Do older adults benefit from post-acute care following hospitalisation? A prospective cohort study at three Swiss nursing homes.

ABSTRACT

BACKGROUND: Post-acute care (PAC) programmes appear favourable for older adult inpatients too fragile to be discharged home without extensive support, but otherwise not qualifying for specific rehabilitation. Consequently, many Swiss nursing homes have opened PAC wards after a new federal law refined reimbursement in 2012. However, PAC outcomes in this setting have not been well studied. OBJECTIVE: To investigate the functional outcomes of a nursing home-based PAC programme for older adult patients and to evaluate the influences of age, gender and frailty status on these outcomes. METHODS: This was a prospective cohort study in 135 consecutive patients aged 60 and older admitted to PAC at three nursing homes in Zurich, Switzerland, over a two-month period. Geriatric assessment at admission included mobility, physical performance, cognition, nutrition, frailty, activities of daily living (ADL) and social support. The primary outcomes of the study, Short Physical Performance Battery (SPPB), handgrip strength (HGS) and Barthel Index (BI), were repeated before discharge from PAC. Multivariable linear models were used to analyse differences between these primary outcomes at admission and discharge, adjusting for baseline age, gender, BMI, length of stay (LOS), polypharmacy, cognition, and prior living status. RESULTS: We identified statistically significant improvements between admission and discharge (mean [95% confidence interval]; % change) in BI (69.0 [65.0–72.9] vs 79.6 [75.6–83.6]; +15.4%), gait speed (0.55 [0.48–0.62] vs 0.65 [0.58–0.71] m/s; +18.2%) and SPPB scores (5.5 [5.0–6.1] vs 6.9 [6.3–7.4]; +24%), p-values for all comparisons <0.001. CONCLUSIONS: In this real-word sample, PAC resulted in a significant and clinically relevant improvement in physical performance and ADL. However, our study should be replicated with a larger sample. Furthermore, long-term outcomes of PAC warrant additional investigation.