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Joisten, Susanne (2006): Mobility of geriatric patients at admission to early post-acute rehabilitation facilities predicts change in living situation after discharge. Dissertation, LMU München: Medizinische Fakultät



Objectives: The identification of the problems and characteristics of geriatric patients at the beginning of post-acute rehabilitation therapy which predict the worsening of living situation after hospital discharge and which may be amenable to intensified rehabilitation interventions. Methods: In a cross-sectional survey a cohort of 128 elderly patients undergoing early post-acute rehabilitation was interviewed at the beginning of their rehabilitation therapy. To identify the patients’ problems the second level of the ICF (International Classification of Functioning, Disability and Health) was used. Predictors were analyzed by conducting a multiple logistic regression model with worsening of living conditions as the dependent variable and using age, gender and main diagnosis as forced-in variables. Results: The mean age of the population was 80.3 years (SD 7.2). Sixty-nine percent were female. The group of patients with a worse living situation after discharge from rehabilitation facility compared to the situation before the acute event which lead to hospital admission (52.3% of the sample) had more frequently trauma or joint replacement as main diagnosis and were in the mean one year older than the group of patients who did not worsen. The only “negative” predictor for worsening in living situation was the ICF category d465 “Moving around with equipment” (Odds ratio 2.92, 95% Confidence interval 1.24 – 6.83). This means that patients who were not able to move around with equipment at the beginning of rehabilitation therapy had a 2.9fold higher risk of being more dependent on assistance after their discharge. When using age, gender and main diagnosis as forced-in variables this result did not change. Conclusions: The use of the ICF to identify potential predictors for discharge destination provided the possibility of investigating a broad spectrum of patients’ functioning. The findings of the underlying study suggest that assistive technologies, especially those enhancing mobility, demand special attention in a geriatric inpatient rehabilitation setting. Use of assistive devices should have an early part in the planning of rehabilitation interventions.