Trends in Function and Postdischarge Mortality in a Medicine for the Elderly Rehabilitation Center Over a 10-Year Period

Witham, Miles D.; Ramage, L.; Burns, Suzanne L; Gillespie, Neil D.; Hanslip, J.; Laidlaw, Simon; Leslie, Carolyn A.; McMurdo, Marion E. T.

doi:10.1016/j.apmr.2011.02.019

Cited by 10 publications

(5 citation statements)

References 15 publications

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“…Mortality data were obtained using death certification information derived from Scottish Register Officer. This cohort has been described in detail previously [ 12 – 14 ].…”

Section: Methodsmentioning

confidence: 99%

Causes and correlates of 30 day and 180 day readmission following discharge from a Medicine for the Elderly Rehabilitation unit

Hughes

Witham

2018

BMC Geriatr

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BackgroundRecently hospitalized patients experience a period of generalized risk of adverse health events. This study examined reasons for, and predictors of, readmission to acute care facilities within 30 and 180 days of discharge from an inpatient rehabilitation unit for older people.MethodsRoutinely collected, linked clinical data on admissions to a single inpatient rehabilitation facility over a 13-year period were analysed. Data were available regarding demographics, comorbid disease, admission and discharge Barthel scores, length of hospital stay, and number of medications on discharge. Discharge diagnoses for the index admission and readmissions were available from hospital episode statistics. Univariate and multivariate Cox regression analyses were performed to identify baseline factors that predicted 30 and 180-day readmission.ResultsA total of 3984 patients were included in the analysis. The cohort had a mean age of 84.1 years (SD 7.4), and 39.7% were male. Overall, 5.6% (n = 222) and 23.2% (n = 926) of the patients were readmitted within 30 days and 180 days of discharge respectively. For patients readmitted to hospital, 26.6% and 21.1% of patients were readmitted with the same condition as their initial admission at 30 days and 180 respectively. For patients readmitted within 30 days, 13.5% (n = 30) were readmitted with the same condition with the most common diagnoses associated with readmission being chest infection, falls/immobility and stroke. For patients readmitted within 180 days, 12.4% (n = 115) of patients were readmitted with the same condition as the index condition with the most common diagnoses associated with readmission being falls/immobility, cancer and chest infections. In multivariable Cox regression analyses, older age, male sex, length of stay and heart failure predicted 30 or 180-day readmission. In addition, discharge from hospital to patients own home predicted 30-day readmission, whereas diagnoses of cancer, previous myocardial infarction or chronic obstructive pulmonary disease predicted 180-day readmission.ConclusionMost readmissions of older people after discharge from inpatient rehabilitation occurred for different reasons to the original hospital admission. Patterns of predictors for early and late readmission differed, suggesting the need for different mitigation strategies.

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“…Mortality data were obtained using death certification information derived from Scottish Register Officer. This cohort has been described in detail previously [ 12 – 14 ].…”

Section: Methodsmentioning

confidence: 99%

Causes and correlates of 30 day and 180 day readmission following discharge from a Medicine for the Elderly Rehabilitation unit

Hughes

Witham

2018

BMC Geriatr

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“…The study cohort was derived from a group of older patients who underwent inpatient rehabilitation over a 12 year period (from January 1999 to December 2011) in the Dundee Medicine for the Elderly service; details of the service and of a subset of the cohort have been published previously 7 . Patients were transferred to the rehabilitation unit after recovery from acute illness including stroke, fractures, general medical or general surgical illness.…”

Section: Study Populationmentioning

confidence: 99%

Association Between Kidney Function, Rehabilitation Outcome, and Survival in Older Patients Discharged From Inpatient Rehabilitation

Doyle

Sloan

Goodbrand

et al. 2015

American Journal of Kidney Diseases

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“…We analysed routinely collected, linked datasets on a cohort of older people who had undergone inpatient rehabilitation following acute illness over a 12 year period. The study population has been described before [ 8 – 9 ]. Individuals included in the study were all above 65 years of age, and had survived an initial acute hospital admission under the Medicine for the Elderly service in Ninewells Hospital, Dundee before undergoing inpatient rehabilitation under this service between 1999 and 2011.…”

Section: Methodsmentioning

confidence: 99%

Slower Decline in C-Reactive Protein after an Inflammatory Insult Is Associated with Longer Survival in Older Hospitalised Patients

et al. 2016

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BackgroundEnhancing biological resilience may offer a novel way to prevent and ameliorate disease in older patients. We investigated whether changes in C-reactive protein (CRP), as a dynamic marker of the acute inflammatory response to diverse stressors, may provide a way to operationalize the concept of resilience in older adults. We tested this hypothesis by examining whether such changes could predict prognosis by identifying which individuals are at greater risk of 6-month mortality.MethodsAnalysis of prospective, routinely collected datasets containing data on hospitalization, clinical chemistry and rehabilitation outcomes for rehabilitation inpatients between 1999 and 2011. Maximum CRP response during acute illness and CRP recovery indices (time and slope of CRP decay to half maximum, and to <50mg/L if peak values were greater than 50mg/L) was derived from biochemistry data. 6-month survival plots were conducted on quartiles of CRP recovery indices. Cox proportional hazards models were used to test univariate and multivariate predictors of 6-month mortality. Covariates included age, sex, number of medications, serum calcium, haemoglobin level, renal function, and the presence of previous myocardial infarction, stroke, chronic heart failure, COPD and diabetes.Results3723 patients, mean age 84 years, were included. 1535 (41%) were male and 733 (20%) died during six-month follow-up. The lower an individual’s peak CRP reading, and the longer the time taken for their CRP to fall, the better their 6-month survival. The time for CRP to reach half of its maximum value was the best dynamic CRP index of survival (HR 0.93 per week, 95% CI 0.89 to 0.98; p = 0.004); this remained significant even after adjustment for maximum CRP level and covariates listed above.ConclusionCRP recovery indices are associated with survival in older people; further work is required to explain differences in physiology between patients with a fast and slow CRP recovery.

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Trends in Function and Postdischarge Mortality in a Medicine for the Elderly Rehabilitation Center Over a 10-Year Period

Cited by 10 publications

References 15 publications

Causes and correlates of 30 day and 180 day readmission following discharge from a Medicine for the Elderly Rehabilitation unit

Causes and correlates of 30 day and 180 day readmission following discharge from a Medicine for the Elderly Rehabilitation unit

Association Between Kidney Function, Rehabilitation Outcome, and Survival in Older Patients Discharged From Inpatient Rehabilitation

Slower Decline in C-Reactive Protein after an Inflammatory Insult Is Associated with Longer Survival in Older Hospitalised Patients

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