Physical Therapy and Discharge Disposition Following Acute Hospitalization for UTI in Community-Dwelling Older Adults

Abstract

Background: Bed rest during acute hospitalization is associated with new-onset mobility impairments in community-dwelling older adults, resulting in discharge to skilled nursing facilities rather than home. Purpose: The purpose of this retrospective study is to determine whether the number of physical therapy (PT) visits is related to discharge disposition following an acute hospitalization for urinary tract infection (UTI) in the older adult population. Methods: Medical records over a 3-year period of 523 community-dwelling older adults (65 years and older) admitted from home functionally independent were reviewed. Demographic and patient characteristics, including age, gender, living status, length of stay (LOS), discharge disposition, and the number of PT visits, were collected. Multinomial regression was conducted to determine predictors of disposition. Results:The multinomial logistic regression model was statistically significant, χ 2 (2) = 6.90, P = .032. Older age, longer LOS with fewer PT visits during acute hospitalization, and a higher comorbidity score were significant predictors of hospital discharge to subacute rehabilitation facilities than those who were able to return home with home health PT. These variables were not predictors of the disposition for younger patients with fewer comorbidities. Limitations: Due to the retrospective nature of this study, assessment of potential preexisting levels of frailty, standardized delivery of PT, and level of activity outside of PT could not be performed. Conclusions: Reduced frequency of physical therapist intervention for older adults hospitalized with UTI was associated with discharge to rehabilitation in a skilled nursing facility compared with those of similar age with increased PT intervention frequency.Multimorbidity, which is a common occurrence with aging, significantly increases the risk of mobility impairments. 7,8 For the older adult, staying in bed for as little as half a day represents an increased risk of developing a new-onset disability. 9 With nearly 70% of older adults being discharged from hospitals below their prior level of function, researchers forecast exponential growth in disability, compounding the rate of health care spending for the senior population over the next decade. [10][11][12] Immobility during a hospital stay accounts for approximately 50% of previously independent community-dwelling older adults discharging to a skilled nursing facility rather than returning home. This postacute care disposition increases the cost of each episode of care for both patients and payers. 5,[13][14][15] When older adults are discharged from acute care hospitals to skilled nursing facilities, they are less likely to recover preadmission levels of function and are at risk of being permanently institutionalized. 15,16 Even more alarming is the high 1-year mortality rate following the hospitalization of older adults. 17 Baztan et al 17 reported that 32.6% of community-dwelling older adults died within 1 year of hospitalization due to acute illne...