Modification in self-rated health in patients discharged by a geriatric rehabilitation ward

Eleonora Marelli, Giuseppe Procino, Maria Cottino, Giorgio Previderè, Silvio Giorgi, Davide Dell’Acqua, Santina Bruno, Marco Cairati, Danila Ferrari, Rosella Capuano, Mauro Colombo

Geriatric Institute “Camillo Golgi”, Milan, Italy.
Geriatric Institute “Camillo Golgi”, Milan, Italy;.

DOI: 10.4236/health.2013.56A2014                

Abstract

Self-rated health is a valuable outcome in geriatric rehabilitation besides objective results. The present work aims at measuring and analyzing overall health as it is perceived at admission into and at discharge from a geriatric rehabilitation ward. Overall health was self-appraised through a visual-analogue scale (VAS), spanning from 0 (worst) to 10 (best). We studied 1997 patients (70% females), aged 79 (standard deviation, s.d. 8.7) years; most were frail, either functionally, clinically and cognitively. 80% of patients were discharged to home after a length of stay lasting 47.5 (s.d. 22.7) days. At admission, 3/5 patients appraised favorably their overall health (VAS ≥ 6/10): at discharge, the proportion rose to 3/4, with a mean (s.d.) gain = 2 (2) points. The improvement in self-perceived health score positively correlates with the grade expressing clients’ overall satisfaction for the stay (p 0.001), and with discharge versus admission differences in: Barthel Index (BI) total score (p < 0.001), Tinetti total score, Mini Mental State Examination (MMSE), Geriatric Depression Scale (5 items GDS), pain (VAS 0 to 10). A Linear regression model predicting the changes in self-perceived health included changes in BI, MMSE, GDS, pain, dropping Tinetti test. Changes in self-rated health were positively correlated to functional gain adjusted for pre-morbid level, and to relative functional gain. By analysis of variance, health self-appraisal changed more favorably in patients discharged to home than for other social outcomes (all p < 0.001). As expected, trends in self-perceived health parallel improvements in objective functional gauges and subjective indicators.

Keywords

Cognition; Functional Gains; Geriatric Rehabilitation; Mood; Pain; Self-Rated Health

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Bellelli, G., Bernardini, B., Pievani, M., Frisoni, G.B., Guaita, A. and Trabucchi, M. (2012) A score to predict the development of adverse clinical events after transition from acute hospital wards to post-acute care settings. Rejuvenation Research, 15, 553-563. doi:10.1089/rej.2012.1332
[2]	Gurwitz, J.H., Sanchez-Cross, M,T., Eckler, M.A. and Matulis, J. (1994) The epidemiology of adverse and unexpected events in the long-term care setting. Journal of the American Geriatrics Society, 42, 33-38
[3]	Bellelli, G., Guerini, F., Bianchetti, A., De Palma, D., Ther, P. and Trabucchi, M. (2002) Medical comorbity and complexity of the rehabilitative procedures for older patients with functional impairments. Journal of the American Geriatrics Society, 50, 2095-2096. doi:10.1046/j.1532-5415.2002.50628.x
[4]	Yancic, R., Ershler, W., Satariano, W., Hazzard, W., Cohen, H.J. and Ferrucci L. (2007) Report of the National Institute on aging task force on comorbidity. Journal of Gerontology Medical Sciences, 62A, 275-280. doi:10.1093/gerona/62.3.275
[5]	Ferrucci, L., Baldasseroni, S., Bandinelli, S., de Alfieri, W., Cartei, A., Calvani, D., Baldini, A., Masotti, G. and Marchionni, N. (2000) Disease severity and health-related quality of life across different chronic conditions. Journal of the American Geriatrics Society, 48, 1490-1495.
[6]	Pearlman, R.A. and Uhlmann, R.F. (1988) Quality of life in chronic diseases: Perceptions of elderly patients. Journal of Gerontology, 43, M25-M30. doi:10.1093/geronj/43.2.M25
[7]	Kutner, N.G., Schechtman, K.B., Ory, M.G. and Baker, D.I. (1994) Older adults’ perceptions of their health and functioning in relation to sleep disturbance, falling, and urinary incontinence. FICSIT Group. Journal of the American Geriatrics Society, 42, 757-762.
[8]	Gama, E.V., Damián, J.E., Pérez de Molino, J., López, M.R., López Pérez, M. and Gavira Iglesias, F.J. (2000) Association of individual activities of daily living with self-rated health in older people. Age and Ageing, 29, 267-270. doi:10.1093/ageing/29.3.267
[9]	Mulrow, C.D., Gerety, M.B., Cornell, J.E., Lawrence, V.A. and Kanten, D.N. (1994) The relationship between disease and function and perceived health in very frail elders. Journal of the American Geriatrics Society, 42, 374-380.
[10]	Stolee, P., Stadnyk, K., Myers, A.M. and Rockwood, K. (1999) An individualized approach to outcome measurement in geriatric rehabilitation. Journal of Gerontology A Biological Sciences Medical Sciences, 54, M641-M647. doi:10.1093/gerona/54.12.M641
[11]	Shah, S., Vanclay, F. and Cooper, B. (1989) Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology, 42, 703-709. doi:10.1016/0895-4356(89)90065-6
[12]	Tinetti, M.E. (1986) Performance-oriented assessment of mobility problems in elderly patients. Journal of the American Geriatrics Society, 34, 119-126.
[13]	Cipriani-Dacko, L.M., Innerst, D., Johannsen, J. and Rude, V. (1997) Interater reliability of the Tinetti Balance Score in novice and experienced physical therapy clinicians. Archives of Physical Medicine and Rehabilitation, 78, 1160-1164. doi:10.1016/S0003-9993(97)90145-3
[14]	Kegelmeyer, D.A., Kloos, A.D., Thomas, K.M. and Kostyk, S.K. (2007) Reliability and validity of the Tinetti Mobility Test for individuals with Parkinson Disease. Physical Therapy, 87, 1369-1378. doi:10.2522/ptj.20070007
[15]	Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198. doi:10.1016/0022-3956(75)90026-6
[16]	Tombaugh, T.N. and McIntyre, N.J. (1992) The Mini- Mental State Examination: A comprehensive review. Journal of the American Geriatrics Society, 40, 922-935.
[17]	Mecocci, P., Cherubini, A., Mariani, E., Ruggiero, C. and Senin, U. (2004) Depression in the elderly: New concepts and therapeutic approaches. Aging Clinical Experimental Research, 16, 176-189.
[18]	Rinaldi, P., Mecocci, P., Benedetti, C., Ercolani, S., Bregnocchi, M., Menculini, G., Catani, M., Senin, U. and Cherubini, M. (2003) Validation of the five-item Geriatric Depression Scale in elderly subjects in three different settings. Journal of the American Geriatrics Society, 51, 694-698. doi:10.1034/j.1600-0579.2003.00216.x
[19]	Heruti, R.J., Lusky, A., Dankner, R., Ring, H., Dolgopiat, M., Barell, V., Levenkrohn, S. and Adunsky, A. (2002) Rehabilitation outcome of elderly patients after a first stroke: effect of cognitive status at admission on the functional outcome. Archives of Physical Medicine and Rehabilitation, 83, 742-749. doi:10.1053/apmr.2002.32739
[20]	Whiteneck, G.G. (1994) Measuring what matters: Key rehabilitation outcomes. Archives of Physical Medicine and Rehabilitation, 75, 1073-1076. doi:10.1016/0003-9993(94)90080-9
[21]	Reinstein, L. (1994) Physical medicine and rehabilitation in the 21st century. Archives of Physical Medicine and Rehabilitation, 75, 1-2.
[22]	American Geriatrics Society, John A. Hartford Foundation (2002) A statement of principles towards improved care of older patients in surgical and medical specialties. Archives of Physical Medicine and Rehabilitation, 83, 1317-1319. doi:10.1053/apmr.2002.34803
[23]	Strasser, D,C,, Solomon, D.H. and Burton, J.R. (2002) Geriatrics and physical medicine and rehabilitation: Common principles, complementary approaches, and 21st century demographics. Archives of Physical Medicine and Rehabilitation, 83, 1323-1324. doi:10.1053/apmr.2002.34804
[24]	Grönstedt, H., Hellström, K., Bergland, A., Helbostad, J.L., Puggaard, L., Andresen, M., Granbo, R. and Frändin, K. (2011) Functional level, physical activity and wellbeing in nursing home residents in three Nordic countries. Aging Clinical Experimental Research, 23, 413-420.
[25]	Frändin, K., Borell, L., Grönstedt, H., Bergland, A., Helbostad, J.L., Puggaard, L., Andresen, M., Granbo, R. and Hellström, K. (2009) A Nordic multi-center study on physical and daily activities for residents in nursing home settings: Design of a randomized, controlled trial. Aging Clinical Experimental Research, 21, 314-322.
[26]	Colombo, M., Guaita, A., Cottino, M., Previderè, G., Ferrari, D. and Vitali, S. (2004) The impact of cognitive impairment on the rehabilitation process in geriatrics. Archives of Gerontology and Geriatrics Supplement, 9, 85- 92. doi:10.1016/j.archger.2004.04.014
[27]	Masiero, S., Avesani, R., Pegoraro, S., Frigo, A.C. and Bonaldo, L. (2011) Predictive factors for functional recovery in patients admitted to subacute care nursing home in Italy. Aging Clinical Experimental Research, 23, 74- 77.
[28]	Ostir, G.V., Smith, P.M., Smith, D., Berges, I.M. and Ottenbacher, K.J. (2005) The influence of perceived pain on satisfaction with community participation after hospital discharge. Archives of Physical Medicine and Rehabilitation, 86, 2095-2100. doi:10.1016/j.apmr.2005.05.011
[29]	Bergés, I.M., Ottenbacher, K.J., Smith, P.M., Smith, D. and Ostir, G.V. (2006) Perceived pain and satisfaction with medical rehabilitation after hospital discharge. Clinical Rehabilitation, 20, 724-730. doi:10.1191/0269215506cre1006oa
[30]	Barbisoni, P., Bertozzi, B., Franzoni, S., Rozzini, R., Frisoni, G.B. and Trabucchi, M. (1996) Mood improvement in elderly women after in-hospital physical rehabilitation. Archives of Physical Medicine and Rehabilitation, 77, 346-349. doi:10.1016/S0003-9993(96)90082-9
[31]	Blumenthal, J.A., Babyak, M.A., O’Connor, C., Keteyian, S., Landzberg, J., Howlett, J., Kraus, W., Gottlieb, S., Blackburn, G., Swank, A. and Whellan, D.J. (2012) Effects of exercise training on depressive symptoms in patients with chronic heart failure: the HF-ACTION randomized trial. The journal of the American Medical Association, 308, 465-474. doi:10.1001/jama.2012.8720
[32]	McPhail, S. and Haines, T. (2012) Patients undergoing sub acute rehabilitation have accurate expectations of their health-related quality of life at discharge. Health and Quality of Life Outcomes, 10, 94. http://www.hqlo.com/content/10/1/94 doi:10.1186/1477-7525-10-94
[33]	Colombo, M., Guaita, A., Cottino, M., Cairati, M., Previderè, G., Procino, G., Gandolfi, M.C., Tararà, R. and Mercanti, A. (2009) Customer satisfaction as a quality factor in geriatric rehabilitation. The Open Geriatric Medicine Journal, 2, 1-4. doi:10.2174/1874827900902010001
[34]	Studenski, S. and Duncan, P.M. (1993) Measuring rehabilitation outcomes. Clinics in Geriatric Medicine, 9, 823-830.
[35]	Ostir, G.V., Smith, P.M., Smith, D., Rice, J.L. and Ottenbacher, J. (2005) Orthopedic impairment after medical rehabilitation: functional performance and satisfaction with community participation. American Journal of Physical Medicine and Rehabilitation, 84, 763-769. doi:10.1097/01.phm.0000179440.91045.f9
[36]	Mancuso, M., Smith, P., Illig, S., Granger, C.V., Gonzales V.A., Linn, R.T. and Ottenbacher, K.J. (2003) Satisfaction with medical rehabilitation in patients with orthopedic impairment. Archives of Physical Medicine and Rehabilitation, 84, 1343-1349. doi:10.1016/S0003-9993(03)00144-8
[37]	Tooth, L.R., Ottenbacher, K.J., Smith, P.M., Illig, S., Linn, R.T., Gonzales V.A. and Granger, C.V. (2003) Effect of functional gain on satisfaction with medical rehabilitation after stroke. American Journal of Physical Medicine and Rehabilitation, 82, 692-699. doi:10.1097/01.PHM.0000083672.01300.47
[38]	Papadopoulos, C., Jagsch, R., Griesser, B., Magenheim, E., Mozelt, C., Chhatwal, C., Kryspin-Exner, I. and Pils, K. (2007) Health-related quality of life of patients with hip fracture before and after rehabilitation therapy: Discrepancies between physicians’ findings and patients’ ratings. Aging Clinical Experimental Research, 19, 125-131.
[39]	Borgquist, L., Nilsson, L.T., Lindelöw, G., Wiklund, I., Thorngren, K.G. (1992) Perceived health in hip-fracture patients: a prospective follow-up of 100 patients. Age and Ageing, 21, 109-116. doi:10.1093/ageing/21.2.109
[40]	Bachmann, S., Finger, C., Huss, A., Egger, M., Stuck, A.E. and Clough-Gorr, K.M. (2010) Inpatient rehabilitation specifically designed for geriatric patients: Systematic review and meta-analysis of randomised controlled trials. BMJ, 340, c1718. doi:10.1136/bmj.c1718
[41]	Di Blasi, Z., Harkness, E., Ernst, E., Georgiou, A. and Kleijnen, J. (2001) Influence of context effects on health outcomes: A systematic review. Lancet, 357, 757-762. doi:10.1016/S0140-6736(00)04169-6
[42]	Wright, J.G. (2000) Evaluating the outcome of treatment: Shouldn’t we ask the patients if they are better? Journal of Clinical Epidemiology, 53, 549-553.