[Variables associated with functional recovery and post-discharge institutionalization of elderly cared in an average stay geriatric unit].

BASIS

To describe the evolution and results of the rehabilitation of elderly disabled cared in an average stay geriatric unit, and to define the factors associated with functional improvement and post-discharge institutionalization.

PATIENTS AND METHOD

Observational longitudinal study in 459 patients with functional disability consecutively hospitalized between May 2000 and December 2001. Basal variables collected included the clinical, functional, mental, and sociodemographic manifestations previous to the admission. The favorable functional response (defined as a functional gain during the admission of > or = 20 points in the Barthel index) and the post-discharge institutionalization were regarded the main result variables.

RESULTS

The average age of patients was 80.56 (SD: +/- 7.45) years, 64.9% were women and 81% came from acute hospital units; the main cause of disability was stroke (48.5%) followed by orthopedic pathology (26.2%) and immobility for different causes (23.5%). 72.5% of patients get functional improvement and 16.4% were institutionalized after the discharge. The main independent risk factors for poor functional response found in the multivariate analysis were a scoring in Pfeiffer's cognitive test of 5-7 points (OR: 0.42; 95% CI: 0,22-0.78) and > or = 8 (OR: 0.29; 95% CI: 0.12-0.71), and a scoring in Barthel's index < 60 prior to the deterioration (OR: 0.36; 95% CI: 0.14-0.93). Independent risk factors for institutionalization after the discharge were age (OR: 1.06; 95% CI: 1.01-1.12), and a scoring in the Gijon's sociofamiliar scale > or = 9 (OR: 6.83; 95% CI: 1.91-24.47). A functional disability after the discharge in the Barthel's index < 40 also was independently associated to post-discharge institutionalization (OR: 3,07; 95% CI: 1.04-10.06).

CONCLUSIONS

Most of elderly with recent disability benefit functionally from care in specific hospital geriatric units. Moderate or severe cognitive deterioration after hospitalization is associated to lower recovery probability. Very advanced age, higher social precariousness and severe disability after discharge are associated with higher risk of institutionalization.