Effects of a short-term occupational therapy intervention in an acute geriatric unit. A randomized clinical trial.

OBJECTIVES: To compare the benefits of a short-term occupational therapy intervention (OTI) when added to the conventional treatment model (CTM) in the functional recovery of patients admitted to an acute geriatric unit (AGU). STUDY DESIGN: Non-pharmacological randomized clinical trial. 400 patients were randomized to OTI (n = 198) or CTM (n = 202) group. Mean age 83.5. Interventions included needs assessment, iatrogenic prevention, retraining in activities of daily living, and instructions for caregivers in three groups of patients defined a priori (cardiopulmonary disease, stroke, other conditions) 5 days a week, 30-45 min a day. MAIN OUTCOME MEASURE: Recovery of ≥ 10 Barthel index points by discharge. Secondary outcome was the reduction in confusional episodes. RESULTS: The adjusted relative risk (RR) of functional recovery in the OTI group was 1.16 (95%CI 0.91-1.47). In participants with cardiopulmonary disease was 1.57 (95%CI 1.06-2.32), number needed to treat (NNT) 5. Participants with other conditions assigned to OTI had a reduction in acute confusional episodes; RR 0.48 (95% CI 0.26-0.87), NNT 7. CONCLUSIONS: Although overall there were no significant differences, patients with cardiopulmonary disease or non-stroke pathologies admitted to an AGU, may benefit from a short-term OTI.

La pérdida funcional al ingreso, principal variable explicativa de discapacidad y mortalidad al alta y al mes en ancianos hospitalizados / Functional decline on admission: the main independent variable associated with disability and mortality at discharge and 1 month later in the hospitalized elderly

Objetivo: la hospitalización por enfermedad aguda en ancianos provoca frecuentemente deterioro funcional y mortalidad. Es preciso, en nuestro medio, cuantificar la magnitud de esos eventos adversos e identificar cuáles son las variables explicativas de discapacidad y mortalidad asociadas a un ingreso hospitalario. Material y métodos: estudio de cohortes, longitudinal y prospectivo, sobre 376 pacientes consecutivos ingresados en una unidad geriátrica de agudos de un hospital docente terciario durante 6 meses. Variables independientes: edad, sexo, situación funcional previa, pérdida funcional al ingreso (PFi = Barthel previo ­ Barthel ingreso), estado cognitivo, depresión, confusión mental, diagnóstico principal, comorbilidad, número de fármacos y estancia hospitalaria. Variables dependientes: pérdida funcional al alta (PFa = Barthel previo ­ Barthel alta) y al mes (PFm = Barthel previo ­ Barthel mes) y mortalidad al alta y al mes. Resultados: la PFi y la situación funcional previa fueron las variables explicativas de mortalidad o pérdida funcional al alta. La PFi, la edad y la demencia lo fueron de pérdida funcional o mortalidad al mes. La intensidad de la asociación dependió de la cantidad de PFi; la odds ratio varió entre 2,9 y 24,7. Conclusiones: la pérdida de función al ingreso de ancianos hospitalizados es la principal variable explicativa de discapacidad y mortalidad al alta y al mes. La intensidad de asociación depende de la cantidad de función perdida al ingreso

Objective: hospitalization for acute illness in the elderly is frequently associated with functional decline and mortality. In our setting, measurement of these adverse events and identification of the variables associated with disability and mortality following hospitalization due to an acute illness is required. Material and methods: we performed a prospective longitudinal cohort study comprising 376 consecutive elderly patients admitted to an acute geriatric ward of a tertiary teaching hospital over a 6-month period. Independent variables were age, sex, previous functionality, admission functional decline (FDa = previous Barthel score ­ Barthel score on admission), cognitive status, depression, confusional status, main diagnosis, comorbidity, number of drugs, and length of hospital stay. Dependent variables were functional decline at discharge (FDd = previous Barthel score ­ Barthel score at discharge) and at 1 month (FDm = previous Barthel score ­ Barthel score at 1 month), and mortality at discharge and at 1 month. Results: FDa and previous functionality were independently associated with functional decline or mortality at discharge. FDa, age and a diagnosis of dementia were associated with functional decline or mortality at 1 month. The magnitude of the association varied with different FDa, ranging from OR 2.9 to 24.7. Conclusions: functional decline on admission in elderly patients admitted to an acute geriatric ward is a strong independent variable associated with functional decline and mortality at discharge and at 1 month. The magnitude of the association varies with the severity of functional decline on admission