
assistive devices should have an early part in the planning of
rehabilitation interventions.