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BACKGROUND: multidisciplinary rehabilitation is of proven benefit in the management of older inpatients. However, the identification of patients who will do well with rehabilitation currently lacks a strong evidence base. OBJECTIVES: the aims of this study were to compare the importance of chronological age, gender, co-morbidities and frailty in the prediction of adverse outcomes for patients admitted to an acute geriatric rehabilitation ward. DESIGN: prospective observational cohort study. SUBJECTS AND SETTING: two hundred and sixty-five patients admitted consecutively to an acute geriatric rehabilitation ward at a tertiary care teaching hospital. METHODS: frailty status was measured by an index of accumulated deficits, giving a potential score from 0 (no deficits) to 1.0 (all 40 deficits present). Patients were stratified into three outcomes: good (discharged to original residence within 28 days), intermediate (discharged to original residence but longer hospital stay) and poor (newly institutionalised or died). RESULTS: patients were old (82.6 ± 8.6 years) and frail (mean frailty index (FI) 0.34 ± 0.09). Frailty status correlated significantly with length of stay and was a predictor of poor functional gain. The odds ratio of intermediate and poor outcome relative to a good outcome was 4.95 (95% CI = 3.21, 7.59; P < 0.001) per unit increase in FI. Chronological age, gender and co-morbidity showed no significant association with outcomes. CONCLUSION: frailty is associated with adverse rehabilitation outcomes. The FI may have clinical utility, augmenting clinical judgement in the management of older inpatients.

Original publication

DOI

10.1093/ageing/afr179

Type

Journal article

Journal

Age Ageing

Publication Date

03/2012

Volume

41

Pages

242 - 246

Keywords

Age Factors, Aged, Aged, 80 and over, Chi-Square Distribution, Comorbidity, Female, Frail Elderly, Geriatric Assessment, Geriatrics, Health Status Indicators, Hospital Mortality, Hospital Units, Hospitals, Teaching, Humans, Institutionalization, Kaplan-Meier Estimate, Length of Stay, Logistic Models, Male, Multivariate Analysis, Odds Ratio, Patient Care Team, Patient Discharge, Patient Selection, Prospective Studies, Risk Assessment, Risk Factors, Sex Factors, Treatment Outcome, Wales