Top

Published in:

Open Access 01-12-2016 | Research article

Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review

Authors: Irma H. J. Everink, Jolanda C. M. van Haastregt, Sofie J. M. van Hoof, Jos M. G. A. Schols, Gertrudis I. J. M. Kempen

Published in: BMC Geriatrics | Issue 1/2016

Abstract

Background

Although rehabilitation for older patients has the potential to improve function and prevent admission to nursing homes, returning home after discharge is not possible for all patients. Better understanding of patient factors related to discharge home may lead to more realistic rehabilitation goals, more targeted rehabilitation interventions and better preparation of both patient and informal caregiver for discharge. Various studies provided insight into factors related to home discharge after stroke rehabilitation, but we still lack insight into factors related to home discharge in non-stroke patients. Therefore, the aim of this review is to provide an overview of factors influencing home discharge in older non-stroke patients admitted to an inpatient rehabilitation unit.

Methods

A systematic literature search was executed in the databases PubMed, EMBASE, CINAHL and Web of Science to retrieve articles published between January 2000 and October 2015. The search focused on factors related to home discharge after rehabilitation for older patients. Studies were included if home discharge after rehabilitation was assessed as an outcome measure and if the non-stroke population was, on average, 65 years or older and admitted to an inpatient rehabilitation unit.

Results

Eighteen studies were included. The methodological quality was moderate to good in 15 studies. The factors significantly associated with home discharge are younger age, non-white ethnicity, being married, better functional and cognitive status, and the absence of depression.

Conclusions

Because various factors are significantly associated with home discharge of older non-stroke patients after rehabilitation, we recommend assessing these factors at admission to the rehabilitation unit. Further research into the factors that lack sufficient evidence concerning their association with home discharge is recommended.

Available only for authorised users

McCloskey R. Functional and self-efficacy changes of patients admitted to a Geriatric Rehabilitation Unit. J Adv Nurs. 2004;46(2):186–93.PubMedCrossRef

Stucki G, Stier-Jarmer M, Grill E, Melvin J. Rationale and principles of early rehabilitation care after an acute injury or illness. Disabil Rehabil. 2005;27(7–8):353–9.PubMedCrossRef

Boston Working Group on Improving Health Care Outcomes Through Geriatric Rehabilitation. Med Care. 1997;35(6 Suppl):JS4-20.

Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in geriatric rehabilitation. Part II: clinical challenges. Arch Phys Med Rehabil. 2003;84(6):898–903.PubMedCrossRef

Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM. Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ. 2010;340:c1718.PubMedPubMedCentralCrossRef

Kus S, Muller M, Strobl R, Grill E. Patient goals in post-acute geriatric rehabilitation--goal attainment is an indicator for improved functioning. J Rehabil Med. 2011;43(2):156–61.PubMedCrossRef

Graham JE, Chang PF, Berges IM, Granger CV, Ottenbacher KJ. Race/ethnicity and outcomes following inpatient rehabilitation for hip fracture. J Gerontol A Biol Sci Med Sci. 2008;63(8):860–6.PubMedPubMedCentralCrossRef

Buijck BI, Zuidema SU, Spruit-van Eijk M, Bor H, Gerritsen DL, Koopmans RT. Is patient-grouping on basis of condition on admission indicative for discharge destination in geriatric stroke patients after rehabilitation in skilled nursing facilities? The results of a cluster analysis. BMC Health Serv Res. 2012;12:443.PubMedPubMedCentralCrossRef

Chang PF, Ostir GV, Kuo YF, Granger CV, Ottenbacher KJ. Ethnic differences in discharge destination among older patients with traumatic brain injury. Arch Phys Med Rehabil. 2008;89(2):231–6.PubMedPubMedCentralCrossRef

10.

Chin R, Ng B, Cheung LP. Factors predicting rehabilitation outcomes of elderly patients with hip fracture. Hong Kong Med J. 2008;14(3):209–15.PubMed

11.

Brauer SG, Bew PG, Kuys SS, Lynch MR, Morrison G. Prediction of discharge destination after stroke using the motor assessment scale on admission: a prospective, multisite study. Arch Phys Med Rehabil. 2008;89(6):1061–5.PubMedCrossRef

12.

Boyd CM, Landefeld CS, Counsell SR, Palmer RM, Fortinsky RH, Kresevic D, et al. Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc. 2008;56(12):2171–9.PubMedPubMedCentralCrossRef

13.

Gill TM, Williams CS, Tinetti ME. The combined effects of baseline vulnerability and acute hospital events on the development of functional dependence among community-living older persons. J Gerontol A Biol Sci Med Sci. 1999;54(7):M377–83.PubMedCrossRef

14.

Vincent HK, Omli MR, Vincent KR. Absence of combined effects of anemia and bilateral surgical status on inpatient rehabilitation outcomes following total knee arthroplasty. Disabil Rehabil. 2010;32(3):207–15.PubMedCrossRef

15.

Meijer R, Ihnenfeldt DS, van Limbeek J, Vermeulen M, de Haan RJ. Prognostic factors in the subacute phase after stroke for the future residence after six months to one year. A systematic review of the literature. Clin Rehabil. 2003;17(5):512–20.PubMedCrossRef

16.

Meijer R, van Limbeek J, de Haan R. Development of the Stroke-unit Discharge Guideline: choice of assessment instruments for prediction in the subacute phase post-stroke. Int J Rehabil Res. 2006;29(1):1–8.PubMedCrossRef

17.

Spruit-van Eijk M, Zuidema SU, Buijck BI, Koopmans RT, Geurts AC. Determinants of rehabilitation outcome in geriatric patients admitted to skilled nursing facilities after stroke: a Dutch multi-centre cohort study. Age Ageing. 2012;41(6):746–52.PubMedCrossRef

18.

Van Almenkerk S, Smalbrugge M, Depla MF, Eefsting JA, Hertogh CM. What predicts a poor outcome in older stroke survivors? A systematic review of the literature. Disabil Rehabil. 2013;35(21):1774–82.PubMedCrossRef

19.

Patrick L, Knoefel F, Gaskowski P, Rexroth D. Medical Comorbidity and Rehabilitation Efficiency in Geriatric Inpatients. J Am Geriatr Soc. 2001;49(11):1471–7.PubMedCrossRef

20.

Hayden JA, Cote P, Bombardier C. Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med. 2006;144(6):427–37.PubMedCrossRef

21.

Mols F, Vingerhoets AJ, Coebergh JW, van de Poll-Franse LV. Quality of life among long-term breast cancer survivors: a systematic review. Eur J Cancer. 2005;41(17):2613–9.PubMedCrossRef

22.

Kay E, Deutsch A, Chen D, Semik P, Rowles D. Effects of gender on inpatient rehabilitation outcomes in the elderly with incomplete paraplegia from nontraumatic spinal cord injury. J Spinal Cord Med. 2010;33(4):379–86.PubMedPubMedCentral

23.

New PW, Epi MC. Influence of age and gender on rehabilitation outcomes in nontraumatic spinal cord injury. J Spinal Cord Med. 2007;30(3):225–37.PubMedPubMedCentral

24.

Vincent HK, Vincent KR, Lee LW, Alfano AP. Effect of obesity on inpatient rehabilitation outcomes following total knee arthroplasty. Clin Rehabil. 2007;21(2):182–90.PubMedCrossRef

25.

Vincent KR, Vincent HK, Lee LW, Alfano AP. Inpatient rehabilitation outcomes in primary and revision total knee arthroplasty patients. Clin Orthop Relat Res. 2006;446:201–7.PubMedCrossRef

26.

Vincent KR, Vincent HK, Lee LW, Weng J, Alfano AP. Outcomes after inpatient rehabilitation of primary and revision total hip arthroplasty. Arch Phys Med Rehabil. 2006;87(8):1026–32.PubMedCrossRef

27.

Sansone GR, Alba A, Frengley JD. Analysis of FIM instrument scores for patients admitted to an inpatient cardiac rehabilitation program. Arch Phys Med Rehabil. 2002;83(4):506–12.PubMedCrossRef

28.

Yan K, Pogoda T. Orthopaedic patient outcomes following interdisciplinary inpatient rehabilitation. Int J Ther Rehabil. 2013;20(7):361–6.CrossRef

29.

Berges IM, Kuo YF, Ostir GV, Granger CV, Graham JE, Ottenbacher KJ. Gender and ethnic differences in rehabilitation outcomes after hip-replacement surgery. Am J Phys Med Rehabil. 2008;87(7):567–72.PubMedPubMedCentralCrossRef

30.

Hershkovitz A, Kalandariov Z, Hermush V, Weiss R, Brill S. Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture. Arch Phys Med Rehabil. 2007;88(7):916–21.PubMedCrossRef

31.

Kurichi JE, Ripley DC, Xie D, Kwong PL, Bates BE, Stineman MG. Factors associated with home discharge after rehabilitation among male veterans with lower extremity amputation. PM R. 2013;5(5):408–17.PubMedPubMedCentralCrossRef

32.

Siebens HC, Sharkey P, Aronow HU, Horn SD, Munin MC, DeJong G, et al. Outcomes and weight-bearing status during rehabilitation after arthroplasty for hip fractures. PM R. 2012;4(8):548–55.PubMedCrossRef

33.

Vincent HK, Alfano AP, Lee L, Vincent KR. Sex and age effects on outcomes of total hip arthroplasty after inpatient rehabilitation. Arch Phys Med Rehabil. 2006;87(4):461–7.PubMedCrossRef

34.

Vincent KR, Vincent HK. A multicenter examination of the Center for Medicare Services eligibility criteria in total-joint arthroplasty. Am J Phys Med Rehabil. 2008;87(7):573–84.PubMedCrossRef

35.

Vincent HK, DeJong G, Mascarenas D, Vincent KR. The effect of body mass index and hip abductor brace use on inpatient rehabilitation outcomes after total hip arthroplasty. Am J Phys Med Rehabil. 2009;88(3):201–9.PubMedCrossRef

36.

Field A. Discovering statistics using IBM SPSS statistics. 4th ed. Los Angeles: Sage; 2013.

37.

Campbell SE, Seymour DG, Primrose WR, project ftAp. A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing. 2004;33(2):110–5.PubMedCrossRef

38.

Carle AC. Mitigating systematic measurement error in comparative effectiveness research in heterogeneous populations. Med Care. 2010;48(6 Suppl):S68–74.PubMedCrossRef

Title: Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review
Authors: Irma H. J. Everink
Jolanda C. M. van Haastregt
Sofie J. M. van Hoof
Jos M. G. A. Schols
Gertrudis I. J. M. Kempen
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Geriatrics / Issue 1/2016
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-016-0187-4

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

Impact of physical and mental health on life satisfaction in old age: a population based observational study

Candidate gene resequencing to identify rare, pedigree-specific variants influencing healthy aging phenotypes in the long life family study

An evaluation of the psychometric properties of the Indicator of Relative Need (IoRN) instrument

Understanding the role of contrasting urban contexts in healthy aging: an international cohort study using wearable sensor devices (the CURHA study protocol)

Self-perceived uselessness is associated with lower likelihood of successful aging among older adults in China

Co-morbidities, complications and causes of death among people with femoral neck fracture – a three-year follow-up study

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page