Trends in function and postdischarge mortality in a medicine for the elderly rehabilitation center over a 10-year period.

OBJECTIVES: To ascertain trends in function and mortality after admission to a medicine for the elderly rehabilitation unit, and to analyze factors associated with these outcomes. DESIGN: Retrospective cohort analysis of routinely collected clinical data during the period from January 1, 1999, to December 31, 2008. SETTING: Hospital-based medicine for the elderly rehabilitation unit. PARTICIPANTS: Patients (N=4449) admitted for rehabilitation after medical and surgical illness, stroke, and fractured neck of the femur. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Analysis of routinely collected clinical data: admission and discharge Barthel scores; indices of cognitive impairment, mental illness, swallowing and feeding difficulties. Discharge diagnoses, place of discharge, date of death, and discharge medications were analyzed, along with length of stay. Regression analysis of factors associated with improvement in Barthel score, place of discharge, and postdischarge mortality. RESULTS: Length of stay and admission Barthel scores were unchanged over the study period, but discharge Barthel scores improved from 13.5 (maximum score, 20) in 2002 to 14.8 in 2008 (P=.002 for trend). Discharge to home increased from 290 (61%) of 472 patients in 2001 to 290 (76%) of 382 patients in 2007 (P<.001 for trend). Age, admission Barthel score, cognitive impairment, problems with understanding, and problems with expression were independent predictors of the change in Barthel score between admission and discharge. The adjusted hazard ratio for postdischarge mortality in 2007 to 2008 compared with 1999 to 2000 was .76 (95% confidence interval, .63-.93). CONCLUSIONS: Functional and mortality outcomes improved over a 10-year period in this rehabilitation unit, despite similar Barthel scores on admission and equivalent lengths of stay.

Using the RT3 accelerometer to measure everyday activity in functionally impaired older people.

BACKGROUND AND AIMS: Triaxial accelerometry may provide a simple measure of physical activity in older people, but the effect of different walking aids and accelerometer placements on measurement is not known. This study aimed to examine the effect of accelerometer placement, use of walking aids, and different types of physical activity on Stay- Healthy RT3 triaxial accelerometer readings in older people. METHODS: Twenty subjects aged over 65 years and five younger volunteers were recruited from Medicine for the Elderly services. Subjects performed six minutes each of standardized standing activity, sitting activity, sitting at rest, walking, and stair climbing. Counts generated from RT3 accelerometers worn anteriorly over both hips were recorded in subjects using different walking aids during these standardized activities. RESULTS: There were significant differences between counts generated by the left and right hip positions. The intraclass correlation coefficient of RT3 counts between left and right hip positions was 0.48, 0.39 and 0.99 for sedentary tasks (standing, sitting and rest), stair and walking tasks respectively. Counts ranged between 250-3000 min-1 during the walking task. Counts were proportional to the distance walked. Resting, sitting or standing all generated counts below 250 min-1, but there was no clear demarcation between these activities. The use of different walking aids did not affect the counts generated for any activity. CONCLUSIONS: Walking can be distinguished from other activities by upper and lower cutoffs. The RT3 accelerometer should be used on the same side of the body. Different walking aids do not appear to affect RT3 counts in older people.