title: Predictive Value of Gait Speed and Frailty Indicators on Survival Time and Time Until Discharge to Home in Ambulant Older Patients in a Specialized Rehabilitation Center.
abstract: OBJECTIVE
  "Frailty" is a frequently used term in both scientific research and clinical practice, but it has proven to be difficult to recognize and measure frailty. In this study, we aim to identify variables related to frailty as simple and unambiguous predictors of time until discharge to home and until mortality for ambulant individuals residing in a rehabilitation center for older people.
  
  
  METHODS
  This was a longitudinal cohort study. We included data on people admitted to a Dutch rehabilitation center for older people between September 15, 2013, and September 10, 2014 (n = 389). At admission, we collected data regarding participants' demography, details of their admission and origin as well as their gait speed. We also asked both participants and their physiotherapists whether the patients experienced problems as a consequence of fatigue, mobility, balance, or unintentional weight loss (yes/no), which are considered to be indicators of frailty. Date of discharge or death was recorded upon occurrence. We used survival analyses to establish associations between frailty indicators and gait speed with time until death and time until discharge to home.
  
  
  CONCLUSIONS
  We found associations between patients' and physiotherapists' reports regarding indicators of frailty with mortality and discharge to home. Although patients' and physiotherapists' scores were strongly correlated, the physiotherapists' scores proved to be more accurate in predicting time until discharge to home and mortality. Time until death was best predicted by the physiotherapists' report that a patient was fatigued (hazard ratio = 4.09; 95% confidence interval = 1.41-11.83; P < .01). Time until discharge to home was strongly related to physiotherapists' reports of unintentional weight loss in the patient (hazard ratio = 0.67; 95% confidence interval = 0.48-0.95; P < .05). We did not find a relationship between gait speed and time until death and discharge to home.
  
  
  CONCLUSIONS
  Simple yes/no reports by physiotherapists at the time of admission regarding patients feeling fatigued and losing weight unintentionally showed strong associations with time until death and time until discharge to home. These simple questions could be used for screening at admission to identify people at risk of prolonged rehabilitation and mortality.
authors: 1Department of Research and Development, Argos Zorggroep, Schiedam, the Netherlands. 2Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands. 3Department of Paramedical Services, Argos Zorggroep, Schiedam, the Netherlands. 4Department of Faculty of Health, Sports, and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands. 5Department of Research and Development, Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.
authors: Eva
authors: E
authors: van der Ploeg
authors: Yvette
authors: Y
authors: van der Velde
authors: Robbert
authors: R
authors: Gobbens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D016330:Frail Elderly; D000073496:Frailty / Q000401:mortality / Q000534:rehabilitation*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D026741:Physical Therapy Modalities; D012047:Rehabilitation Centers; D013997:Time Factors; D000072797:Walking Speed / Q000502:physiology*