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Cognitive Impairment May Slow Rehab for Elderly Patients

After a hospital discharge, many older adults will transfer to a skilled nursing facility to finish their recovery. The goal of this type of short-term nursing care is to help older patients regain their ability to function and perform daily activities so they can eventually return home.

But for patients with cognitive impairments, the road to recovery may be much longer. In a new study, researchers found that nursing facility residents with more severe cognitive issues may need additional support and more intense rehabilitation to make the same gains as residents who are cognitively intact.

The findings are published in the Journal of the American Geriatrics Society.

Participants in the study were Medicare Part A beneficiaries who stayed in a skilled care facility between January 1 and June 30, 2017, but who had not stayed in one in 2016. The study included 246,395 skilled nursing home stays of residents ages 65 to 84.

The researchers used the following measures of self-care and mobility:

  • eating;
  • oral hygiene;
  • ability to use/get to the toilet;
  • moving from a sitting to lying position;
  • moving from a lying to sitting position;
  • moving from a sitting to standing position;
  • ability to move from chair or bed to chair.

At both admission and discharge, each resident was scored on these items by a nursing facility health professional. Mobility was based on a scale ranging from 1 (dependent: helper does all of the effort) to 6 (independent: resident completes the activity by themselves with no assistance from a helper).

The average length of stay in the nursing facilities was 24 days. At the time of admission, 68 percent of residents had no cognitive impairment, 18.3 percent had mild impairment, 11.8 percent had moderate impairment, and 1.7 percent had severe impairment.

About 20 percent of the participants had an active diagnosis of a fracture, 30 percent had diabetes, and 27 percent had psychiatric mood disorders. Almost half the participants experienced some urinary incontinence and half had fallen in the last six months.

The researchers found that the patients’ cognitive status significantly affected their self-care and mobility scores. At discharge, residents with no cognitive problems scored about two points higher than they did at admission. However, residents with severe cognitive impairment scored only around one point higher than they did at admission.

Nearly all of the patients with no cognitive impairments at admission improved their ability to get around, while only 87 percent of those with severe cognitive impairments showed improvement.

The findings confirm that residents with more severe cognitive impairments experienced reduced improvements in terms of self-care and mobility compared to those who were cognitively intact at admission.

Residents with cognitive impairment may need additional support and more intense rehabilitation to make the same gains as residents who are cognitively intact.

Source: American Geriatrics Society

 



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