A prospective observational study of outcomes from rehabilitation of elderly patients with moderate to severe cognitive impairment.

Clinical rehabilitation

PubMedID: 27496699

Vassallo M, Poynter L, Kwan J, Sharma JC, Allen SC. A prospective observational study of outcomes from rehabilitation of elderly patients with moderate to severe cognitive impairment. Clin Rehabil. 2016;30(9):901-8.
OBJECTIVES
To evaluate rehabilitation outcomes in patients with moderate to severe cognitive impairment.

DESIGN
Prospective observational cohort study.

SETTING
Rehabilitation unit for older people.

SUBJECTS
A total of 116 patients (70F) mean age (SD) 86.3 (6.4). Group 1: 89 patients with moderate cognitive impairment (Mini-Mental State Examination 11-20); and Group 2: 27 patients with severe cognitive impairment (Mini-Mental State Examination 0-10).

INTERVENTION
A personalised rehabilitation plan.

MAIN MEASURES
Barthel Activity of Daily Living score on admission and discharge, length of stay and discharge destination.

RESULTS
Of 116 patients, 64 (55.2%) showed an improvement in Barthel score. Mini-Mental State Examination was significantly higher in those who improved, 15.4 (SD 3.7) vs.13.2 (SD 5.1): p?=?0.01. The mean Barthel score improved in both groups; Group 1 - 14.7 (SD 19.1) vs. Group 2 - 9.3 (SD 16.3): p?=?0.17. Of 84 home admissions in Group 1, more patients returning home showed improvements of at least 5 points in the Barthel score compared with nursing/residential home discharges (32/37 - 86.5% vs. 10/28 - 35.7%: p?=?0.0001). In Group 2 of 17 home admissions, 6/6 (100%) home discharges showed improvement compared with 3/7 (42.8%) discharges to nursing/residential home (p?=?0.07). In Group 1, a discharge home was associated with significantly greater improvement in number of Barthel items than a nursing/residential home discharge (3.27 (SD 2.07) vs. 1.86 (SD 2.32): p?=?0.007). A similar non-significant pattern was noted for severe cognitive impairment patients (3.5 (3.06) vs. 1.14 (1.06); p?=?0.1).

CONCLUSION
Patients with moderate to severe cognitive impairment demonstrated significant improvements in Barthel score and Barthel items showing that such patients can and do improve with rehabilitation.