Outcomes of older persons receiving rehabilitation for medical and surgical conditions compared with hip fracture and stroke.
OBJECTIVE
Older persons with general medical and surgical conditions increasingly receive posthospital rehabilitation care in nursing homes and rehabilitation hospitals. This study describes the characteristics of such patients, contrasted with patients with traditional rehabilitation diagnoses of hip fracture and stroke.


METHODS
Prospective cohort study.


METHODS
Seventeen skilled nursing facilities and six rehabilitation hospitals in seven states.


METHODS
Medicare patients age 65 or older receiving posthospital rehabilitation.


METHODS
A total of 290 medical/surgical patients were compared with 336 hip fracture and 429 stroke patients. Data were collected prospectively from charts, nursing assessments, and patient interviews. Patient characteristics associated with functional recovery and mortality were estimated using multivariate regression.


RESULTS
Medical/surgical patients had greater premorbid activities of daily living (ADL) (P < .001) and instrumental activities of daily living (IADL) (P < .01) disability, but suffered less decline with the acute event than hip fracture or stroke patients (P < .001). Medical/surgical patients were more likely to recover premorbid ADL function (P < .05) but 1-year mortality was significantly greater (30% vs. 14% hip fracture; 18% stroke; P < .001). Predictors of functional recovery and mortality differed between the three groups. Among medical/surgical patients, premorbid ADL difficulty, cognitive impairment, a pressure ulcer at rehabilitation admission, and depression were associated with failure to recover premorbid function whereas increasing comorbidity and incontinence were associated with mortality.


CONCLUSIONS
Medical/surgical patients represent a unique rehabilitation population. They experienced greater premorbid functional disability, less acute decline, but greater mortality than patients with traditional rehabilitation diagnoses. Further study of this distinct rehabilitation population may help identify patients most likely to benefit from rehabilitation.
Johnson
M F
MF
University of Colorado Health Sciences Center, Denver 80262, USA.
Kramer
A M
AM
Lin
M K
MK
Kowalsky
J C
JC
Steiner
J F
JF
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000401:mortality / Q000534:rehabilitation*; D006801:Humans; D016014:Linear Models; D008297:Male; D006278:Medicare; D009026:Mortality; D011183:Postoperative Complications / Q000401:mortality / Q000534:rehabilitation*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012046:Rehabilitation; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D012944:Social Support; D020521:Stroke / Q000401:mortality; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014481:United States