Frailty, underweight and impaired mobility are associated with institutionalisation after post-acute care

Abstract

AIMS OF THE STUDY Post-acute care (PAC) is intended for older adult patients who are unable to return home directly after acute hospitalisation but who do not otherwise qualify for specific rehabilitation. However, data on potential predictors of PAC outcomes remain limited. Our aim was to identify patient characteristics upon admission to PAC that are associated with subsequent institutionalisation. METHODS Prospective cohort study enrolling 140 former acute care inpatients aged 60 and older who were referred to PAC units at nursing homes in Zurich, Switzerland. MEASURES Geriatric assessment at admission included Barthel Index (BI), Short Physical Performance Battery (SPPB), frailty status (Fried phenotype), nutrition and cognitive status. Logistic regression was used to determine statistically significant associations. RESULTS Mean age was 84.1 (standard deviation [SD] 8.6) years; 62.9% of participants were women. Mean body mass index (BMI) was 25.0 (SD 5.8) kg/m2, with 12.1% being underweight (BMI <20 kg/m2). Mean BI at admission was 62.1 (SD 19.1), mean SPPB score was 5.2 (SD 2.8), and 55% were frail (≥3 Fried criteria present). After a mean length of stay in PAC of 30.9 (SD 16.5) days, 48.6% were institutionalised. Patients who were frail at admission had a 2.97-fold higher (odds ratio [OR] 2.9,7 95% confidence interval [CI] 1.04–8.42), and patients who were underweight had a 4.94-fold higher (OR 4.94, 95% CI 1.11–22.01) chance of institutionalisation. Conversely, each points increment on the SBBP score lowered the likelihood of institutionalisation by 23% (OR 0.77, 95% CI 0.65–0.92). CONCLUSIONS Frailty, low SPPB score and being underweight at admission to PAC were significantly associated with a higher chance of subsequent institutionalisation. Strategies to improve these factors could improve PAC outcomes.

Improved Balance and Gait Ability and Basic Activities of Daily Living after Comprehensive Geriatric Care in Frail Older Patients with Fractures

“…These findings indicate that improvements in activities of daily living in older patients with a recent fracture are dependent on a certain level of cognition, walking ability, and gait and balance. This finding is in line with previous investigations which indicated a direct relationship between the general capability for rehabilitation and the preexisting mobility and cognition status [ 32 , 33 ]. In conclusion, among older patients with a current fracture or fall event undergoing CGC, those who had performed well in terms of gait and balance (Tinetti score of median 10 (IQR 4–15)) and who had a good cognition status (MMSE score of median 25 (18–28)) could be expected to benefit most from the treatment.…”

Functional Status among Polymedicated Geriatric Inpatients at Discharge: A Population-Based Hospital Register Analysis

“…Our findings showed that functional mobility impairment, dependency in the activities of daily living, and cognitive impairment were strong determinants of unplanned institutionalization (OR = 3.22, 95%CI 2.67–3.87; OR = 4.62, 95%CI 3.76–5.67; and OR = 3.75, 95%CI 3.06–4.59, respectively) [ 51 ]. These results complement another recent Swiss study by Tröster and Thalmann [ 52 ], which highlighted that frailty, physical decline and being underweight were significantly associated with a greater risk of subsequent institutionalization.…”

“…This deserves reflection, considering the well-known association between malnutrition and adverse health outcomes. A study of underweight patients in Switzerland by Tröster and Thalmann [ 52 ] pointed to almost a five-fold higher (OR = 4.94, 95%CI 1.11–22.01) risk of institutionalization after discharge. Furthermore, Griffin and O’Neill [ 56 ] reported that malnourished older adults were more at risk of hospital readmission, nursing home admission, reduced quality of life, and functional decline.…”

“…Geriatric inpatients are susceptible to greater functional decline and adverse health events which are not directly related to the illness for which they were hospitalized [ 11 , 14 , 15 ]. Additionally, they are at risk of not being able to return to their homes [ 52 ]. Therefore, planning a multi-dimensional, patient-centered treatment program as soon as they are hospitalized seems to be crucial to prevent functional decline while it is still reversible [ 15 , 62 ].…”

Assessment Tools for the Admission of Older Adults to Inpatient Rehabilitation: A Scoping Review

“…Another 18.9% (n = 7) of the studies measured frailty. Following CFS, the Frailty Index (FI) and the Fried Frailty Phenotype (FFP) were used in 2.7% of each [40,41].…”