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Clinical instability as a predictor of negative outcomes among elderly patients admitted to a rehabilitation ward.
J Am Med Dir Assoc 2010; 11(6):443-8JA

Abstract

OBJECTIVES

To assess the impact of clinical instability (CI) and delirium on admission to a rehabilitation unit on clinical and functional outcomes (death, transfer to acute care, poor functional recovery) at discharge, in a population of elderly patients.

DESIGN

Observational study.

SETTING

Rehabilitation and Aged Care Unit (RACU).

PARTICIPANTS

Participants were 583 consecutively and firstly admitted elderly patients.

MEASUREMENTS

On admission, all patients underwent a comprehensive geriatric assessment including sociodemographics, cognitive and depressive symptoms, nutritional status, physical health, and functional status. CI was recorded for all patients on admission, assessing 5 vital signs (temperature, heart rate, systolic blood pressure, respiratory rate, and oxygen saturation). Delirium was assessed daily with the Confusion Assessment Method.

RESULTS

Patients were on average old (mean age: 77.8 +/- 9.8), predominantly female (68.6%), with mild cognitive deterioration (MMSE: 22.1 +/- 6.3) and depressive symptoms (GDS: 5.9 +/- 3.5). They had moderate comorbidity (means CIRS: 3.1 +/- 1.9), and functional impairment both before (Barthel Index pre-admission: 84.5 +/- 19.2; IADL: 3.3 +/- 3.0) and on admission (Barthel Index: 55.8 +/- 27.5). On admission, 136 (23.3%) patients were classified as clinically unstable: 76 (13%) had either CI or delirium, and 60 (10.3%) had CI associated to delirium. At discharge, 26 patients were transferred to acute care hospitals, and 14 died. Transfer to acute care occurred in more than 10% of patients with almost one altered condition (CI or delirium), and in one fifth of patients with the association of CI and delirium. In-RACU death was observed only in this latter group. Functional recovery at discharge was significantly higher in stable patients than in patients with CI and/or delirium.

CONCLUSIONS

CI and delirium are useful prognostic markers of adverse clinical and functional outcomes in a population of elderly subjects admitted to a rehabilitative unit.

Authors+Show Affiliations

Rehabilitation and Aged Care Unit "Ancelle della Carità" Hospital, Cremona, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20627186

Citation

Guerini, Fabio, et al. "Clinical Instability as a Predictor of Negative Outcomes Among Elderly Patients Admitted to a Rehabilitation Ward." Journal of the American Medical Directors Association, vol. 11, no. 6, 2010, pp. 443-8.
Guerini F, Frisoni GB, Morghen S, et al. Clinical instability as a predictor of negative outcomes among elderly patients admitted to a rehabilitation ward. J Am Med Dir Assoc. 2010;11(6):443-8.
Guerini, F., Frisoni, G. B., Morghen, S., Speciale, S., Bellelli, G., & Trabucchi, M. (2010). Clinical instability as a predictor of negative outcomes among elderly patients admitted to a rehabilitation ward. Journal of the American Medical Directors Association, 11(6), pp. 443-8. doi:10.1016/j.jamda.2009.10.005.
Guerini F, et al. Clinical Instability as a Predictor of Negative Outcomes Among Elderly Patients Admitted to a Rehabilitation Ward. J Am Med Dir Assoc. 2010;11(6):443-8. PubMed PMID: 20627186.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical instability as a predictor of negative outcomes among elderly patients admitted to a rehabilitation ward. AU - Guerini,Fabio, AU - Frisoni,Giovanni B, AU - Morghen,Sara, AU - Speciale,Salvatore, AU - Bellelli,Giuseppe, AU - Trabucchi,Marco, Y1 - 2010/04/02/ PY - 2009/08/05/received PY - 2009/10/17/revised PY - 2009/10/19/accepted PY - 2010/7/15/entrez PY - 2010/7/16/pubmed PY - 2010/11/3/medline SP - 443 EP - 8 JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc VL - 11 IS - 6 N2 - OBJECTIVES: To assess the impact of clinical instability (CI) and delirium on admission to a rehabilitation unit on clinical and functional outcomes (death, transfer to acute care, poor functional recovery) at discharge, in a population of elderly patients. DESIGN: Observational study. SETTING: Rehabilitation and Aged Care Unit (RACU). PARTICIPANTS: Participants were 583 consecutively and firstly admitted elderly patients. MEASUREMENTS: On admission, all patients underwent a comprehensive geriatric assessment including sociodemographics, cognitive and depressive symptoms, nutritional status, physical health, and functional status. CI was recorded for all patients on admission, assessing 5 vital signs (temperature, heart rate, systolic blood pressure, respiratory rate, and oxygen saturation). Delirium was assessed daily with the Confusion Assessment Method. RESULTS: Patients were on average old (mean age: 77.8 +/- 9.8), predominantly female (68.6%), with mild cognitive deterioration (MMSE: 22.1 +/- 6.3) and depressive symptoms (GDS: 5.9 +/- 3.5). They had moderate comorbidity (means CIRS: 3.1 +/- 1.9), and functional impairment both before (Barthel Index pre-admission: 84.5 +/- 19.2; IADL: 3.3 +/- 3.0) and on admission (Barthel Index: 55.8 +/- 27.5). On admission, 136 (23.3%) patients were classified as clinically unstable: 76 (13%) had either CI or delirium, and 60 (10.3%) had CI associated to delirium. At discharge, 26 patients were transferred to acute care hospitals, and 14 died. Transfer to acute care occurred in more than 10% of patients with almost one altered condition (CI or delirium), and in one fifth of patients with the association of CI and delirium. In-RACU death was observed only in this latter group. Functional recovery at discharge was significantly higher in stable patients than in patients with CI and/or delirium. CONCLUSIONS: CI and delirium are useful prognostic markers of adverse clinical and functional outcomes in a population of elderly subjects admitted to a rehabilitative unit. SN - 1538-9375 UR - https://www.unboundmedicine.com/medline/citation/20627186/Clinical_instability_as_a_predictor_of_negative_outcomes_among_elderly_patients_admitted_to_a_rehabilitation_ward_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-8610(09)00371-5 DB - PRIME DP - Unbound Medicine ER -