Effect of Cognitive Impairment on Rehabilitation Outcome1

Abstract

Previous studies examining the relationship between cognition and ability to benefit from inpatient rehabilitation have found cognitive dysfunction to be associated with a poor rehabilitation outcome. To examine whether cognitive dysfunction precluded effective rehabilitation, 52 consecutive admissions to a geriatric rehabilitation unit were assigned Mini Mental State Examination (MMSE) scores. Functional gains were assessed by the change in Functional Independence Measure (FIM) score from admission to discharge. Neither MMSE score alone nor in combination with age was significantly associated with change in FIM (r = 0.10; R = 0.25; P< 0.18). MMSE score alone and in combination with age was correlated with functional status on admission (r = 0.58; R = 0.58; P< 0.0001) and discharge (r = 0.49; R = 0.51; P< 0.0004). Patients evidenced a similar increase in functional status regardless of cognitive ability, but cognitively impaired individuals entered the inpatient unit with a lower functional status, and their level of function at discharge was also impaired relative to cognitively intact cohorts. Low MMSE scores were associated with a greater likelihood of nursing home placement, but a considerable percentage (38%) of individuals with severe cognitive impairment and the majority of individuals with mild to moderate cognitive impairment returned home following discharge. These findings suggest that geriatric patients with cognitive dysfunction should be considered for admission to rehabilitation programs if functional gains will affect quality of life or disposition.

Outcomes for older adults in an inpatient rehabilitation facility following hip fracture (HF) surgery

“…Preliminary evidence indicates that this care program assisted with allowing older adults to continue living in the community. This is in contrast to previous research by Diamond et al (1996) and Lenze et al (2004), who found that patients with CI were more likely to be discharged to a nursing home. The most probable reason for patients not being discharge to a nursing home is the expectation made clear to family members and patients at admission that the patients will be going back to their home.…”

“…These differences, which were not statistically significant, are attributable to the fact that CI patients were, on average, on the rehabilitation unit for 3 days less than patients with intact cognition prior to being discharged home. This result was not expected, as previous research has found the opposite: patients with CI usually have longer LOS than those who are cognitively intact (Diamond et al, 1996;Moncada et al, 2006), and patients with CI usually have lower rehabilitation efficiency scores than those patients who are intact (Heruti et al, 1999).…”

Rehabilitation Programs monitored by Functional Independence Measure: An Observational Study

“…However, it has been reported that geriatric patients with higher FIM social cognitive items are more often discharged home. 30 Diamond et al 31 indicate that geriatric patients with cognitive dysfunction should be considered for rehabilitation if functional gains will affect their quality of life. It is also important to note that patients of geriatric rehabilitation units classified as depressed at discharge have lower FIM scores at admission and at discharge.…”

Timely discharge of older patients from hospital: improving the process

“…20 Cognitive impairment is associated with a Timely discharge of older patients from hospital poorer outcome from rehabilitation, although some patients with significant cognitive impairment do return home following appropriate rehabilitation. 21 It is reasonable in cases of uncertainty to obtain advice from a member of the geriatric MDT.…”