title: Clinical instability as a predictor of negative outcomes among elderly patients admitted to a rehabilitation ward.
abstract: OBJECTIVE
  To assess the impact of clinical instability (CI) and delirium on admission to a rehabilitation unit on clinical and functional outcomes (death, transfer to acute care, poor functional recovery) at discharge, in a population of elderly patients.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Rehabilitation and Aged Care Unit (RACU).
  
  
  METHODS
  Participants were 583 consecutively and firstly admitted elderly patients.
  
  
  METHODS
  On admission, all patients underwent a comprehensive geriatric assessment including sociodemographics, cognitive and depressive symptoms, nutritional status, physical health, and functional status. CI was recorded for all patients on admission, assessing 5 vital signs (temperature, heart rate, systolic blood pressure, respiratory rate, and oxygen saturation). Delirium was assessed daily with the Confusion Assessment Method.
  
  
  RESULTS
  Patients were on average old (mean age: 77.8 +/- 9.8), predominantly female (68.6%), with mild cognitive deterioration (MMSE: 22.1 +/- 6.3) and depressive symptoms (GDS: 5.9 +/- 3.5). They had moderate comorbidity (means CIRS: 3.1 +/- 1.9), and functional impairment both before (Barthel Index pre-admission: 84.5 +/- 19.2; IADL: 3.3 +/- 3.0) and on admission (Barthel Index: 55.8 +/- 27.5). On admission, 136 (23.3%) patients were classified as clinically unstable: 76 (13%) had either CI or delirium, and 60 (10.3%) had CI associated to delirium. At discharge, 26 patients were transferred to acute care hospitals, and 14 died. Transfer to acute care occurred in more than 10% of patients with almost one altered condition (CI or delirium), and in one fifth of patients with the association of CI and delirium. In-RACU death was observed only in this latter group. Functional recovery at discharge was significantly higher in stable patients than in patients with CI and/or delirium.
  
  
  CONCLUSIONS
  CI and delirium are useful prognostic markers of adverse clinical and functional outcomes in a population of elderly subjects admitted to a rehabilitative unit.
authors.affiliation: Rehabilitation and Aged Care Unit "Ancelle della Carità" Hospital, Cremona, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Guerini
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Frisoni
authors.forename: Sara
authors.initials: S
authors.lastname: Morghen
authors.forename: Salvatore
authors.initials: S
authors.lastname: Speciale
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellelli
authors.forename: Marco
authors.initials: M
authors.lastname: Trabucchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium; D005260:Female; D005544:Forecasting; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D019370:Observation; D010361:Patients; D012047:Rehabilitation Centers; D016896:Treatment Outcome