Importance of Early Inpatient Geriatric Rehabilitation on Outcomes in Individuals on Dialysis

Abstract

Objective: To report short-term functional outcomes of patients incident to dialysis undergoing inpatient rehabilitation within 3 months of dialysis initiation.

Design: Retrospective observation study using prospectively collected data.

Setting: Single-center, hospital-based geriatric dialysis rehabilitation unit. All patients incident to hemodialysis admitted to the geriatric dialysis rehabilitation unit between May 2002 and April 2016 were identified using a retrospective observational design. Clinical and demographic data were collected prospectively and linked, using the unique hospital number and dates of admission and discharge, to FIM scores (used to assess functional recovery) at admission and discharge.

Participants: Patients (N=449; mean age ± SD, 74±9y) newly started on hemodialysis (within 3mo).

Interventions: Inpatient rehabilitation care, short daily dialysis therapy with nephrologist support, and geriatrician assessment.

Main outcomes: Change in FIM score; discharge location.

Results: Patients were admitted within 3 months of hemodialysis initiation. The median length of stay in the rehabilitation program was 43 days (25th and 75th quartile, 33-55 days). Of those with complete data (n=370), 95% had improvement in FIM scores (median changes in total FIM score 25 [quartiles, 16, 33]; in motor FIM 23 [quartiles, 15, 32]; and in cognitive FIM 1 [quartiles, 0, 3], respectively). Most improvement was seen in transfer abilities, grooming, and mobility. A total of 324 patients (72%; 95% CI, 68%-76%) were discharged to a private home. An additional 11 were discharged to a seniors' residence.

Conclusion: The data suggest that older patients incident to dialysis with functional decline respond well to specialized rehabilitation care and suggest this may be a novel approach to dialysis initiation.

Keywords: Aging; Dialysis; Rehabilitation.