Geriatric home-based rehabilitation in Australia: Preliminary data from an inpatient bed-substitution model

Abstract

Background: The REStORing health of acutely unwell adulTs (RESORT) is an observational longitudinal cohort, including geriatric rehabilitation inpatients aged ≥65 years admitted to a geriatrician-led rehabilitation service at a tertiary hospital. The aim of this study is to describe a home-based bed-substitution rehabilitation model for geriatric inpatients, including patient phenotype, and health outcomes at preadmission, admission, discharge, and three-month follow-up.

Methods: A standardized Comprehensive Geriatric Assessment was performed on admission and discharge, including demographics (home situation, cognitive impairment, medical diagnoses, etc.), frailty (Clinical Frailty Scale (CFS)), mobility (patient-reported and Functional Ambulation Classification), physical performance (Short Physical Performance Battery (SPPB), handgrip strength), and functional independence (Activities of Daily Living (ADL), Instrumental ADL (IADL)). Service provision data (health care staff visits, length of stay (LOS), and negative events (e.g., falls)) were extracted from medical records. Three-month outcomes included mobility, ADL and IADL scores, institutionalization, and mortality.

Results: Ninety-two patients were included with a mean age of 81.1 ± 7.8 years, 56.5% female. Twenty-nine (31.5%) patients lived alone, 39 (42.4%) had cognitive impairment and the commonest geriatric rehabilitation admission reason was falls (n = 30, 32.6%). Patients received care from nurses, physicians, and a median of four (interquartile range (IQR) 3-6) allied health disciplines for a median LOS of 13.0 days (IQR 10.0-15.0). On a population level, patient mobility and functional independence worsened from preadmission to admission. CFS, SPPB, ADL, and IADL scores improved from admission to discharge, and seven (7.6%) patients fell. At three-month follow-up, patient-reported mobility was comparable to preadmission baseline, but functional independence (ADL, IADL) scores worsened for 27/69 (39.1%) and 28/63 (44.4%), respectively.

Conclusions: Hospitalization-associated decline in mobility and functional independence improved at discharge and three-months, but was not fully reversed in the multidisciplinary home-based geriatric rehabilitation bed-substitution service. Future research should compare outcomes to equivalent hospital-based geriatric rehabilitation and evaluate patient perspectives.

Keywords: geriatrics; home care services; hospital at home; hospital-based; rehabilitation.

FIGURE 1

Patient recruitment and follow‐up

FIGURE 3

Home‐based rehabilitation patient mobility (A), total functional independence (B) and functional independence scores (C) from preadmission to 3‐month follow‐up. Pre‐Adm: two weeks preadmission to hospital; Admission: admission to home‐based rehabilitation; Discharge: discharge from home‐based rehabilitation; Follow‐up: 3‐month follow‐up postdischarge from home‐based rehabilitation. (A) Patient‐reported mobility. (B) Percentage of patients with total functional independence measured by Activities of Daily Living (ADL and Instrumental Activities of Daily Living (IADL) at each study time point. Patients were considered independent in ADLs and IADLs if no points were lost, that is, ADL score = 6, IADL score = 8. 2.C. Patient functional independence level measured by ADL (0–6) and IADL (0–8) score at each study time point. Median scores are represented within boxes by horizontal lines, and limits of the interquartile range are represented by the top and bottom box borders. Points represent individuals

FIGURE 2

Change in home‐based rehabilitation patient frailty and physical performance from admission to discharge (A), and change in functional independence from preadmission to 3‐month follow‐up (B). Pre‐Adm: two weeks preadmission to hospital; Adm: admission to home‐based rehabilitation; Disch: discharge from home‐based rehabilitation; Fol‐up: 3‐month follow‐up postdischarge from home‐based rehabilitation. Patients were considered improved or worsened in the measured ability if their score improved or worsened by ≥1 point between the specified study time points. Patients were considered unchanged in the measured ability if there was no change in score. (A) Frailty measured by the Clinical Frailty Scale and physical performance measured by the Short Physical Performance Battery. (B) Functional independence measured by Activities of Daily Living and Instrumental Activities of Daily Living scores