Curtin School of Allied Health, Curtin University, Kent Street, Perth, WA 6102, Australia.
School of Allied Health, WA Centre for Health & Ageing, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
Aust Health Rev. 2023 Jun;47(3):322-330. doi: 10.1071/AH22226.
Objectives There is limited evidence regarding the effectiveness of transition care programs (TCP) in improving health-related outcomes and discharge destination for older adults. This study aimed to (i) identify changes in health-related outcomes in older adults undergoing a facility-based TCP between admission and discharge; and (ii) compare health-related outcomes between participants discharged home and those discharged to permanent residential care. Method A prospective, observational study was conducted with older adults aged ≥60 years who participated in a facility-based TCP that provided short-term rehabilitation including mobility training, group exercise and cognitive activities. Physical, cognitive and social outcomes were measured at admission and discharge. Data were analysed using linear mixed modelling. Results Of the 41 participants (mean age 80.1 (±8.9) years), 26 (63.4%) were discharged home compared with 14 (34.2%) to residential care. Participants showed statistically significantly improvement in performance of activities of daily living (ADL), mobility and health-related quality of life, with a statistically and clinically significant decline in performance of instrumental ADL. Participants discharged home had statistically and clinically significant greater improvement in mobility compared with those discharged to residential care (de Morton mobility index: home, 13.6 (95% CI: 9.8, 17.4) vs residential, 6.9 (95% CI: 1.7, 12.0), P interaction = 0.04) and statistically and clinically significant less decline in instrumental ADL (Lawton's scale: home, -0.8 (95% CI: -1.3, -0.2) vs residential, -2.1 (95% CI: -2.9, -1.4), P interaction = 0.002). Conclusion Older adults participating in a facility-based TCP had improvements in physical, cognitive and social functional abilities. However, those who returned home still had residual mobility deficits and decreased performance of instrumental ADL when compared with normative community level recommendations, which could impact on longer term community living. Further research investigating which program service components could be modified to further improve rehabilitation outcomes could benefit older adults in returning and remaining at home.
关于过渡护理计划（TCP）在改善老年人健康相关结局和出院去向方面的有效性，相关证据有限。本研究旨在：（i）确定入住和出院期间接受以机构为基础的 TCP 的老年人健康相关结局的变化；（ii）比较出院回家和出院到永久性居住护理的参与者的健康相关结局。
对参加提供短期康复的以机构为基础的 TCP（包括行动能力训练、小组运动和认知活动）的年龄≥60 岁的老年人进行前瞻性、观察性研究。在入院和出院时测量身体、认知和社会结局。使用线性混合模型进行数据分析。
41 名参与者（平均年龄 80.1（±8.9）岁）中，26 名（63.4%）出院回家，14 名（34.2%）出院到居住护理机构。参与者的日常生活活动（ADL）、行动能力和健康相关生活质量表现有统计学显著改善，而工具性 ADL 的表现则有统计学和临床显著下降。出院回家的参与者的行动能力改善有统计学和临床显著优于出院到居住护理机构的参与者（德莫顿行动能力指数：回家，13.6（95%可信区间：9.8，17.4）vs 居住，6.9（95%可信区间：1.7，12.0），P 交互作用=0.04），而工具性 ADL 的下降有统计学和临床显著较小（劳顿量表：回家，-0.8（95%可信区间：-1.3，-0.2）vs 居住，-2.1（95%可信区间：-2.9，-1.4），P 交互作用=0.002）。
参加以机构为基础的 TCP 的老年人的身体、认知和社会功能能力都有所改善。然而，与社区正常水平的建议相比，那些回家的人仍然存在行动能力缺陷和工具性 ADL 表现下降，这可能对他们的长期社区生活产生影响。进一步研究哪些方案服务组件可以进行修改以进一步改善康复结果，可能使老年人受益，帮助他们返回并留在家里。
