Predictors of rehabilitation outcomes in frail patients treated in a geriatric hospital

OBJECTIVES: To evaluate the effect of medical indicators of health status on functional gain during rehabilitation of frail older patients. DESIGN: Observational study. SETTING: A hospital geriatric rehabilitation department (Catholic University of Rome). PARTICIPANTS: Two hundred forty-four older patients admitted consecutively for rehabilitation after acute illnesses between March 1999 and June 2000. MEASUREMENTS: Patients were evaluated with the Minimum Data Set for Post-Acute Care (MDS-PAC) assessment form soon after the admission and every 2 weeks thereafter. Two summary scales based on MDS-PAC items are designed to describe the performance in personal activities of daily living (ADLs) and the level of cognitive function (Cognitive Performance Scale). To identify predictors of functional recovery, we constructed a multiple logistic regression model having as a dependent variable the improvement of one or more points in the ADL scale. RESULTS: Patients aged 85 and older with cognitive or sensory impairment were less likely to significantly improve physical functioning after an intensive rehabilitation program. However, the cognitive impairment was the only "negative" factor that remained significant in a multivariable model (odds ratio = 0.36, 95% confidence interval = 0.14-0.92) after adjusting for several potential negative predictors. CONCLUSIONS: The results of the present study document that severe cognitive impairment may be considered a negative predictor of functional recovery after a period of intensive rehabilitation. However, the effectiveness of such a rehabilitation program in patients with dementia is controversial. Additional studies are necessary to better clarify the effect of cognitive impairment on the potential recovery of the older subjects after a period of rehabilitation and whether this is influenced by different pathologies.