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

Abstract

(1) Purpose: Comprehensive geriatric care (CGC) is a multidisciplinary treatment approach for elderly patients. We aimed to investigate outcomes in fracture patients who had been treated using this approach in a large geriatric unit. (2) Methods: This observational cohort study assessed the gait function (using the Tinetti Balance and Gait Test (TBGT)) and basic activities of daily living (ADL) (using the Barthel index (BI)) before and after CGC and compared the results. Baseline data, walking ability assessments (Timed Up and Go, TUG), and cognitive status (mini mental status examination, MMSE) were also analyzed in the subgroup of patients with versus without fractures. (3) Results: Out of 1263 hospitalized patients, 1099 received CGC (median age: 83.1 years (IQR: 79.0–87.8 years); 64.1% were female). TBGT improvement was observed in 90.7% and BI increased in 82.7% of fracture patients. A TBGT improvement of >5 was noted in 47.3% and was associated with female sex, a lower BI at admission (median: 40 versus 45; p = 0.010), and poorer mobility on admission (TUG: median 5 versus 4; p = 0.001). An improvement in BI of ≥15 was observed in 63.0% of the cases, and was associated with a better cognitive status (MMSE: median 25 versus 18; p = 0.001) and inversely associated with diabetes mellitus and a previous stroke. (4) Conclusion: CGC in specialized geriatric units improves the balance and gait and the basic ADL in geriatric patients. After fracture, female patients are more likely to experience improvements in gait and balance, while patients with better cognitive condition are more likely to experience improvements in ADL.

Mobility outcomes and associated factors of acute geriatric care in hospitalized older patients: results from the PAGER study

“…), as a composite measure for basic daily mobility tasks, and in walking capacity (median change in GS = + 0.09 m/s), as the most fundamental form of human locomotion. This finding suggests the physical resilience of multi-morbid older patients with acute medical conditions and the potential of AGC to enhance the locomotor capacity of this vulnerable patient population, which is consistent with previous studies [ 27 , 28 , 35 ]. A 1-point improvement in the SPPB during (post-)acute geriatric care has been associated with about 20% lower risk of mortality and institutionalization within three months after hospital discharge in older patients [ 55 ], and each 1-point higher SPPB at hospital discharge with a 13% [ 40 ] and 14% [ 41 ] lower risk of hospital readmission and/or mortality, respectively, and an 18% lower risk of functional decline after one year [ 41 ].…”

“…However, those with distinct mobility outcomes have not yet been examined in detail among this patient population. Some observational studies in older patients admitted to acute geriatric hospital wards reported an improvement in locomotor capacity (e.g., Δ Timed Up and Go = + 27.3–28.1% [ 27 ], Δ Performance Oriented Mobility Assessment = + 33–75% [ 28 ]) or an increase in PA (Δ median daily step count = + 77–130%, Δ median standing and/or walking duration: + 120–150% [ 5 , 8 ]) over hospital stay; however, findings on LSM outcomes of AGC are lacking.…”