Skip to main content
SpringerLink
Log in

Three different outcomes in older community-dwelling patients receiving intermediate care in nursing home after acute hospitalization

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

To evaluate the recovery and outcome of older communitydwelling patients admitted to intermediate care (IC) in nursing homes after acute hospitalization, and to compare patients who were able and unable to return directly to their own homes.

Design

Prospective, observational, cohort study conducted between June 2011 and 2014.

Setting

A 19- bed IC unit in a nursing home with increased multidisciplinary staffing.

Participants

A total of 961 community-dwelling patients, ≥70 years of age, considered to have a rehabilitation potential and no major cognitive impairment or delirium, transferred from internal medicine, cardiac, pulmonary and orthopaedic hospital departments.

Measurements

Demographic data, clinical information, comprehensive geriatric assessment (CGA), discharge destination and length of stay. Residence status and mortality 1 month, 2 months, 3 months, and 6 months after discharge from the hospital.

Results

The trajectory of recovery was divided into 3 groups: 1) Rapid recovery, able to return home after median 14 days in IC (n=785, 82%); 2) Slow recovery, requiring additional transfer to other nursing home after IC, but still able to return home within 2 months (n=106, 11%). 3) Poor recovery, requiring transfer to other nursing home after IC and still in a nursing home or dead at 2 months (n=66, 7%). Significant different clinical characteristics were demonstrated between the patients in the 3 groups. After 6 months, the recovery of patients with rapid or slow recovery was similar, 87% were living at home, compared to only 20% of the patients with poor recovery. In multiple logistic regression analysis, slow or poor recovery was significantly associated with low scores on the Barthel index and orthopaedic admission diagnosis.

Conclusions

Although the majority of patients selected for treatment in the IC unit were able to recover and return home, a group of patients needed extra time, up to 2 months, to recover and another group had a poor chance of recovering and returning home. Different caring pathways for different patient groups may be considered in the PAC setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Table 1
Table 2
Table 3

Similar content being viewed by others

References

  1. Boyd CM, Landefeld CS, Counsell SR, Palmer RM, Fortinsky RH, Kresevic D, et al. Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc. 2008;56:2171–2179.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wong RY, Miller WC. Adverse outcomes following hospitalization in acutely ill older patients. BMC geriatr. 2008;8:10.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gill TM, Gahbauer EA, Han L, Allore HG. Factors associated with recovery of prehospital function among older persons admitted to a nursing home with disability after an acute hospitalization. J Gerontol A Biol Sci Med Sci. 2009;64:1296–1303.

    Article  PubMed  Google Scholar 

  4. Martin GP, Hewitt GJ, Faulkner TA, Parker H. The organisation, form and function of intermediate care services and systems in England: results from a national survey. Health Soc Care Community 2007;15:146–54.

    PubMed  Google Scholar 

  5. Garasen H, Windspoll R, Johnsen R. Intermediate care at a community hospital as an alternative to prolonged general hospital care for elderly patients: a randomised controlled trial. BMC Public Health. 2007;7:68.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ariss SM, Enderby PM, Smith T, Nancarrow SA, Bradburn MJ, Harrop D, et al. Secondary analysis and literature review of community rehabilitation and intermediate care: an information resource. Health Serv Deliv Res 2015;No3. 1. Southampton (UK).

    Google Scholar 

  7. Young J, Green J, Forster A, Small N, Lowson K, Bogle S, et al. Postacute care for older people in community hospitals: a multicenter randomized, controlled trial. J Am Geriatr Soc. 2007;55:1995–2002.

    Article  PubMed  Google Scholar 

  8. Lee WJ, Peng LN, Cheng YY, Liu CY, Chen LK, Yu HC. Effectiveness of shortterm interdisciplinary intervention on postacute patients in Taiwan. J Am Med Dir Assoc. 2011;12:29–32.

    Article  PubMed  Google Scholar 

  9. Kane RL. Assessing the effectiveness of postacute care rehabilitation. Arch Phys Med Rehab 2007;88:1500–1504

    Article  Google Scholar 

  10. Chen LK, Chen YM, Hwang SJ, Peng LN, Lin MH, Lee WJ, et al. Effectiveness of community hospital-based post-acute care on functional recovery and 12-month mortality in older patients: a prospective cohort study. Ann Med 2010;42:630–6.

    Article  PubMed  Google Scholar 

  11. Plochg T, Delnoij DM, van der Kruk TF, Janmaat TA, Klazinga NS. Intermediate care: for better or worse? Process evaluation of an intermediate care model between a university hospital and a residential home. BMC Health Services Res 2005;5:38.

    Article  Google Scholar 

  12. Buurman BM, Hoogerduijn JG, van Gemert EA, de Haan RJ, Schuurmans MJ, de Rooij SE. Clinical characteristics and outcomes of hospitalized older patients with distinct risk profiles for functional decline: a prospective cohort study. PloS one. 2012;7:e29621.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kilgore C. Why intermediate care services need to be refreshed. Nurs Older People. 2014;26:16–20.

    Article  PubMed  Google Scholar 

  14. Lee WJ, Cheng YY, Liu CY, Peng LN, Liu LK, Chen LK. Dose-dependent effect of rehabilitation in functional recovery of older patients in the post-acute care unit. Arch Gerontol Geriatr 2012;54:e290–3.

    Article  PubMed  Google Scholar 

  15. Herfjord JK, Heggestad T, Ersland H, Ranhoff AH. Intermediate care in nursing home after hospital admission: a randomized controlled trial with one year follow-up. BMC Res Notes 2014;7:889.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Abrahamsen J, Haugland C, Nilsen R, Ranhoff AH. Predictors for return to own home and being alive at 6 months after nursing home intermediate care following acute hospitalization. Eur Geriatr Med 2014;5:108–12.

    Article  Google Scholar 

  17. Mahoney FI. Functional Evaluation: the Barthel Index. Md State Med J 1965;14:108–12.

    Google Scholar 

  18. Folstein MF, Folstein SE, McHugh PR. «Mini-mental state». A practical method for grading the cognitive state of patients for clinicians. J Psychiatr Res 1975;12:189–98.

    Article  CAS  PubMed  Google Scholar 

  19. Strobel CEK, Engedal K. MMSE-NR. Norwegian Revised Mini Mental Status Evaluation. Revised and Expanded Manual. Norwegian Centre for Ageing and Health Oslo, Norway 2008.

    Google Scholar 

  20. Yesavage JA. Geriatric Depression Scale. Psychopharmacolo Bull 1988;24:709–11.

    CAS  Google Scholar 

  21. Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med 2002;18:737–757.

    Article  PubMed  Google Scholar 

  22. Portegijs E, Buurman BM, Essink-Bot ML, Zwinderman AH, de Rooij SE. Failure to regain function at 3 months after acute hospital admission predicts institutionalization within 12 months in older patients. J Am Med Dir Assoc 2012;13:569 e1-7.

  23. Hardy SE, Dubin JA, Holford TR, Gill TM. Transitions between states of disability and independence among older persons. Am Journal Epidemiol. 2005;161:575–84.

    Article  Google Scholar 

  24. Hardy SE, Gill TM. Recovery from disability among community-dwelling older persons. JAMA 2004;291:1596–602.

    Article  CAS  PubMed  Google Scholar 

  25. Buurman BM, van Munster BC, Korevaar JC, Abu-Hanna A, Levi M, de Rooij SE. Prognostication in acutely admitted older patients by nurses and physicians. J Gen Int Med 2008;23:1883–9.

    Article  Google Scholar 

  26. Dorner TE, Luger E, Tschinderle J, Stein KV, Haider S, Kapan A, et al. Association between nutritional status (MNA(R)-SF) and frailty (SHARE-FI) in acute hospitalised elderly patients. J Nutr, Health Aging 2014;18:264–9.

    Article  CAS  Google Scholar 

  27. Matzen LE, Jepsen DB, Ryg J, Masud T. Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit. BMC geriatrics 2012;12:32.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deaconess Hospital, Bergen, Norway

    Jenny Foss Abrahamsen & A. H. Ranhoff

  2. Research physiotherapist, Storetveit Nursing Home, Bergen, Norway

    C. Haugland

  3. Centre for Clinical Research, Haukeland University Hospital, Armauer Hansens Hus, Bergen, Norway

    R. M. Nilsen

Authors
  1. Jenny Foss Abrahamsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Haugland
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. M. Nilsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. H. Ranhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jenny Foss Abrahamsen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abrahamsen, J.F., Haugland, C., Nilsen, R.M. et al. Three different outcomes in older community-dwelling patients receiving intermediate care in nursing home after acute hospitalization. J Nutr Health Aging 20, 446–452 (2016). https://doi.org/10.1007/s12603-015-0592-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-015-0592-y

Key words

Search

Navigation