Universität zu Köln

Meyer, Anna Maria, Bartram, Malte P., Antczak, Philipp, Becker, Ingrid ORCID: 0000-0001-5829-3553, Benzing, Thomas ORCID: 0000-0003-0512-1066 and Polidori, M. Cristina (2022). A Tailored Discharge Program Improves Frailty and Mood in Patients Undergoing Usual Rehabilitative Care: A Randomized Controlled Trial. J. Am. Med. Dir. Assoc., 23 (12). NEW YORK: ELSEVIER SCIENCE INC. ISSN 1538-9375

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Abstract

Objective: To investigate whether a tailored intersectoral discharge program (TIDP) impacts on multidimensional frailty, rehospitalization days, and patient-related outcome measures in older in-patients undergoing acute care and usual rehabilitative care. Design: Randomized controlled trial of TIDP vs usual rehabilitative care with a 6-month follow-up, 2019 e2020, and historical control with a 6-month follow-up, 2016-2019. Setting and Participants: Geriatric co-managed internal medicine ward of a metropolitan university hospital. One hundred-twelve multimorbid patients older than age 60 years were consecutively assessed for eligibility and inclusion (age >= 60 years, multimorbidity, admitted for treatment of acute disease, at least 2 geriatric syndromes requiring usual rehabilitative care, and able to consent) and signed informed consent, with 110 recruited and randomized to either TIDP or usual rehabilitative care. At discharge, 104 patients were alive in the intention-to-treat group, the 6-month follow-up was completed for 91 patients. A historical control group of 468 patients was included for comparison. Methods: Fifty-four patients underwent TIDP, 53 patients underwent usual rehabilitative care only. Rehospitalization days at follow-up as primary endpoint; multidimensional frailty and prognosis (Multidimensional Prognostic Index, Geriatric Depression Scale, Rosenberg Self-Esteem Scale, quality of life, falls, mortality, home care service need, and need of long-term care at 1-, 3- and 6-month follow-up as secondary endpoints.Intervention: TIDP as intervention included contact with treating general practitioner to discuss the further treatment plan, a structured medical and lifestyle counseling to patients and caregivers at admission as well as a discharge program with internist, geriatrician, and general practitioner in shared decision making with patients. Results: TIDP (median age 76.0 years, 56% female) showed significantly improved Multidimensional Prognostic Index scores at discharge compared with usual rehabilitative care (median age 78.5 years, 58% female) (0.43 vs 0.49, P =.011). Compared with usual rehabilitative care, TIDP improved self-confidence (Rosenberg Self-Esteem Scale 13.9 vs 12.4, P =.009) and mood (Geriatric Depression Scale 4 vs 5, P =.027) at follow-up. Compared with historical control (median age 77.0 years, 39 % female), usual rehabilitative care patients showed significantly lower rehospitalization rates (53% vs 70%, P =.002) and lower mortality rates (13% vs 32%, P <.001). Conclusions and Implications: A feasible TIDP improves frailty and mood in advanced age. In older patients undergoing potentially disabling acute treatments, usual rehabilitative care significantly reduces rehospitalization rates. Therefore, implementing geriatric treatment in general is useful to improve outcomes in older in-patients and a tailored discharge program can further increase the benefit for this frail population. (c) 2022 AMDA e The Society for Post-Acute and Long-Term Care Medicine.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Meyer, Anna Maria UNSPECIFIED UNSPECIFIED UNSPECIFIED Bartram, Malte P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Antczak, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Becker, Ingrid UNSPECIFIED orcid.org/0000-0001-5829-3553 UNSPECIFIED Benzing, Thomas UNSPECIFIED orcid.org/0000-0003-0512-1066 UNSPECIFIED Polidori, M. Cristina UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-667368
DOI:	10.1016/j.jamda.2022.09.003
Journal or Publication Title:	J. Am. Med. Dir. Assoc.
Volume:	23
Number:	12
Date:	2022
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1538-9375
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MULTIDIMENSIONAL PROGNOSTIC INDEX; OLDER-ADULTS; GERIATRIC SYNDROMES; SELF-ESTEEM; CLINICAL-PRACTICE; MULTIMORBIDITY; MORTALITY; READMISSIONS; RESILIENCE; MEDICINE Multiple languages Geriatrics & Gerontology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/66736