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Original article

Vol. 150 No. 0910 (2020)

Do older adults benefit from post-acute care following hospitalisation? A prospective cohort study at three Swiss nursing homes

  • Marion Thalmann
  • Thomas Tröster
  • Karina Fischer
  • Gabriela Bieri-Brüning
  • Patrick E. Beeler
  • Heike A. Bischoff-Ferrari
  • Michael Gagesch
DOI
https://doi.org/10.4414/smw.2020.20198
Cite this as:
Swiss Med Wkly. 2020;150:w20198
Published
24.02.2020

Summary

BACKGROUND

Post-acute care (PAC) programmes appear favourable for older adult inpatients too fragile to be discharged home without extensive support, but otherwise not qualifying for specific rehabilitation. Consequently, many Swiss nursing homes have opened PAC wards after a new federal law refined reimbursement in 2012. However, PAC outcomes in this setting have not been well studied.

OBJECTIVE

To investigate the functional outcomes of a nursing home-based PAC programme for older adult patients and to evaluate the influences of age, gender and frailty status on these outcomes.

METHODS

This was a prospective cohort study in 135 consecutive patients aged 60 and older admitted to PAC at three nursing homes in Zurich, Switzerland, over a two-month period. Geriatric assessment at admission included mobility, physical performance, cognition, nutrition, frailty, activities of daily living (ADL) and social support. The primary outcomes of the study, Short Physical Performance Battery (SPPB), handgrip strength (HGS) and Barthel Index (BI), were repeated before discharge from PAC. Multivariable linear models were used to analyse differences between these primary outcomes at admission and discharge, adjusting for baseline age, gender, BMI, length of stay (LOS), polypharmacy, cognition, and prior living status.

RESULTS

We identified statistically significant improvements between admission and discharge (mean [95% confidence interval]; % change) in BI (69.0 [65.0–72.9] vs 79.6 [75.6–83.6]; +15.4%), gait speed (0.55 [0.48–0.62] vs 0.65 [0.58–0.71] m/s; +18.2%) and SPPB scores (5.5 [5.0–6.1] vs 6.9 [6.3–7.4]; +24%), p-values for all comparisons <0.001.

CONCLUSIONS

In this real-word sample, PAC resulted in a significant and clinically relevant improvement in physical performance and ADL. However, our study should be replicated with a larger sample. Furthermore, long-term outcomes of PAC warrant additional investigation.

References

  1. Population Reference Bureau. America’s Aging Population. Washington, DC: Population Reference Bureau; 2011.
  2. Ageing Working Group of the Economic Policy Committee and European Commission’s Directorate-General for Economic and Financial Affairs. The 2018 Ageing Report., Luxembourg: Publications Office of the European Union; 2017.
  3. Bundesamt für Statistik. Medizinische Statistik der Krankenhäuser 2014 – Standardtabellen. Neuchâtel: Bundesamt für Statistik; 2016. p. 60.
  4. Gächter T, Leu A, Elger B. 365 Tage SwissDRG: Anreize, Instrumente, Wirkungen. 2013.
  5. Theou O, Squires E, Mallery K, Lee JS, Fay S, Goldstein J, et al. What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr. 2018;18(1):139. doi:.https://doi.org/10.1186/s12877-018-0823-2
  6. Abrahamsen JF, Haugland C, Nilsen RM, Ranhoff AH. Three Different Outcomes in Older Community-dwelling Patients Receiving Intermediate Care in Nursing Home after Acute Hospitalization. J Nutr Health Aging. 2016;20(4):446–52. doi:.https://doi.org/10.1007/s12603-015-0592-y
  7. Busato A, von Below G. The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective. Health Res Policy Syst. 2010;8(1):31. doi:.https://doi.org/10.1186/1478-4505-8-31
  8. Koné I, Zimmermann B, Wangmo T, Richner S, Weber M, Elger B. Hospital discharge of patients with ongoing care needs: a cross-sectional study using data from a city hospital under SwissDRG. Swiss Med Wkly. 2018;148:w14575.
  9. Bundesamt für Gesundheit. Kennzahlen der Schweizer Pflegeheime 2016, BAG, ed. Bern: Schweizerische Eidgenossenschaft; 2016.
  10. Young J, Green J, Forster A, Small N, Lowson K, Bogle S, et al. Postacute care for older people in community hospitals: a multicenter randomized, controlled trial. J Am Geriatr Soc. 2007;55(12):1995–2002. doi:.https://doi.org/10.1111/j.1532-5415.2007.01456.x
  11. Chen LK, Chen YM, Hwang SJ, Peng LN, Lin MH, Lee WJ, et al.; Longitudinal Older Veterans Study Group. Effectiveness of community hospital-based post-acute care on functional recovery and 12-month mortality in older patients: a prospective cohort study. Ann Med. 2010;42(8):630–6. doi:.https://doi.org/10.3109/07853890.2010.521763
  12. Lee WJ, Peng LN, Cheng YY, Liu CY, Chen LK, Yu HC. Effectiveness of short-term interdisciplinary intervention on postacute patients in Taiwan. J Am Med Dir Assoc. 2011;12(1):29–32. doi:.https://doi.org/10.1016/j.jamda.2010.01.002
  13. Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM. Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ. 2010;340(apr20 2):c1718. doi:.https://doi.org/10.1136/bmj.c1718
  14. Singh I, Gallacher J, Davis K, Johansen A, Eeles E, Hubbard RE. Predictors of adverse outcomes on an acute geriatric rehabilitation ward. Age Ageing. 2012;41(2):242–6. doi:.https://doi.org/10.1093/ageing/afr179
  15. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98. doi:.https://doi.org/10.1016/0022-3956(75)90026-6
  16. Thalmann B, Spiegel R, Monsch AU. Dementia Screening in General Practice: Optimised Scoring for the Clock Drawing Test. Brain Aging. 2002;2(2):36–43.
  17. Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001;56(6):M366–72. doi:.https://doi.org/10.1093/gerona/56.6.M366
  18. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94. doi:.https://doi.org/10.1093/geronj/49.2.M85
  19. Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000;55(4):M221–31. doi:.https://doi.org/10.1093/gerona/55.4.M221
  20. Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J. 1965;14:61–5.
  21. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al.; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56. doi:.https://doi.org/10.1093/gerona/56.3.M146
  22. Seematter-Bagnoud L, Lécureux E, Rochat S, Monod S, Lenoble-Hoskovec C, Büla CJ. Predictors of functional recovery in patients admitted to geriatric postacute rehabilitation. Arch Phys Med Rehabil. 2013;94(12):2373–80. doi:.https://doi.org/10.1016/j.apmr.2013.06.024
  23. Baztán JJ, González M, Morales C, Vázquez E, Morón N, Forcano S, et al. Variables asociadas a la recuperación funcional y la institucionalización al alta en ancianos ingresados en una unidad geriátrica de media estancia [Variables associated with functional recovery and post-discharge institutionalization of elderly cared in an average stay geriatric unit]. Rev Clin Esp. 2004;204(11):574–82. Article in Spanish. doi:.https://doi.org/10.1016/S0014-2565(04)71550-7
  24. Salvà A, Roqué M, Vallès E, Bustins M, Bullich I, Sanchez P. Prognostic factors of functional status improvement in individuals admitted to convalescence care units. Eur Geriatr Med. 2015;6(4):341–7. doi:.https://doi.org/10.1016/j.eurger.2014.11.012
  25. Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006;54(5):743–9. doi:.https://doi.org/10.1111/j.1532-5415.2006.00701.x
  26. Kwon S, Perera S, Pahor M, Katula JA, King AC, Groessl EJ, et al. What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study). J Nutr Health Aging. 2009;13(6):538–44. doi:.https://doi.org/10.1007/s12603-009-0104-z
  27. Abizanda P, López MD, García VP, Estrella JD, da Silva González Á, Vilardell NB, et al. Effects of an Oral Nutritional Supplementation Plus Physical Exercise Intervention on the Physical Function, Nutritional Status, and Quality of Life in Frail Institutionalized Older Adults: The ACTIVNES Study. J Am Med Dir Assoc. 2015;16(5):439.e9–16. doi:.https://doi.org/10.1016/j.jamda.2015.02.005
  28. Bohannon RW, Glenney SS. Minimal clinically important difference for change in comfortable gait speed of adults with pathology: a systematic review. J Eval Clin Pract. 2014;20(4):295–300. doi:.https://doi.org/10.1111/jep.12158
  29. Peel NM, Navanathan S, Hubbard RE. Gait speed as a predictor of outcomes in post-acute transitional care for older people. Geriatr Gerontol Int. 2014;14(4):906–10. doi:.https://doi.org/10.1111/ggi.12191
  30. Roberts PS, Goud M, Aronow HU, Riggs RV. Frailty in a Post-Acute Care Population: A Scoping Review. PM R. 2018;10(11):1211–20. doi:.https://doi.org/10.1016/j.pmrj.2018.03.009

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