Community Care, Unnan City Hospital, Unnan City, Shimane, Japan
Department of Rehabilitation, Unnan City Hospital, Unnan City, Shimane, Japan
Rural Remote Health. 2021 Jan;21(1):6406. doi: 10.22605/RRH6406. Epub 2021 Jan 7.
The aging of society continues to progress in Japan. As aging is more pronounced in rural than in urban societies, rehabilitation can contribute to rural elderly patients' discharge to home after hospitalization for various causes. The relationship between rural elderly patients' improvement of motor and cognitive function in relation to activities of daily life (ADL) through rehabilitation and their discharge to home has not been clarified in rural communities. The purpose of this study was to clarify whether an improvement of ADL can enable elderly hospitalized patients to discharge to their homes in a rural community.
This retrospective cohort study included 783 consecutive patients aged over 65 years with frailty and multimorbidity who were admitted with acute diseases and underwent active rehabilitation at a rural community hospital. This study was conducted from April 2016 to March 2020. The following patient data were collected from the electronic medical records: age, sex, body mass index, serum albumin, diagnosis on admission, the Charlson Comorbidity Index, living with family or alone, duration of disease from the onset of symptoms to the start of rehabilitation, duration of rehabilitation, care level based on the Japanese insurance system, cognitive and motor components of the functional independence measure (FIM) as the measurement of the level of ADL at both admission and discharge, change in these components of the FIM, and the place to which patients were discharged (home or facility). Two groups of patients were distinguished based on whether the discharge was to home or a facility. Logistic regression was performed to investigate the relationships between patients' characteristics and the effects of rehabilitation determined as a change in the FIM on one hand and to where patients were discharged on the other. The variables with statistically significant differences in the logistic regression were further analyzed to calculate sensitivity, specificity and likelihood ratio with the area under the curve for predicting discharge to home.
Patients' average age was 82.1 years, and 33.5% were male. A high score in the motor component of the FIM after rehabilitation and short duration of rehabilitation were statistically related to discharge to home. The cognitive component of the FIM was not associated with discharge to home. The motor-FIM cutoff after rehabilitation was calculated to be 60, resulting in sensitivity, specificity and positive likelihood ratio to predict discharge to home of 0.86, 0.78, and 4.00, respectively.
This study showed that elderly patients' motor aspect of ADL after rehabilitation in rural community hospitals might predict discharge to home in rural settings. Rehabilitation in rural community hospitals can be effective in rural elderly patients with frailty and multimorbidity. The improvement in physical abilities was more important than cognitive functions for the effective discharge of the elderly patients in this study to their rural homes. By respecting patients' and their families' desires, effective rehabilitation may enable elderly patients to live at home.
日本社会的老龄化进程仍在继续。由于农村地区的老龄化比城市地区更为明显，因此康复可以帮助农村老年患者在因各种原因住院后出院回家。在农村社区，尚未明确农村老年患者通过康复治疗提高日常生活活动（ADL）的运动和认知功能与出院回家之间的关系。本研究的目的是阐明 ADL 的改善是否可以使农村社区中住院的老年患者出院回家。
本回顾性队列研究纳入了 783 名年龄在 65 岁以上、身体虚弱且患有多种疾病的连续患者，他们因急性疾病入院，并在农村社区医院接受积极的康复治疗。本研究于 2016 年 4 月至 2020 年 3 月进行。从电子病历中收集了以下患者数据：年龄、性别、体重指数、血清白蛋白、入院诊断、Charlson 合并症指数、与家人同住或独居、从症状发作到开始康复的病程、康复持续时间、基于日本保险制度的护理水平、入院和出院时的功能独立性测量（FIM）的认知和运动成分作为 ADL 水平的测量、FIM 的这些成分的变化以及患者出院的地点（家或机构）。根据患者是否出院回家或出院到机构，将患者分为两组。一方面，使用逻辑回归研究患者特征与康复效果（即 FIM 的变化）之间的关系，另一方面研究这些关系与患者出院地点之间的关系。对逻辑回归中具有统计学差异的变量进行进一步分析，计算预测出院回家的曲线下面积的灵敏度、特异性和似然比。
患者的平均年龄为 82.1 岁，33.5%为男性。康复后 FIM 的运动成分得分较高且康复持续时间较短与出院回家具有统计学相关性。FIM 的认知成分与出院回家无关。康复后计算出的 FIM 运动部分的截止值为 60，从而得出预测出院回家的灵敏度、特异性和阳性似然比分别为 0.86、0.78 和 4.00。
本研究表明，农村社区医院老年患者康复后的日常生活活动的运动方面可能可以预测农村地区的出院回家情况。农村社区医院的康复对农村地区身体虚弱和患有多种疾病的老年患者可能是有效的。在这项研究中，对于有效出院到农村家中的老年患者，身体能力的提高比认知功能更为重要。通过尊重患者及其家人的意愿，有效的康复可以使老年患者能够在家中生活。
