Rehospitalization following a stay in geriatric rehabilitation wards: rates and predictive factors.

Hospitalization in the elderly patients is highly associated with morbi-mortality. Geriatric post-acute and rehabilitation care wards are designed to provide care and to implement life project of elderly patients. Objective of this study was to characterize rehospitalizations after a stay in geriatric post-acute and rehabilitation care wards. METHODS: The study was retrospective, case-control, including all the patients hospitalized in the 4 geriatric post-acute and rehabilitation care wards of a hospital in Paris (France) and returned at home. Data collection was carried out on the basis of the hospitalization report and the information system of the hospital. Rehospitalizations were documented by the information system as well as by telephone interview. We compared patients according to whether they had been rehospitalized or not within 60 days after discharge. RESULTS: Out of a total of 1,063 stays during a 12 months period, 435 (41%) were discharged at home. Re-admission rate was 10.1% at 30 days and 18.4% at 90 days. Mean age of rehospitaliszed patients was 87.2 years ± 5.3 vs 87.9 years ± 5.8 for non-rehospitalized patients. Patients rehospitalized had more often a delirium during the prior hospitalization. CONCLUSION: Unplanned rehospitalisation is a major public health issue and should be prevented particularly after a stay in a geriatric post-acute and rehabilitation care wards.

[First year prognosis of patients hospitalized in an acute geriatric ward with a known dementia or newly diagnosed]. / Devenir à un an des patients hospitalisés en court séjour gériatrique, avec un syndrome démentiel connu, ou nouvellement diagnostiqué.

In France, only a third of demented patients have an established diagnostic of dementia. Hospitalization is often an opportunity to perform a diagnostic of dementia. Real benefits for patients of such a diagnostic process are unknown. The objective of the study was to observe prognosis of elderly patients hospitalized in geriatric courses in terms of mortality, hospitalization rate and entry into an institution. This was a monocentric prospective study with a one-year follow-up of 90 patients hospitalized in an acute geriatric ward with either dementia known by general practitioner, either diagnosed during the hospitalization according to DSM IV criteria. A one year follow-up by phone has been conducted. From a consecutive set of 159 inpatients for 18 weeks, we included in this study 49 patients with a known dementia (group 1, mean age 85.7±4.6 years, mean Mini-mental state examination (MMSE) score 12.4±6.2) and 41 patients with dementia diagnosed during hospitalization (group 2, mean age 88.4±6.4 years, mean MMSE score 16.1±6.5). Differences between the two groups were significant for age (p<0.03) and MMSE score (p<0.02). One-year mortality rate was near 30% in the 2 groups. Rate of institutionalization was 33% in group 1 and 49% in group 2 (not statistically significant). There was a significant difference in number of days spent at home between group 1 and group 2, respectively 190.9±159.9 days vs 111.1±148.1 days (p<0.03). Demented patients previously diagnosed lived longer at home at one year than patients newly diagnosed. These results tend to support the diagnosis of dementia in very elderly patients with multiple comorbidities. Conditions of living at home, in particular the quality of life, should be the object of further studies.

Patterns of loss of basic activities of daily living in Alzheimer patients: A cross-sectional study of the French REAL cohort.

BACKGROUND/AIMS: To characterize loss of basic activities of daily living (BADL) in 687 Alzheimer's disease (AD) community-dwelling patients included in the French REAL cohort. METHODS: Patients had mild to moderately severe AD, and the mean age was 77.8 years. Patterns of loss of the 6 BADL were described at inclusion using the Lawton scale. RESULTS: With 6 binary BADL scores, each patient presented at inclusion a set of losses. For 53% of women, the sets of losses were included within each other or were identical, adding losses in physical ambulation, grooming, bathing, dressing, toilet and feeding, respectively. For 47% of men, a similar sequence was identified, with loss of dressing occurring secondly. A global cohesion of sets of losses was found for 87% of women and 86% of men. The Lawton scale is very useful for the assessment of AD patients.

Patterns of loss of abilities in instrumental activities of daily living in Alzheimer's disease: the REAL cohort study.

BACKGROUND/AIMS: To determine patterns of loss of abilities in instrumental activities of daily living (IADL) in community-dwelling women with Alzheimer's disease (AD). METHODS: Sixteen French university hospitals included 471 consecutive women with mild to moderately severe AD (Mini-Mental State Examination scores between 10 and 26) from April 2000 to June 2002 in the noninterventional REAL cohort. At inclusion, 6 and 12 months, IADL were assessed with the Lawton scale. Patterns of loss of abilities in the 8 IADL of the Lawton scale were described using Lawton binary grading. RESULTS: At inclusion, 56.7% of the patients shared the same pattern of loss of abilities and 84.3% had this pattern or variants of it. Frequencies of the 8 incapacities were: 80.7% to do the grocery shopping, 76.0% to take medication, 72.2% to prepare meals, 41.4% to travel on public transportation even when assisted, 40.6% to manage purchases, 30.1% to launder small items, 14.2% to participate in some housekeeping tasks and 11.0% to answer the telephone. CONCLUSION: In this study including 471 community-dwelling women with AD of the French REAL cohort, the loss of the 8 IADL, assessed with the Lawton binary grading, was homogeneous for more than four fifths of the patients.