Predictive role of single diseases and their combination on recovery of balance and gait in disabled elderly patients.
OBJECTIVE
In the elderly population, chronic diseases are common determinants of mobility limitations and comorbidity consistently shows a strong association with functional status. This study was designed to evaluate the role of single chronic diseases and of their combination on functional recovery after rehabilitative treatment in disabled elderly patients.


METHODS
With respect to the difference in magnitude of their disabling effect, diseases were classified into 2 groups: "more disabling" diseases (COPD, heart failure, peripheral artery diseases, diabetes, and not life-threatening cancer) and "less disabling" diseases (anemia, kidney, gastrointestinal, and liver diseases).


METHODS
35-bed Geriatric Evaluation and Rehabilitation Unit.


METHODS
We studied 710 patients (age 77.8 +/- 7.4 years, 76.2% females), consecutively admitted for stroke, Parkinson's disease, and osteoarthritis.


METHODS
A multidimensional evaluation for mobility (Tinetti-score), cognitive status (MMSE), and somatic health (Greenfield's Individual Disease Severity Index-IDS, Burden of diseases-BoD) was performed. Functional recovery was decided based on the Delta-Tinetti, which is the difference of the values between admission and discharge.


RESULTS
We tested, in a multivariate regression model, the predictive role of single chronic conditions and of their combinations on functional recovery, after having adjusted for which diseases are direct causes of disability (stroke, Parkinson's disease, and osteoarthritis) and other potential predictors (age, sex, cognitive function, depressive symptoms, albumin, and c-reactive protein). A negative prediction of functional recovery was expressed by the "more disabling" diseases group. The determinants of poor recovery were characterized by the combination of "more disabling diseases" rather than single condition effects, independently by age, cognitive, and functional status on admission.


CONCLUSIONS
Our study adds a new perspective about the role of COPD, heart failure, peripheral artery diseases, diabetes and not life-threatening cancer on functional recovery, emphasizing their combined impact in elderly people.
Di Fazio
Ignazio
I
Geriatric Evaluation and Rehabilitation Unit Richiedei Hospital, Palazzolo s/O, and Geriatric Research Group, Brescia, Italy. i.difazio@tiscali.it
Franzoni
Simone
S
Frisoni
Giovanni B
GB
Gatti
Simonetta
S
Cornali
Cristina
C
Stofler
Paolo M
PM
Trabucchi
Marco
M
D000203:Activities of Daily Living; D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D017281:Cost of Illness; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D016330:Frail Elderly; D005684:Gait; D015577:Geriatric Assessment; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D051346:Mobility Limitation; D015999:Multivariate Analysis; D010003:Osteoarthritis / Q000150:complications; D010300:Parkinson Disease / Q000150:complications; D004856:Postural Balance; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012678:Sensation Disorders / Q000209:etiology / Q000534:rehabilitation*; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications