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An Inpatient Rehabilitation Service for Deconditioned Older Adults

Raj, George MD; Munir, Jawad MD; Ball, Linda PhD; Carr, David B. MD

Topics in Geriatric Rehabilitation: April-June 2007 - Volume 23 - Issue 2 - p 126–136
doi: 10.1097/01.TGR.0000270181.06027.7d
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Objective To determine whether deconditioned older adults referred from internal medicine units in an acute hospital setting benefited from inpatient rehabilitation services.

Design The design of this study was a retrospective review of consecutive admissions to a rehabilitation hospital.

Setting The rehabilitation setting was an 80-bed HealthSouth acute medical rehabilitation center adjacent to the Washington University Medical Center in mid-town St Louis, Mo, and affiliated with Barnes-Jewish Hospital.

Patients Participants were 88 patients aged 55 years and older, having a primary diagnosis of deconditioning or weakness admitted to an inpatient rehabilitation unit from February 2004 to February 2005.

Main Outcome Measures Medical diagnoses, laboratory data, medications prescribed, nutritional status, physical, occupational, and speech therapy interventions, and documentation of geriatric syndromes were obtained from the rehabilitation medical records. Outcomes measured were discharge disposition, the change in functional status as assessed by the Functional Independence Measure (FIM), and the FIM efficiency rating.

Results The majority of patients were referred from the hospital after an average length of stay of 9 days and stayed for an average of 12 days in the acute inpatient rehabilitation unit. The average FIM scores dramatically improved during inpatient rehabilitation (29.4 ± 16.2), the FIM efficiency rating was 3.0 ± 1.9, and 71% of patients were discharged home. Common geriatric syndromes in this sample included depression, cognitive impairment, pain, falls, and polypharmacy. When assessed, vitamin D deficiency/insufficiency was also common in this sample.

Conclusions An inpatient rehabilitation service, focused on the deconditioned older adult, was able to demonstrate significant improvement in FIM scores during an inpatient rehabilitation stay and the majority of these patients were discharged home. These outcomes occurred despite the presence of geriatric syndromes, comorbid illnesses, and a recent hospitalization for an acute medical illness. Further pilot studies on deconditioned patients who are admitted to inpatient rehabilitation service may confirm the need for trials that compare outcomes across other settings such as home and long-term care.

Departments of Rehabilitation (Dr Raj) and Medicine (Dr Munir) and the Division of Geriatrics and Nutritional Science (Drs Ball and Carr), Washington University School of Medicine, St Louis, Mo.

Corresponding author: David B. Carr, MD, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, 4488 Forest Park, St Louis, MO 63108 (e-mail: dcarr@im.wustl.edu).

© 2007 Lippincott Williams & Wilkins, Inc.