Abstract
1. Introduction
Both increased frailty and multi-morbidity are independently associated with high mortality and increased risk for nursing home placement.
There is limited data on the best ways of assessing frailty and complex comorbidities to guide patient selection for rehabilitation.
It is important we do not deprive an individual of the chance of inpatient rehabilitation, but this needs to be balanced with potential poor outcomes at one year due to frailty and comorbidities.
2. Method
Data was collated retrospectively on all discharged patients over a 90-day period from May to July 2023.
A sub-analysis was undertaken to evaluate one-year outcomes, based on clinical frailty scales on discharge, Barthel's index, their length of admission and number of subsequent hospital admissions.
3. Results
153 patients were discharged over the 90 day period with mean age of 84.
At one year 31 % had died, 12% had gone to placement and 57% remain alive at home.
Higher clinical frailty scores and lower Barthel's index at discharge were correlated with poorer outcomes with mortality & placement.
Higher length of stay, increased subsequent hospital admissions, and more advanced age were associated with unfavourable outcomes.
Among those died, 42% were transferred back to the acute hospital due to acute instability, and 15% had been discharged to placement.
Among those gone to placement, 27% were transferred back to the acute hospital due to acute instability.
Length of stay in rehab is shorter in those still alive and living at home.
4. Conclusion
The results make us consider in more details the risks and benefits of an admission for rehabilitation, as this may account for 10% of an individual’s last year of life.
We aim to relook and refine our pathways to ensure the right patients are accessing rehabilitation.
We will repeat this study in a years’ time.