Predictors of rehabilitation outcome among frail elderly patients living in the community.
OBJECTIVE
Physical therapy is frequently offered to community-dwelling frail elderly as part of home care rehabilitation programs. A better knowledge of predictors of rehabilitative success could allow a better targeting of limited resources. The purpose of this study is to evaluate the association of medical indicators of health status on functional recovery during rehabilitation of frail elderly living in the community.


METHODS
Subjects included 598 patients aged 70 years or more admitted consecutively to a home care rehabilitation program from January 2004 to December 2004.


METHODS
A comprehensive geriatric multidisciplinary evaluation was offered to all patients, based on the Minimum Data Set for Home Care (MDS-HC) assessment form. Predictors of functional recovery were identified by a multiple logistic regression model. Data analyses were based on the items contained in the MDS-HC form.


RESULTS
An improvement in ADL score was seen in 33% of patients, while the others remained unchanged or worsened. In multivariate analysis the negative predictors of functional improvement were as follows: cognitive impairment (OR 0.67; CI 0.60-0.74), depression (OR 0.89, CI 0.82-0.96), visual (OR 0.32, CI 0.21-0.50) and hearing impairment (OR 0.42, CI 0.27-0.67), and urinary (OR 0.21, CI 0.14-0.33) and bowel incontinence (OR 0.16, CI 0.10-0.26).


CONCLUSIONS
Cognitive impairment, depressed mood, sensory impairment, and incontinence are key factors that need to be assessed in order to individuate patients at risk of failure in rehabilitation. A targeted intervention in these areas could offer the opportunity of improving rehabilitation outcome.
Fusco
Domenico
D
Department of Gerontology and Geriatrics, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, Rome, Italy.
Bochicchio
Giovanni B
GB
Onder
Graziano
G
Barillaro
Christian
C
Bernabei
Roberto
R
Landi
Francesco
F
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006305:Health Status Indicators; D006699:Home Care Services; D006801:Humans; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012046:Rehabilitation