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Factors affecting rehabilitation medicine such as frailty
ISPRM 2024 – 18th World Congress of the ISPRM
Abstract
Aim/Objective: Frailty is prevalent amongst geriatric inpatients and worsens clinical outcomes. We identified the factors, including frailty, affecting the efficiency of the Comprehensive Functional Independence Measure (FIM) or the home discharge in rehabilitation medicine.
Methods: Patients aged 65 years or older who were hospitalized and discharged for rehabilitation medicine between August 2020 and June 2023 included. However, we excluded (1) cases of death during hospitalization, (2) cases of hospitalization period of less than 4 weeks, and (3) patients who did not live at
home before hospitalization.
Results: 459 patients were included. A total of 376 patients (71.0%) were discharged home. There were 146 males (31.8%) with an average age of 83.6±7.4 years. At admission, the average FIM (motor items) was 33.1±14.6, the average FIM (cognitive items) was 22.5±8.4, and the average total FIM was 55.7±20.2. At discharge, the average FIM (motor items) was 63.6±23.8, the average FIM (cognitive items) was 25.1±8.5, and the average comprehensive FIM was 88.5±30.6. The mean value of Hasegawa's Dementia Scale-Revised (HDS-R) was 19.6±6.7. HDS-R (P value <0.001) and Clinical Frailty Scale (CFS) (P value: 0.008) were independent factors that contributed to overall FIM efficiency in multivariate analysis. Independent factors
that contribute to home discharge in multivariate analysis were CFS (P value 0.011, odds ratio 0.69 95% ①CI (0.52-0.92)) FIM (motor items) at admission (P value 0.004, odds ratio 1.04 95% CI (1.01-1.07)), HDS-R ② ③(P value 0.023 odds ratio 1. 06 95% CI (1.01-1.11)).
Conclusion: Multivariate analysis showed that CFS and HDSR were the same independent factors contributing to home discharge and FIM efficiency. The CFS and HDS-R are promising risk predictors of poor outcome and admission to permanent nursing home discharge among older patients attending an
inpatient rehabilitation. If able and motivated, those with potentially reversible functional limitations should be given the opportunity to participate in inpatient rehabilitation as even small gains can have a significant impact on quality of life.
