Influence of Frailty on Discharge Setting for Older Adults With Hip Fracture at Inpatient Rehabilitation Facilities

Abstract Inpatient rehabilitation Facilities (IRFs) provide intensive rehabilitation therapy to patients to reduce functional impairment, enhance independence and return patients back to the community. Determination of eligibility for IRF is currently based on a preadmission screening. Frailty, a pervasive characteristic in older adults with hip fractures has not been examined as a clinical factor influencing function and discharge destination IRF outcomes. This study purpose was to determine the prevalence of frailty among older adult IRF patients with hip fractures and determine the association between frailty and function and discharge destination among IRF hip fracture patients. A retrospective cohort study design using CMS 2014 Inpatient Rehabilitation Facility-Patient Assessment Instrument file. Frailty was measured using a Frailty Index of 30 items. The final sample included 26,134 patients. Frailty, pre-frailty, and nonfrailty were present in 0.92% (n=24043), 3.3% (n=862), and .076% (n=199) of hip fracture patients, respectively. The majority (65%) of the patients were discharged home. There were significantly greater proportion of females than males discharged home and those of white race, 65 to 74 years of age, and those with higher functional status. Regression analysis showed significantly lower functional status at discharge (p < .0001) for males and those of non-white race, older age and frail. Study implications include the use of frailty status to identify hip fracture patients at high risk for adverse outcomes and need for future studies to explore the potential of frailty to provide value-added utility to IRF clinical settings and identify ongoing opportunities to guide person-centered care.

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Abstract 2224: The Relationship Between Process and Outcomes for Stroke Post Prospective Payment in Inpatient Rehabilitation Facilities

Stroke ◽

10.1161/str.43.suppl_1.a2224 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Suzanne R O'Brien ◽

Gail Ingersoll ◽

Ying Xue ◽

Adam Kelly ◽

Din Chen

Keyword(s):

Inpatient Rehabilitation ◽

Functional Independence ◽

Assessment Instrument ◽

Discharge Destination ◽

Medicare Beneficiaries ◽

Prospective Payment ◽

Rehabilitation Facilities ◽

Race Ethnicity ◽

Stroke Type ◽

The Relationship

Background and Objective: Previous studies have reported decreasing length of stay (LOS) for inpatient rehabilitation facilities (IRFs), with conflicting effects on discharge Functional Independence Measure (FIM) scores and discharge destination (DD). This study was the first to examine the post prospective payment system (PPS) period using Medicare data drawn from the national Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) database. The purposes were to examine trends over time for process and outcome factors, and to describe the relationships between process, LOS, and outcomes (discharge FIM scores and DD), for Medicare patients with stroke. Methods: The study included 371,211 Medicare Part A beneficiaries aged 65 and older with stroke, admitted to United States (US) IRFs between January 1, 2002 and June 30, 2007. Descriptive statistics and generalized estimating equations (GEE) modeling for clustered data were used for analysis. Continuous GEE evaluated LOS and discharge FIM scores, and binomial GEE evaluated LOS and DD (community verses institution). Covariates in models were: admission FIM scores, age, gender, race/ethnicity, comorbidities, complications, and stroke type. Time interactions with admission FIM scores, LOS, and discharge FIM scores (binomial model only) were examined. Results: During the study period, mean LOS decreased from 17.9 (SD=9.9) to 16.1(SD=8.3) days (p<. 0001), mean discharge FIM scores decreased from 80.1 (SD=24.5) to 76.5 (SD=24.5) points (p<. 0001), and rate of community discharge decreased from 66.6% to 61.2% (p<. 0001). LOS predicted discharge FIM scores (95% CI, .48, .52, p<.0001), but the relationship to community discharge was weak (OR .997, p=.007). Discharge FIM scores predicted discharge destination (OR 1.07, p<.0001). Covariates of admission FIM scores, age, gender, race/ethnicity, comorbidities, complications, and stroke type also predicted outcomes. Time interactions were present for LOS, admission FIM scores, and discharge FIM scores. Conclusions: During the first 5.5 years of PPS, declining trends were found for LOS, discharge FIM scores, and rate of community discharge for Medicare beneficiaries with stroke. LOS was a strong predictor for discharge FIM scores, but weak for DD. Discharge FIM scores were a better predictor of DD than LOS. Effects of covariates on discharge FIM scores and DD have clinical implications for IRF stroke rehabilitation in the US. Because of the reduced time for treatment, dose of IRF rehabilitation for Medicare beneficiaries may not be achieving expected results in the post-PPS period.

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Physiotherapists’ role during hospital-to-home transition for older adults with hip fracture and mobility limitation: A research protocol

International Journal of Care Coordination ◽

10.1177/2053434520937408 ◽

2020 ◽

Vol 23 (2-3) ◽

pp. 123-129 ◽

Cited By ~ 1

Author(s):

Michael E Kalu ◽

Augustine C Okoh ◽

Henrietha Nwankwo ◽

Ebuka Anieto ◽

Israel Adandom ◽

...

Keyword(s):

Older Adults ◽

Hip Fracture ◽

Hip Fractures ◽

Hospital Readmission ◽

Group Discussion ◽

Inpatient Rehabilitation ◽

Difficult Case ◽

Functional Deficits ◽

Hospital To Home ◽

Discharge Summaries

Introduction Functional deficits such as gait speed, muscle strength or reduced activities in daily living after discharge are predictors for hospital readmission for older adults with hip fractures. However, physiotherapists (PTs) who are inherently mobility experts, do not actively participate during the hospital-to-home transition of older adults with hip fractures in the developing countries, including Nigeria. This qualitative study aims to describe and explore how PTs working within inpatient rehabilitation units prepare older adults (≥60 years) with a hip fracture for transfer to their home in the community. Methods We will adopt Sally Thorne’s Interpretive Description approach to purposively select 25 PTs with 5-years experience of participating in discharging older adults with hip fractures from inpatient rehabilitation-to-home. Data collection will include (a) semi-structured, one-on-one interviews with PTs, (b) discharge summaries of two older adults, and (c) final focus group discussion with PTs. We will ask the physiotherapists to provide discharge summaries of two older adults - one that they described as a “difficult” case and one that they described as an “easy” case during inpatient rehabilitation-to-home transition. Data will be analyzed employing Sally Thorne’s “borrowing techniques”- content and thematic analysis for the patients’ discharge summaries and PT interviews, respectively.

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Characteristics and Outcomes of Hip Fracture Patients Hospitalized in an Orthogeriatric Unit Versus an Orthopedic Department: A Retrospective Cohort Study

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320986299 ◽

2021 ◽

Vol 12 ◽

pp. 215145932098629 ◽

Cited By ~ 1

Author(s):

Yulia Bugaevsky ◽

Yochai Levy ◽

Avital Hershkovitz ◽

Irena Ocheretny ◽

Adaya Nissenholtz ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Hip Fracture ◽

Hip Fractures ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Functional Independence ◽

Functional Improvement ◽

Orthopedic Department ◽

Successful Recovery

Introduction: Hip fractures are a significant health risk in older adults and a major cause of morbidity, functional decline and mortality. Our aim was to compare clinical outcomes of older patients hospitalized in an ortho-geriatric (OG) unit to those hospitalized in an orthopedic department (OD) for surgical treatment of a hip fracture. Methods: A retrospective cohort study of hip fractured patients hospitalized between 2015-2016 in a single tertiary university-affiliated medical center. Included were patients aged 65 and older who had undergone hip fracture surgery and were admitted to either a geriatric or orthopedic ward. Results: 441 patients met the inclusion criteria (195 in the OG unit, 246 in the OD); 257 were transferred to an affiliated geriatric center hospital (107 from the OG unit and 127 from the OD) for rehabilitation. Patients in the OG unit were older, more cognitively and functionally impaired and with more comorbidities. The 1-year mortality rate was significantly lower in the OD group (OR 0.32, CI 95% 0.19-0.53, p < 0.001), however, after propensity matching, the 30-day and 1 year mortality rates were similar in both groups. No difference was found in the rehabilitation length of stay between the groups. The functional independence measure improvement was similar in both groups, with a non-significant trend toward better functional improvement among OG unit patients. Conclusions: Despite the higher complexity of patients, worse baseline functional capacity in the OG unit, improvement after rehabilitation was similar in both groups. These results demonstrate the advantages of the OG unit in treating and stabilizing frail older adults, thus maximizing their chances for a successful recovery after hip fractures. Level of Evidence: Level IV

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Outcomes and Reimbursement of Inpatient Rehabilitation Facilities and Subacute Rehabilitation Programs for Medicare Beneficiaries With Hip Fracture

Medical Care ◽

10.1097/01.mlr.0000173591.23310.d5 ◽

2005 ◽

Vol 43 (9) ◽

pp. 892-901 ◽

Cited By ~ 37

Author(s):

Anne Deutsch ◽

Carl V. Granger ◽

Roger C. Fiedler ◽

Gerben DeJong ◽

Robert L. Kane ◽

...

Keyword(s):

Hip Fracture ◽

Inpatient Rehabilitation ◽

Medicare Beneficiaries ◽

Rehabilitation Programs ◽

Rehabilitation Facilities

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Understanding immunesenescence

The New Dynamics of Ageing Volume 2 ◽

10.1332/policypress/9781447314783.003.0007 ◽

2018 ◽

pp. 107-130

Author(s):

Anna C. Whittaker ◽

Jane Upton ◽

Niharika Arora Duggal ◽

Chadni Deb ◽

Charanjit Randhawa ◽

...

Keyword(s):

Older Adults ◽

Hip Fracture ◽

Health Service ◽

Physical Function ◽

Illness Perceptions ◽

Stress Hormones ◽

Policy And Practice ◽

Factors Affecting ◽

Rehabilitation Facilities ◽

The Impact

This chapter discusses the impact of hip fracture in older age and in particular factors affecting recovery of physical function and wellbeing. It focuses particularly on a study of the impact of depression following hip fracture in older adults, and the influence of this depression on a range of outcomes including immune function, stress hormones, illness perceptions, physical function, and length of stay in health service and rehabilitation facilities. It shows that depression is common following hip fracture among older people, and is the biggest predictor of a slower recovery and poorer function in terms of immunity, wellbeing and physical ability. A pilot study associated with this research showed that illness perceptions following hip fracture did not differ between UK and Punjabi older adults, but that Punjabi speakers in India had greater levels of distress. Implications for health service policy and practice resulting from this research are discussed in this chapter, including potential intervention strategies to improve outcomes after hip fracture.

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