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Predictors of survival within 2years of inpatient rehabilitation among older adults

Published:April 04, 2012DOI:https://doi.org/10.1016/j.ejim.2012.03.008

      Abstract

      Background

      Restoring functional independence in elderly people with disabilities is one of the main purposes of a geriatric rehabilitation unit. However, the rehabilitation period may also represent a useful circumstance to identify predictors of long-term health outcomes. The aim of this study was to evaluate a broad spectrum of characteristics in geriatric patients admitted to a rehabilitation unit in order to identify possible predictors of long-term survival.

      Methods

      This cross-sectional and prospective study was carried out in an Evaluation and Rehabilitation unit in Northern Italy. 243 persons aged 65 or older were enrolled over a period of 12 months (2007–8) and followed for 2 years. Possible predictors of survival were identified among a large spectrum of demographic, clinical (Charlson Index, lab data), nutritional (Mini-Nutritional Short-Form, bio-impedance analysis), and respiratory (spirometry) features. Logistic regression models were used to evaluate the association between patients' characteristics and survival.

      Results

      189 (86.3%) participants were alive after 2 years of follow-up. Younger age, better functional status at discharge, a lower Charlson Index score, higher hemoglobin and albumin values at discharge, lower basal fasting glucose, creatinine, TNF-α levels, and extra-cellular water, as well as higher cholesterol, vital capacity (VC), and inspiratory capacity were significantly associated with survival. In the multivariate model, higher VC (OR=6.2; 95%CI=1.6–24.6) and albumin (OR=3.7; 95%CI=1.2–11.8) were associated with survival, whereas the Charlson Index and male gender showed an inverse correlation (OR=0.77; 95%CI=0.60–0.99 and OR=0.23; 95%CI=0.10–0.95, respectively).

      Conclusion

      VC was identified as one of the best predictors of survival along with higher albumin and lower Charlson Index score within 2 years of inpatient rehabilitation among older adults.

      Keywords

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      References

        • Patrick L.
        • Knoefel F.
        • Gaskowski P.
        • Rexroth D.
        Medical comorbidity and rehabilitation efficiency in geriatric inpatients.
        J Am Geriatr Soc. 2001; 49: 1471-1477
        • Volpato S.
        • Maraldi C.
        • Fellin R.
        Type 2 diabetes and risk for functional decline and disability in older persons.
        Curr Diabetes Rev. 2010; 6: 134-143
        • Marengoni A.
        • Cossi S.
        • De Martinis M.
        • Calabrese P.A.
        • Orini S.
        • Grassi V.
        Homocysteine and disability in hospitalized geriatric patients.
        Metabolism. 2004; 53: 1016-1020
        • Miller G.D.
        • Nicklas B.J.
        • Loeser R.F.
        Inflammatory biomarkers and physical function in older, obese adults with knee pain and self-reported osteoarthritis after intensive weight-loss therapy.
        J Am Geriatr Soc. 2008; 56: 644-651
        • Harris R.E.
        • Mion L.C.
        • Patterson M.B.
        • Frengley J.D.
        Severe illness in older patients: the association between depressive disorders and functional dependency during the recovery phase.
        J Am Geriatr Soc. 1988; 36: 890-896
        • Neumann S.A.
        • Miller M.D.
        • Daniels L.
        • Crotty M.
        Nutritional status and clinical outcomes of older patients in rehabilitation.
        J Hum Nutr Diet. 2005; 18: 129-136
        • Ghisla M.K.
        • Cossi S.
        • Timpini A.
        • Baroni F.
        • Facchi E.
        • Marengoni A.
        Predictors of successful rehabilitation in geriatric patients: subgroup analysis of patients with cognitive impairment.
        Aging Clin Exp Res. 2007; 19: 417-423
        • Wells J.L.
        • Seabrook J.A.
        • Stolee P.
        • Borrie M.J.
        • Knoefel F.
        State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment.
        Arch Phys Med Rehabil. 2003; 84: 890-897
        • Sherrington C.
        • Lord S.R.
        • Close J.C.
        • et al.
        A simple tool predicted probability of falling after aged care inpatient rehabilitation.
        J Clin Epidemiol. 2011; 64: 779-786
        • Martin J.L.
        • Fiorentino L.
        • Jouldjian S.
        • Mitchell M.
        • Josephson K.R.
        • Alessi C.A.
        Poor self-reported sleep quality predicts mortality within one year of inpatient post-acute rehabilitation among older adults.
        Sleep. 2011; 34: 1715-1721
        • Cameron I.D.
        • Schaafsma F.G.
        • Wilson S.
        • Baker W.
        • Buckley S.
        Outcomes of rehabilitation in older people — functioning and cognition are the most important predictors: an inception cohort study.
        J Rehabil Med. 2011; https://doi.org/10.2340/16501977-0901
        • Ben-Ezra M.
        • Shmotkin D.
        Predictors of mortality in the Old-Old in Israel: the cross-sectional and longitudinal aging study.
        J Am Geriatr Soc. 2006; 6: 906-911
        • Nybo H.
        • Petersen H.C.
        • Gaist D.
        • et al.
        Predictors of mortality in 2249 nonagenarians. The Danish 1905-Cohort Survey.
        J Am Geriatr Soc. 2003; 10: 1365-1373
        • Tinetti M.E.
        • Williams T.F.
        • Mayewski R.
        Fall risk index for elderly patients based on number of chronic disabilities.
        Am J Med. 1986; 80: 429-434
        • Katz A.
        • Ford A.B.
        • Moskowitz R.W.
        Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function.
        JAMA. 1963; 185: 914-919
        • Lawton M.P.
        • Brody E.M.
        Assessment of older people: self-maintaining and instrumental activities of daily living.
        Gerontologist. 1969; 9: 179-186
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        The Mini-Mental State. A practical method of grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Magni E.
        • Binetti G.
        • Bianchetti A.
        • Rozzini R.
        • Trabucchi M.
        Mini-Mental State Examination: a normative study in Italian elderly population.
        Eur J Neurol. 1996; 3: 198-202
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
        American Psychiatric Association, Washington DC1994
        • Yesavage J.A.
        • Brink T.L.
        • Rose T.L.
        • et al.
        Development and validation of a geriatric depression screening scale: a preliminary report.
        J Psychiatr Res. 1983; 17: 37-49
        • World Health organization
        International Classification of Diseases, Injuries, and Causes of Death. Ninth Revision (ICD-9). Geneva, Switzerland.
        1987
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Rubenstein L.Z.
        • Harker J.O.
        • Salvà A.
        • Guigoz Y.
        • Vellas B.
        Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF).
        J Gerontol A Biol Sci Med Sci. 2001; 56: M366-M372
        • Rösler A.
        • Lehmann F.
        • Krause T.
        • Wirth R.
        • von Renteln-Kruse W.
        Nutritional and hydration status in elderly subjects: clinical rating versus bio-impedance analysis.
        Arch Gerontol Geriatr. 2010; 50: e81-e85
        • Hadorn David
        • Draper David
        • Rogers William H.
        • Keeler Emmett B.
        • Brook Robert H.
        Cross-validation performance of mortality prediction models.
        RAND Corporation, Santa Monica, CA2004
        • de Groot L.C.
        • Verheijden M.W.
        • de Henauw S.
        • Schroll M.
        • van Staveren W.A.
        Lifestyle, nutritional status, health, and mortality in elderly people across Europe: a review of the longitudinal results of the SENECA study.
        J Gerontol A Biol Sci Med Sci. 2004; 59: 1277-1284
        • Bakhos C.
        • O'Connor J.
        • Kyriakides T.
        • Abou-Nukta F.
        • Bonadies J.
        Vital capacity as a predictor of outcome in elderly patients with rib fractures.
        J Trauma. 2006; 61: 131-134
        • Buchman A.S.
        • Boyle P.A.
        • Wilson R.S.
        • Leurgans S.
        • Shah R.C.
        • Bennett D.A.
        Respiratory muscle strength predicts decline in mobility in older persons.
        Neuroepidemiology. 2008; 31: 174-180
        • Pedone C.
        • Bellia V.
        • Sorino C.
        • Forastiere F.
        • Pistelli R.
        • Antonelli-Incalzi R.
        Prognostic significance of surrogate measures for forced vital capacity in an elderly population.
        J Am Med Dir Assoc. 2010; 11: 598-604
        • Chen H.I.
        • Kuo C.S.
        Relationship between respiratory muscle function and age, sex, and other factors.
        J Appl Physiol. 1989; 66: 943-948
        • Wannamethee S.G.
        • Shaper A.G.
        • Ebrahim S.
        Respiratory function and risk of stroke.
        Stroke. 1995; 26: 2004-2010
        • Fielding R.A.
        • Vellas B.
        • Evans W.J.
        • et al.
        Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia.
        J Am Med Dir Assoc. 2011; 12: 249-256
        • Singh T.
        • Newman A.B.
        Inflammatory markers in population studies of aging.
        Ageing Res Rev. 2011; 10: 319-329
        • Penninx B.W.
        • Kritchevsky S.B.
        • Newman A.B.
        • et al.
        Inflammatory markers and incident mobility limitation in the elderly.
        J Am Geriatr Soc. 2004; 52: 1105-1113
        • Roubenoff R.
        • Parise H.
        • Payette H.A.
        • et al.
        Cytokines, insulin-like growth factor 1, sarcopenia, and mortality in very old community-dwelling men and women: the Framingham Heart Study.
        Am J Med. 2003; 115: 429-435
        • Pedone C.
        • Scarlata S.
        • Chiurco D.
        • Conte M.E.
        • Forastiere F.
        • Antonelli-Incalzi R.
        Association of reduced total lung capacity (TLC) with mortality and use of health services.
        Chest. 2011; (Nov. 3, e-pub.)