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Early physical rehabilitation effectiveness in frail older patients hospitalized for community-acquired pneumonia: analysis of a nationwide database in Japan

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Abstract

Background

Frailty is a significant predictor of prognosis in older patients with community-acquired pneumonia (CAP). No effective therapy has been reported in frail patients with CAP, with frailty determined using the Hospital Frailty Risk Score (HFRS).

Aims

To investigate whether early physical rehabilitation intervention would effectively minimize adverse outcomes in frail older patients (determined using the HFRS) hospitalized for CAP.

Methods

This retrospective cohort analysis involved patients with CAP aged ≥ 65 years enrolled in the Japanese Diagnostic Procedure Combination Database between 2014 and 2020 and assessed as being frail. We compared 30-day mortality and readmission rates for patients who did and who did not receive physical rehabilitation within three days of admission and evaluated the association between outcomes and receiving early physical rehabilitation using Cox regression models and inverse probability weighting (IPW) for sensitivity analysis.

Results

The analysis involved 31,133 frail older patients hospitalized for CAP (mean age 84.3 ± 6.3 years; females, 49.1%), including 11,515 (37.0%) who received early physical rehabilitation. Cox regression analysis showed that early physical rehabilitation intervention was inversely associated with 30-day mortality and readmission rates. The IPW model also showed similar results.

Discussion

Early physical rehabilitation was associated with reduced risks of 30-day mortality, overall in-hospital mortality, and 30-day readmission rates in frail older patients with CAP.

Conclusions

Early physical rehabilitation in frail older patients hospitalized for CAP may improve outcomes. This finding highlights the importance of simultaneously introducing the HFRS and early physical rehabilitation intervention into clinical practice for frail older patients with CAP.

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Availability of data and materials

The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The study was supported by the Japan Society for the Promotion of Science (Grant number: 21H03390 to Maeda).

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Authors and Affiliations

  1. Department of Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano, 380-8525, Japan

    Akio Shimizu

  2. Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan

    Akio Shimizu, Keisuke Maeda & Naoharu Mori

  3. Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Aichi, 474-0031, Japan

    Akio Shimizu, Keisuke Maeda & Tatsuro Inoue

  4. Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, 950-3198, Japan

    Tatsuro Inoue

  5. Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan

    Ryo Momosaki

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  1. Akio Shimizu
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Contributions

AS, KM, TI, NM, and RM contributed to the study concept and design; AS, KM, TI, NM, and RM were responsible for the acquisition of data; AS, KM, and RM analyzed and interpreted the data; AS, KM, and RM drafted the manuscript; AS, KM, TI, NM, and RM revised the manuscript for important intellectual content. All authors read and approved the final manuscript.

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Correspondence to Akio Shimizu.

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Shimizu, A., Maeda, K., Inoue, T. et al. Early physical rehabilitation effectiveness in frail older patients hospitalized for community-acquired pneumonia: analysis of a nationwide database in Japan. Aging Clin Exp Res 35, 341–348 (2023). https://doi.org/10.1007/s40520-022-02302-w

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  • DOI: https://doi.org/10.1007/s40520-022-02302-w

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