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A Tailored Discharge Program Improves Frailty and Mood in Patients Undergoing Usual Rehabilitative Care: A Randomized Controlled Trial.
A Tailored Discharge Program Improves Frailty and Mood in Patients Undergoing Usual Rehabilitative Care: A Randomized Controlled Trial.
- Source :
-
Journal of the American Medical Directors Association . Dec2022, Vol. 23 Issue 12, p1962.e1-1962.e13. 1p. - Publication Year :
- 2022
-
Abstract
- 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. Randomized controlled trial of TIDP vs usual rehabilitative care with a 6-month follow-up, 2019–2020, and historical control with a 6-month follow-up, 2016–2019. 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. 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. 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. 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). 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. [ABSTRACT FROM AUTHOR]
- Subjects :
- *MEDICAL rehabilitation
*FRAIL elderly
*AFFECT (Psychology)
*EVALUATION of human services programs
*ACADEMIC medical centers
*CONFIDENCE
*COUNSELING
*CAREGIVERS
*CHRONIC diseases
*PATIENT readmissions
*HEALTH outcome assessment
*PATIENTS
*GERIATRIC Depression Scale
*RANDOMIZED controlled trials
*COMPARATIVE studies
*PSYCHOLOGICAL tests
*INFORMED consent (Medical law)
*DECISION making
*HEALTH behavior
*QUALITY assurance
*GERIATRIC rehabilitation
*STATISTICAL sampling
*CONTROL groups
*INTEGRATED health care delivery
*DISCHARGE planning
*LONGITUDINAL method
*COMORBIDITY
*SELF-esteem testing
*BEHAVIOR modification
*ACUTE diseases
*MIDDLE age
*OLD age
Subjects
Details
- Language :
- English
- ISSN :
- 15258610
- Volume :
- 23
- Issue :
- 12
- Database :
- Academic Search Index
- Journal :
- Journal of the American Medical Directors Association
- Publication Type :
- Academic Journal
- Accession number :
- 160587533
- Full Text :
- https://doi.org/10.1016/j.jamda.2022.09.003