Predictors of successful rehabilitation in geriatric patients: subgroup analysis of patients with cognitive impairment.
OBJECTIVE
Understanding which patients benefit from rehabilitation programs may be useful in balancing resources and needs. The aim of this study was to evaluate whether cognitive and nutritional status are associated with functional improvement after rehabilitation in old persons.


METHODS
2650 patients (aged > or =60 years) consecutively admitted to a geriatric rehabilitation unit in Italy between August 2001 and December 2005, were included. Functional status was evaluated with the Tinetti scale, cognitive status with the Mini-Mental State Examination (MMSE), and nutritional status with the Mini-Nutritional Assessment Short Form (MNA-SF). To identify predictors of functional recovery, multiple logistic regression models were run, with improvement on the Tinetti scale score as dependent variable.


RESULTS
Eighty per cent of old persons functionally improved after rehabilitation, ranges being 84% of those with MMSE> or =24 to 58% of those with MMSE<10. Persons with both good cognition and good nutritional status were most likely to improve [odds ratio (OR)=2.5; 95% confidence interval (95% CI)=1.9-3.2]. Stratifying the sample according to cognitive status, we found that in patients with MMSE> or =18 better nutritional status emerged as a factor associated with functional improvement, whereas in patients with severe cognitive impairment (MMSE<18), the only associated factor was a higher MMSE score.


CONCLUSIONS
The results of the present study suggest that both good cognition and good nutritional status are associated with functional improvement in older persons. However, patients with poor cognition can also improve, depending on their degree of cognitive impairment, and they should not be routinely excluded from rehabilitation.
Ghisla
Maria Karin
MK
Geriatric Evaluation and Rehabilitation Unit, Richiedei Foundation, Gussago (Brescia), Italy.
Cossi
Stefania
S
Timpini
Annalisa
A
Baroni
Fiorenzo
F
Facchi
Emanuela
E
Marengoni
Alessandra
A
D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003072:Cognition Disorders / Q000145:classification / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009043:Motor Activity; D009752:Nutritional Status