title: A prospective observational study of outcomes from rehabilitation of elderly patients with moderate to severe cognitive impairment.
abstract: OBJECTIVE
  To evaluate rehabilitation outcomes in patients with moderate to severe cognitive impairment.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Rehabilitation unit for older people.
  
  
  METHODS
  A total of 116 patients (70F) mean age (SD) 86.3 (6.4). Group 1: 89 patients with moderate cognitive impairment (Mini-Mental State Examination 11-20); and Group 2: 27 patients with severe cognitive impairment (Mini-Mental State Examination 0-10).
  
  
  METHODS
  A personalised rehabilitation plan.
  
  
  METHODS
  Barthel Activity of Daily Living score on admission and discharge, length of stay and discharge destination.
  
  
  RESULTS
  Of 116 patients, 64 (55.2%) showed an improvement in Barthel score. Mini-Mental State Examination was significantly higher in those who improved, 15.4 (SD 3.7) vs.13.2 (SD 5.1): p = 0.01. The mean Barthel score improved in both groups; Group 1 - 14.7 (SD 19.1) vs. Group 2 - 9.3 (SD 16.3): p = 0.17. Of 84 home admissions in Group 1, more patients returning home showed improvements of at least 5 points in the Barthel score compared with nursing/residential home discharges (32/37 - 86.5% vs. 10/28 - 35.7%: p = 0.0001). In Group 2 of 17 home admissions, 6/6 (100%) home discharges showed improvement compared with 3/7 (42.8%) discharges to nursing/residential home (p = 0.07). In Group 1, a discharge home was associated with significantly greater improvement in number of Barthel items than a nursing/residential home discharge (3.27 (SD 2.07) vs. 1.86 (SD 2.32): p = 0.007). A similar non-significant pattern was noted for severe cognitive impairment patients (3.5 (3.06) vs. 1.14 (1.06); p = 0.1).
  
  
  CONCLUSIONS
  Patients with moderate to severe cognitive impairment demonstrated significant improvements in Barthel score and Barthel items showing that such patients can and do improve with rehabilitation.
authors: University of Bournemouth, Poole, UK Royal Bournemouth Hospital, Bournemouth, UK michael.vassallo@rbch.nhs.uk.
authors: Michael
authors: M
authors: Vassallo
authors: University of Bournemouth, Poole, UK Royal Bournemouth Hospital, Bournemouth, UK.
authors: Lynn
authors: L
authors: Poynter
authors: University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors: Joseph
authors: J
authors: Kwan
authors: University of Nottingham, Nottingham, UK.
authors: Jagdish C
authors: JC
authors: Sharma
authors: University of Bournemouth, Poole, UK Royal Bournemouth Hospital, Bournemouth, UK.
authors: Stephen C
authors: SC
authors: Allen
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Activities of daily living; Barthel; barriers to rehabilitation; cognitive impairment; elderly