Limited Effect of Rehabilitation for Preventing a Decline in Functional Status after Community-Acquired Pneumonia in Elderly Patients

Abstract

<jats:title>Abstract</jats:title> <jats:p>Background: Functional status is often decreased after hospitalization in elderly community-acquired pneumonia (CAP) survivors. This study investigated factors contributing to decreased functional status.Methods: This retrospective, observational study was conducted in two medical facilities from January 2016 to December 2018. Hospitalized CAP patients &gt;64 years of age were divided into two groups: a maintained group, without decreased functional status, and a decreased group, with decreased functional status. Functional status was evaluated by the Barthel Index (BI) (range, 0–100, in 5-point increments) and graded into three categories: independent, BI 80–100; semi-dependent, BI 30–75; and dependent, BI 0–25. A decreased functional status was considered as a decline of at least one category. The primary outcome was the length of hospital stay. Results: The maintained group included 400 patients, and the decreased group included 138 patients (median age: 77 vs 82 years; p &lt; 0.001). The decreased group had a longer hospital stay (13 vs 27; p&lt;0.001), with a high rate of rehabilitation [189(47.3%) vs 104(75.4%); p&lt;0.001]. Multivariable regression analysis showed that factors affecting functional status were length of hospital stay, aspiration, age, and pneumonia severity index (PSI) category V (odds ratio 1.05, 95%CI 1.04–1.07; 2.66, 95%CI 1.58–4.49; 1.05, 95%CI 1.02–1.09; and 1.92, 95%CI 1.29-3.44; respectively). Rehabilitation showed a limited effect in preventing a decreased functional status on propensity score analysis (p=0.327).Conclusions: Length of hospital stay, aspiration, age, and PSI V were independent contributors to decreased functional status. Rehabilitation showed a limited effect in preventing decreased functional status.</jats:p>