Outcomes of older persons receiving rehabilitation for medical and surgical conditions compared with hip fracture and stroke

OBJECTIVE: Older persons with general medical and surgical conditions incre asingly receive posthospital rehabilitation care in nursing homes and rehab ilitation hospitals. This study describes the characteristics of such patie nts, contrasted with patients with traditional rehabilitation diagnoses of hip fracture and stroke. DESIGN: Prospective cohort study. SETTING: Seventeen skilled nursing facilities and six rehabilitation hospit als in seven states. PARTICIPANTS: Medicare patients age 65 or older receiving posthospital reha bilitation. METHODS: A total of 290 medical/surgical patients were compared with 336 hi p fracture and 429 stroke patients. Data were collected prospectively from charts, nursing assessments, and patient interviews. Patient characteristic s associated with functional recovery and mortality were estimated using mu ltivariate regression. RESULTS: Medical/surgical patients had greater premorbid activities of dail y living (ADL) (P < .001) and instrumental activities of daily living (IADL ) (P < .01) disability, but suffered less decline with the acute event than hip fracture or stroke patients (P < .001). Medical/surgical patients were more likely to recover premorbid ADL function (P < .05) but 1-year mortali ty was significantly greater (30% vs. 14% hip fracture; 18% stroke; P < .00 1). Predictors of functional recovery and mortality differed between the th ree groups. Among medical/surgical patients, premorbid ADL difficulty, cogn itive impairment, a pressure ulcer at rehabilitation admission, and depress ion were associated with failure to recover premorbid function whereas incr easing comorbidity and incontinence were associated with mortality. CONCLUSIONS: Medical/surgical patients represent a unique rehabilitation po pulation. They experienced greater premorbid functional disability, less ac ute decline, but greater mortality than patients with traditional rehabilit ation diagnoses. Further study of this distinct rehabilitation population m ay help identify patients most likely to benefit from rehabilitation.