COGNITIVE STATUS AND AMBULATORY REHABILITATION OUTCOME IN GERIATRIC PATIENTS

Objective: To determine the effect of admission cognitive status on gait and stair climbing rehabilitation outcome in geriatric patients. Design: Before-after trial. Subjects: A total of 179 geriatric patients (139 women and 40 men; age range 67-97 years) consecutively admitted to a geriatric inpatient rehabilitation regimen (mean length of stay 28.7 (standard deviation 13.9) days). Methods: Assessment of admission cognitive status by the Mini-Mental State Examination (MMSE); determination of the ambulatory status before and after rehabilitation by the Performance-Oriented Mobility Assessment (POMA) and standardized judgements about stair climbing ability. Results: Approximately two-thirds of the patients demonstrated functional ability improvements in at least 5 points at the individual level during rehabilitation (as measured by the total POMA scale (POMA-T)). However, at rehabilitation discharge cognitively impaired patients still demonstrated a 3.4 times (95% confidence interval = 1.4-8.6) higher chance of increased fall risk and only 240% of the cohort was able to negotiate stairs with slight or no limitations. Conclusion: Although cognitively impaired patients demonstrated an functional overall intervention response comparable with cognitively intact patients the present study evidenced that the geriatric cohort with reduced mental status (MMSE < 17) are at greater risk of failing and have a greater need for supervision, both in hospital and at discharge.