Vol. 150 No. 2526 (2020)
Frailty, underweight and impaired mobility are associated with institutionalisation after post-acute care
AIMS OF THE STUDY
Post-acute care (PAC) is intended for older adult patients who are unable to return home directly after acute hospitalisation but who do not otherwise qualify for specific rehabilitation. However, data on potential predictors of PAC outcomes remain limited. Our aim was to identify patient characteristics upon admission to PAC that are associated with subsequent institutionalisation.
Prospective cohort study enrolling 140 former acute care inpatients aged 60 and older who were referred to PAC units at nursing homes in Zurich, Switzerland.
Geriatric assessment at admission included Barthel Index (BI), Short Physical Performance Battery (SPPB), frailty status (Fried phenotype), nutrition and cognitive status. Logistic regression was used to determine statistically significant associations.
Mean age was 84.1 (standard deviation [SD] 8.6) years; 62.9% of participants were women. Mean body mass index (BMI) was 25.0 (SD 5.8) kg/m2, with 12.1% being underweight (BMI <20 kg/m2). Mean BI at admission was 62.1 (SD 19.1), mean SPPB score was 5.2 (SD 2.8), and 55% were frail (≥3 Fried criteria present). After a mean length of stay in PAC of 30.9 (SD 16.5) days, 48.6% were institutionalised. Patients who were frail at admission had a 2.97-fold higher (odds ratio [OR] 2.9,7 95% confidence interval [CI] 1.04–8.42), and patients who were underweight had a 4.94-fold higher (OR 4.94, 95% CI 1.11–22.01) chance of institutionalisation. Conversely, each points increment on the SBBP score lowered the likelihood of institutionalisation by 23% (OR 0.77, 95% CI 0.65–0.92).
Frailty, low SPPB score and being underweight at admission to PAC were significantly associated with a higher chance of subsequent institutionalisation. Strategies to improve these factors could improve PAC outcomes.
- Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822–8. doi:.https://doi.org/10.1001/archinte.166.17.1822
- Manville M, Klein MC, Bainbridge L. Improved outcomes for elderly patients who received care on a transitional care unit. Can Fam Physician. 2014;60(5):e263–71.
- Botschaft zum Bundesgesetz über die Neuordnung der Pflegefinanzierung vom 16 Februar 2005. Swiss Federal Gazette, 05.025:2033–94.
- Umsetzung des Bundesgesetzes über die Neuordnung der Pflegefinanzierung vom 13. Juni 2008 in den Kantonen - Erläuternder Bericht vom 3. Oktober 2013. In: Gesundheit Bf, editor. Bern: BAG; 2013. p. 1–80.
- 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.
- 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
- Abrahamsen JF, Haugland C, Nilsen RM, Ranhoff AH. Predictors for return to own home and being alive at 6months after nursing home intermediate care following acute hospitalization. Eur Geriatr Med. 2014;5(2):108–12. doi:.https://doi.org/10.1016/j.eurger.2013.10.012
- 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
- Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62. doi:.https://doi.org/10.1016/S0140-6736(12)62167-9
- Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–7. doi:.https://doi.org/10.1016/j.jamda.2013.03.022
- 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
- Thalmann M, Tröster T, Fischer K, Bieri-Brüning G, Beeler PE, Bischoff-Ferrari HA, et al. Do older adults benefit from post-acute care following hospitalisation? A prospective cohort study at three Swiss nursing homes. Swiss Med Wkly. 2020;150:w20198. doi:.https://doi.org/10.4414/smw.2020.20198
- 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
- Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J. 1965;14:61–5.
- 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
- Berres M, Monsch AU, Bernasconi F, Thalmann B, Stähelin HB. Normal ranges of neuropsychological tests for the diagnosis of Alzheimer’s disease. Stud Health Technol Inform. 2000;77:195–9.
- Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, et al. Overview of the MNA--Its history and challenges. J Nutr Health Aging. 2006;10(6):456–63, discussion 463–5.
- Sergi G, Perissinotto E, Pisent C, Buja A, Maggi S, Coin A, et al.; ILSA Working Group. An adequate threshold for body mass index to detect underweight condition in elderly persons: the Italian Longitudinal Study on Aging (ILSA). J Gerontol A Biol Sci Med Sci. 2005;60(7):866–71. doi:.https://doi.org/10.1093/gerona/60.7.866
- WHO. Obesity and overweight. http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Geneva: World Health Organization; 2018 [cited 2018 October 2].
- Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The Delirium Observation Screening Scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003;17(1):31–50. doi:.https://doi.org/10.1891/rtnp.22.214.171.124169
- Buta BJ, Walston JD, Godino JG, Park M, Kalyani RR, Xue QL, et al. Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev. 2016;26:53–61. doi:.https://doi.org/10.1016/j.arr.2015.12.003
- Lee Y-S, Lin C-S, Jseng Y-H, Luo T-W, Hung P-J, Wu M-C, et al. Predictive factors for patients discharged after participating in a post-acute care program. Journal of Clinical Gerontology and Geriatrics. 2012;3(1):25–8. doi:.https://doi.org/10.1016/j.jcgg.2011.11.008
- Mattila K, Haavisto M, Rajala S. Body mass index and mortality in the elderly. Br Med J (Clin Res Ed). 1986;292(6524):867–8. doi:.https://doi.org/10.1136/bmj.292.6524.867-a
- Grabowski DC, Ellis JE. High body mass index does not predict mortality in older people: analysis of the Longitudinal Study of Aging. J Am Geriatr Soc. 2001;49(7):968–79. doi:.https://doi.org/10.1046/j.1532-5415.2001.49189.x
- Bongue B, Buisson A, Dupre C, Beland F, Gonthier R, Crawford-Achour É. Predictive performance of four frailty screening tools in community-dwelling elderly. BMC Geriatr. 2017;17(1):262. doi:.https://doi.org/10.1186/s12877-017-0633-y
- Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487–92. doi:.https://doi.org/10.1111/j.1532-5415.2012.04054.x
- Fairhall N, Sherrington C, Kurrle SE, Lord SR, Lockwood K, Cameron ID. Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: randomised controlled trial. BMC Med. 2012;10(1):120. doi:.https://doi.org/10.1186/1741-7015-10-120
- 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
- Puts MTE, Toubasi S, Andrew MK, Ashe MC, Ploeg J, Atkinson E, et al. Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies. Age Ageing. 2017;46(3):383–92. doi:.https://doi.org/10.1093/ageing/afw247