Medical Comorbidity and Rehabilitation Efficiency in Geriatric Inpatients

Patrick, Louise; Knoefel, Frank; Gaskowski, Peter; Rexroth, Daniel F.

doi:10.1046/j.1532-5415.2001.4911239.x

Cited by 138 publications

(93 citation statements)

References 27 publications

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“…6 Recent studies provide conflicting evidence regarding the factors that influence recovery in older adults with hip fracture after discharge from inpatient rehabilitation. Factors such as prefracture cognitive and functional status, 7,8 cognitive impairment, [9][10][11][12][13][14][15][16] age, 17 sex, [18][19][20] medical co morbidities, 21 and pain 22 have been found to influence recovery, function, and mobility outcomes over time in older adults after hip fracture, 12,[14][15][16] yet two systematic reviews indicated that individuals with cognitive impairment made gains that were similar to those of individuals without cognitive impairment. 16,23 Albeit informative, these studies were unclear as to how many individuals with complex needs were offered active rehabilitation, the type and approaches used during rehabilitation, and the extent to which inpatient care influenced long-term outcomes.…”

mentioning

confidence: 99%

Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture

McGilton

Chu

Naglie

et al. 2016

J American Geriatrics Society

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Objectives To determine the contribution of cognitive impairment, prefracture functional impairment, and treatment as predictors of functional status and mobility 6 months after discharge from rehabilitation for older adults with hip fracture. Design Longitudinal. Setting Inpatient rehabilitation units of two community hospitals. Participants Adults with hip fractures aged 65 and older who were discharged from a rehabilitation unit and had been living in the community before the fracture (N = 133). Measurements Mini‐Mental State Examination ( MMSE ) score at discharge from rehabilitation was used to identify the presence and severity of cognitive impairment. Outcomes were measured using questions from two subscales of the Functional Independence Measure (Self‐Care Function and Functional Mobility) and the New Mobility Scale ( NMS ). Measurements were made at discharge from a rehabilitation setting and 3 and 6 months after discharge. Results Prefracture functional impairment was associated with worse outcomes throughout the 6 months after discharge and with lower rates of improvement, or in some cases decline, after discharge. Cognitive impairment was associated with worse outcomes throughout the 6 months after discharge but was only weakly associated with lower rates of improvement or decline. The Patient Centered Rehabilitation Model of care targeting persons with cognitive impairment ( PCRM ‐ CI ) intervention group had higher NMS scores after discharge than a usual care group. Conclusion Although cognitive impairment and prefracture functional impairment contribute to poor outcomes, prefracture functional impairment was more strongly associated with poor outcomes than cognitive impairment. There is evidence to show that individuals with cognitive impairment are able to regain their mobility, which suggests a need for postdischarge targeted interventions that include a focus on activities of daily living for older adults with cognitive impairment and functional impairment to stabilize gains from inpatient rehabilitation.

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confidence: 99%

Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture

McGilton

Chu

Naglie

et al. 2016

J American Geriatrics Society

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“…En otros estudios, el promedio de los escores de esta escala variaba de acuerdo a la población estudiada. En un estudio canadiense 33 , que evaluó pacientes internados en unidad de rehabilitación geriátrica, el promedio de los escores fue 3,8, bastante próximo al valor observado en nuestro estudio. Adultos mayores en hospital general, o institucionalizados, presentan promedios más altos 13 .…”

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Confiabilidade e validade da escala de depressão geriátrica em idosos com doença arterial coronariana

Pinho

Custódio

Makdisse

et al. 2010

Arq. Bras. Cardiol.

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ResumenFundamento: La prevalencia de depresión en portadores de enfermedad arterial coronaria (EAC) es alta. La escala de depresión geriátrica (EDG) es un instrumento ampliamente utilizado para rastrear la depresión en adultos mayores. En Brasil, las propiedades psicométricas de la versión corta aún no fueron adecuadamente estudiadas.Objetivo: Evaluar las propiedades psicométricas de la versión corta de la EDG en portadores de EAC en ambulatorio de cardiología. La depresión se asocia además con la disminución de la capacidad funcional 6 , con peor evaluación del estado de salud y de la calidad de vida 7 y con el aumento de los costos relacionados al cuidado de la salud 2 . MétodosA pesar de las evidencias, la depresión frecuentemente es ignorada por profesionales de la salud y, más aún, no es tratada. Apenas la mitad de los cardiólogos refiere haber tratado la depresión en sus pacientes. El uso de instrumentos validados, pero de aplicación simple, puede auxiliar a los profesionales a identificar una depresión en los portadores de coronariopatía, en la práctica clínica de rutina 8 . La escala de depresión geriátrica (EDG)9 es uno de los instrumentos más utilizados en el mundo para rastrear depresión en adultos mayores, tanto en el contexto clínico como en trabajos de investigación. Estudios en diferentes culturas 10-13 sostienen que la EDG es un instrumento con buena validez y confiabilidad. La versión corta, con 15 ítems, IntroducciónLa enfermedad cardiaca se asocia frecuentemente a la depresión. En aproximadamente un 20% de los pacientes con enfermedad arterial coronaria (EAC) y en infartados 1 se observa una depresión grave. La prevalencia es aún mayor cuando son consideradas las formas menos graves de depresión.Luego del infarto agudo de miocardio, la depresión se asocia al riesgo aumentado de complicaciones cardiovasculares fatales y no fatales 2,3 . Barefoot et al 4 , en un estudio de seguimiento a largo plazo, observaron que pacientes coronarios con depresión, de moderada a grave, presentaban riesgo de muerte cardiovascular un 84% mayor que los no deprimidos. Otro estudio longitudinal mostró que el riesgo de 552

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“…Indeed, somatic chronic comorbidities appear to have greater negative influence on the individual's decline in physical functions than expected [13]. In elderly people [14], comorbidities may negatively impact on the rehabilitation of patients, leading to smaller gains [15,16]. This aspect has been further investigated in COPD patients.…”

Section: Patient's Complexitymentioning

confidence: 99%

Determinants of success

Garrod

Malerba²,

Crisafulli³

2011

Eur Respir J

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In chronic obstructive pulmonary disease (COPD) patients, pulmonary rehabilitation is a nonpharmacological intervention aimed at improving physical exercise tolerance, dyspnoea and perceived quality of life. However, identifying predictors of clinical response and which patients achieve benefit remains a difficult question to answer with no conclusive data available.Baseline characteristics of COPD patients, such as degree of breathlessness, body weight and arterial partial pressure of oxygen, generally appear to be too direct to have a correlation with improvement of post-rehabilitation outcomes. Furthermore, some additional benefits of patients treated with rehabilitation are simply not detected by usual measures (social interaction, sleep quality and confidence).Although there are some data suggesting that some medical conditions frequently associated with COPD (osteoporosis, metabolic syndrome and heart diseases) may negatively influence rehabilitation outcomes, at present the evidence is contradictory.

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Medical Comorbidity and Rehabilitation Efficiency in Geriatric Inpatients

Cited by 138 publications

References 27 publications

Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture

Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture

Confiabilidade e validade da escala de depressão geriátrica em idosos com doença arterial coronariana

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