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Age and Ageing Advance Access published online on June 13, 2006
Age and Ageing, doi:10.1093/ageing/afl049
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© The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received September 13, 2005
Accepted April 5, 2006

Article

Comprehensive geriatric assessment and home-based rehabilitation for elderly people with a history of recurrent non-elective hospital admissions

David J. Stott 1 *, Amanda K. Buttery 2, Adam Bowman 1, Rona Agnew 3, Katriona Burrow 4, Sarah L. Mitchell 2, Scott Ramsay 1, and Paul V. Knight 1

1 Department of Medicine for the Elderly, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
2 Department of Physiotherapy, Glasgow Royal Infirmary, Glasgow, UK
3 Greater Glasgow Primary Health Care Division, Glasgow, UK
4 Department of Occupational Therapy, Glasgow Royal Infirmary, Glasgow, UK

* To whom correspondence should be addressed.
David J. Stott, E-mail: d.j.stott{at}clinmed.gla.ac.uk


  Abstract

Objective: to determine whether a co-ordinated programme of geriatric assessment and multidisciplinary home-based rehabilitation reduces disability and prevents non-elective hospital readmission in high-risk elderly patients.

Design: nested case-control study comparing usual post-discharge care versus usual care plus a comprehensive geriatric assessment and home-based rehabilitation service, comprising nursing, occupational therapy and physiotherapy with geriatric medical review. Patients were ≥65 years with ≥2 non-elective hospital admissions within the previous 12 months. Disability was assessed using the 100-point Barthel index and Nottingham extended activities of daily living (EADL) score. Non-elective hospital admissions were recorded over 1-year follow-up.

Results: we studied 84 patients; 56 receiving the new service were matched to 28 controls. Intervention subjects received a median of 19 h [interquartile range (IQR) (7,35)] rehabilitation over 19 [IQR (6,42)] domiciliary visits. At 3 months, there was improvement in median Barthel and Nottingham EADL scores in the intervention group of 3 and 2 points, respectively, compared with reductions in controls of 3 and 6 points (both P<0.001, changes in intervention group versus controls); similar differences persisted in survivors at 12 months. There was a non-significant trend for reduction in the proportion of patients with further non-elective hospital admission in the intervention group (36/56, 64%) compared with controls (21/28, 75%; OR 0.70, 95% CI 0.34, 1.46).

Conclusions: a co-ordinated programme of geriatric assessment and multidisciplinary home-based rehabilitation reduced disability in elderly patients at high risk for non-elective hospital admission. Further research is required to determine whether this approach can reduce the need for hospital admission.

Keywords: comprehensive geriatric assessment, rehabilitation, disability, hospital admission, elderly.
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