Exercising body and mind: an integrated approach to functional independence in hospitalized older people.
OBJECTIVE
To evaluate the effect of a structured, multi-component, early rehabilitation program on functional status, delirium, and discharge outcomes of older acute medical inpatients.


METHODS
Prospective controlled trial with blinded outcome evaluation.


METHODS
Internal medicine service of a metropolitan tertiary teaching hospital in Brisbane, Australia.


METHODS
One hundred twenty-four consecutive inpatients aged 65 and older admitted from the emergency department to control or intervention medical ward. Exclusions included patients completely dependent before admission or admitted from a nursing home, patients too ill to participate or terminally ill, and patients with length of stay less than 72 hours.


METHODS
Early physiotherapy review with provision of an individualized graduated exercise program and activity diary, progressive encouragement of functional independence by nursing staff and other members of the multidisciplinary team, and cognitive stimulation sessions.


METHODS
Modified Barthel Index (MBI) at admission and discharge, timed up-and-go at admission and discharge, incidence of delirium and falls, measured activity, length of hospital stay, discharge destination, 30-day readmission rate.


RESULTS
Intervention and control participants were well matched in terms of age, sex, diagnosis, and functional status. The intervention group had greater improvement in functional status than the control group, with a median MBI improvement of 8.5 versus 3.5 points (P=.03). In the intervention group, there was a reduction in delirium (19.4% vs 35.5%, P=.04) and a trend to reduced falls (4.8% vs 11.3%, P=.19). Length of stay, timed up-and-go, discharge destination, and readmissions did not differ between the groups.


CONCLUSIONS
This intervention was effective in improving function in a vulnerable patient group.
Mudge
Alison M
AM
Department of Internal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia. Alison_Mudge@health.qld.gov.au
Giebel
Andrea J
AJ
Cutler
Alison J
AJ
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome