A Retrospective Audit of an Elderly Rehabilitation Service. How Effective Are We?

C.N. Osuafor1, A. Salawu2, F. McCarthy1,3.

  1. Medicine for the Elderly Department, St Mary’s Hospital, Phoenix Park, Dublin, Ireland.
  2. Physiotherapy Department, St Mary’s Hospital, Phoenix Park, Dublin, Ireland.
  3. University College Dublin, Belfield, Dublin, Ireland.


We report an audit of an elderly rehabilitation service in Dublin. Our report shows the effectiveness of this service in improving balance and mobility of older adults and achieving a safe home discharge in a timely manner. This is in keeping with the objectives of the Health Service Executive National Clinical Program for Older People.

Our unit has a 22-bed specialised ward which offers rehabilitation to frail older adults after acute hospitalization. The ward has a skilled multidisciplinary team who aim to optimise patient’s independence whilst working towards a timely discharge. During this period of rehabilitation, the team address a large spectrum of issues that affect the elderly which include falls, frailty, sarcopenia, malnutrition and cognitive decline. The aim of this report was to audit this rehabilitation service using the change in Berg Balance Scale (BBS) on admission and on discharge and the discharge outcome as the main outcome measures over a 13-month period.

A retrospective audit of all consecutive admissions over a 13-month period was carried out. There were 159 patients admitted for rehabilitation over the study period; 154 patients were included in the final audit as 3 patients had not completed rehabilitation and 2 patients had missing data at the time of the analysis. There were 87/154 females (56.5%). Mean age was 82.7±8.3 years (range 59–102 years). Mean Addenbrooke’s Cognitive Examination-III was 66.2±16.2 (range 29–95). Median length of stay was 35 days (1–250 days). Main outcome measure used was a change in BBS which was obtained in 124 patients of which 111/124 patients (89.5%) showed a detectable improvement; 91/124 patients (73.4%) were deemed to be significant improvements (BBS change ≥5). No change in BBS was noted in 11/124 patients (8.9%) while 2/124 patients (1.6%) showed a decline. In relation to discharge outcome, 130/154 patients (84.4%) were discharged home, 14/154 patients (9.1%) were transferred back to the acute hospital, 5/154 patients (3.2%) were discharged to a nursing home while 5/154 patients (3.2%) died.

Delivery of structured rehabilitation programmes for older people is one of the recommendations of the model of care for specialist geriatric services in Ireland1. The BBS2,3 is a validated 14-item scale designed to measure balance of the older adult in a clinical setting. A change of 5 to 8 points is required to reveal a genuine change in function between 2 assessments4,5. Measuring effectiveness of a rehabilitation service includes use of BBS that can determine change in functional standing balance over time and evaluation of discharge outcome after rehabilitation. This audit showed most of our patients (73.4%) had a significant improvement at the end of their rehabilitation. Also, a large majority (83.4%) achieved a successful discharge home in a time frame suggested as appropriate by the National Clinical Program for Older People1. The overall outcome of an effective rehabilitation service is a promotion of independent living of older adults in their homes in the community, reduction in delayed discharges from the acute hospital setting and overall improvement in the quality of care of older adults in Ireland.

Correspondence:
Christopher N. Osuafor,
Medicine for the Elderly Department,
St Mary’s Hospital,
Phoenix Park,
Dublin
E-mail: chrisosuafor@gmail.com


Footnote
Abstract of this study was presented at the 64th Irish Gerontological Society Annual and Scientific Meeting, Killarney, Ireland.

References:
1. Health Service Executive, Royal College of Physicians of Ireland National Clinical Programme for older people: special geriatric services model of care. Dublin: Health Service Executive, 2011: 93. Available at http://hdl.handle.net/10147/324959.
2. Berg KO, Wood-Dauphinee SL, Williams JI, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can. 1989;41(6):304–11.
3. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992 Jul-Aug;83 Suppl 2:S7-11.
4. Donoghue D, Stokes EK. How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people. J Rehabil Med. 2009;41(5):343–346.
5. Romero S, Bishop MD, Velozo CA, Light K. Minimum detectable change of the Berg Balance Scale and Dynamic Gait Index in older persons at risk for falling. J Geriatr Phys Ther. 2011 Jul-Sep;34(3):131-7.

 

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