Intensive rehabilitation may put off move to nursing facilities for elderly

By Sarah Guy, medwireNews Reporter

Elderly, community-dwelling individuals who visit hospital with an acute illness are less likely to be transferred to skilled nursing facilities (SNF) if they receive an intensified type of rehabilitation rather than usual rehabilitative care, report US researchers.

"For both hospitalized older adults and their families, preventing or deferring nursing home entries hold substantial implications for their psychosocial stability; thus, it might promote their quality of life to defer," they write in Geriatrics and Gerontology International.

Intensive rehabilitation therapy was associated with a significant 41% reduction in the odds of being transferred to SNF compared with usual rehabilitation in the near-1000-person study cohort.

Furthermore, the magnitude of this association increased in participants with more physical limitations, note Ji Won Yoo (University of Michigan Medical School, Ann Arbor) and colleagues, who found conversely, that type of rehabilitation had no significant effect on individuals without any physical limitations.

Among the 929 study participants who were aged at least 65 years and who visited one of two US teaching hospitals between 2009 and 2010, 463 participants underwent intensified rehabilitation therapy (calculated according to the number of total physical therapy and occupational therapy hours divided by the length of hospital stay), while 466 received usual rehabilitation - defined as 0.5 hours or more per day.

Overall, the probability of transition to SNF after hospital discharge was significantly lower among patients who received intensive rehabilitation compared with their peers who received usual rehabilitation, at 14% versus 21%, report the authors.

For participants with mild (n=270; a score of 4-5 on the Katz Index of Independence in Activities in Daily Living), and moderate-severe physical limitations (n=265; 0-3 on the Katz Index), the same pattern emerged, with significantly less chance of SNF transfer after intensive rehabilitation compared with usual rehabilitation, at 16% versus 23%, and 18% versus 28%, respectively.

By contrast, there was no difference in the likelihood of transition to SNF according to rehabilitation type for the 394 patients with no physical limitations, at 9% for intensive rehabilitation, and 11% for usual.

"Although causality cannot be established by the present study, our findings have strong inferences that intensified rehabilitation therapy seemingly plays a 'buffering' role in emancipating community-living seniors from transitions to SNF," conclude Yoo et al.

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