Evaluate the relative contribution of cognitive test performance to post-acute care (PAC) length of stay (LOS) and rehospitalization while controlling for key demographic, medical, and functional outcomes.
Methods:
Retrospective medical record review of 160 older Veterans, including cognitive test performance (Addenbrooke’s Cognitive Examination–Revised [ACE-R]), on admission to a Veterans Administration Hospital Community Living Center (CLC) PAC.
Results:
Individuals with impaired scores on the ACE-R had a longer LOS (10 median days longer; U = 2,547.00, p = .028). Of those rehospitalized, 71.4% (n = 20) screened positive for cognitive impairment. Key medical factors explained the largest amount of variance in CLC-PAC LOS (29.8%), followed by admission ADL (activities of daily living) dependency (4.6%) and ACE-R total score (3.30%).
Discussion:
Cognitive screening should be considered on PAC admission, with impairment on ACE-R predicting geriatric rehabilitation outcomes such as risk of increased LOS and rehospitalization.
AlmashrafiA.ElmontsriM.AylinP. (2016). Systematic review of factors influencing length of stay in ICU after adult cardiac surgery. BMC Health Services Research, 16, Article 318.
2.
AndersonM. E.GlasheenJ. J.AnoffD.PierceR.CappR.JonesC. D. (2015). Understanding predictors of prolonged hospitalizations among general medicine patients: A guide and preliminary analysis. Journal of Hospital Medicine, 10, 623-626.
3.
BoagaiskyM.DezieckL. (2015). Early hospital readmission of nursing home residents and community-dwelling elderly adults discharged from the geriatrics service of an urban teaching hospital: Patterns and risk factors. Journal of the American Geriatrics Society, 63, 548-552.
4.
BreitbartW.RosenfeldB.RothA.SmithM. J.CohenK.PassikS. (1997). The memorial delirium assessment scale. Journal of Pain and Symptom Management, 13, 128-137.
5.
BurkeR. E.Juarez-ColungaE.LevyC.ProchazkaA. V.ColemanE. A.GindeA. A. (2015). Rise of post-acute care facilities as a discharge destination of US hospitalizations. JAMA Internal Medicine, 175, 295-296.
6.
BurkeR. E.WhitfieldE. A.HittleD.MinS.LevyC.ProchazkaA. V.. . . GindeA. A. (2016). Hospital readmission from post-acute care facilities: Risk factors, timing, and outcomes. Journal of the American Medical Directors Association, 17, 249-255.
7.
CampbellS. E.SeymourD. G.PrimroseW. R. (2004). A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age and Ageing, 33, 110-115.
8.
ChodoshJ.PetittiD. B.ElliotM.HaysR. D.CrooksV. C.ReubenD. B.. . . WengerN. (2004). Physician recognition of cognitive impairment: Evaluating the need for improvement. Journal of the American Geriatrics Society, 52, 1051-1059.
9.
DinhT. T. H.BonnerA.ClarkR.RamsbothamJ.HinesS. (2016). The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: A systematic review. JBI Database of Systematic Reviews & Implementation Reports, 14, 210-247.
10.
ElphickH. L.MankadK.MadanS.ParkerC.LiddleB. J. (2007). The determinants of successful in-hospital rehabilitation in people aged 90 years and older. Gerontology, 53, 116-120.
11.
FolsteinM. F.FolsteinS. E.McHughP. R. (1975). “Mini-mental status” A practical method for grading the cognitive states of patients for the clinician. Journal of Psychiatric Research, 12, 189-198.
12.
FurlanettoL. M.da SilvaR. V.BuenoJ. R. (2003). The impact of psychiatric comorbidity on length of stay of medical inpatients. General Hospital Psychiatry, 25, 14-19.
13.
GaberT. A. (2008). Evaluation of the Addenbrooke’s cognitive examination’s validity in a brain injury rehabilitation setting. Brain Injury, 22, 589-593.
14.
GalskiT.BrunoR. L.ZorowitzR.WalkerJ. (1993). Predicting length of stay, functional outcome, and aftercare in the rehabilitation of stroke patients: The dominant role of higher-order cognition. Stroke, 24, 1794-1800.
15.
GopalakrishnaG.IthmanM.MalwitzK. (2015). Predictors of length of stay in a psychiatric hospital. International Journal of Psychiatry in Clinical Practice, 19, 238-244.
16.
GruneirA.Markle-ReidM.FisherK.ReimerH.MaX.PloegJ. (2016). Comorbidity burden and health services use in community-living older adults with diabetes mellitus: A retrospective cohort study. Canadian Journal of Diabetes, 40, 35-42.
17.
HamiltonB. B.GrangerC. V.SherwinF. S.ZieleznyM.TashmanJ. S. (1987). A uniform national data system for medical rehabilitation In FuhrerM. J. (Ed.), Rehabilitation outcomes: Analysis and measurement (pp. 137-147). Baltimore, MD: Brooks.
18.
HirschC. H.SommersL.OlsenA.MullenL.WinogradC. H. (1990). The natural history of functional morbidity in hospitalized older patients. Journal of the American Geriatrics Society, 38, 1296-1303.
19.
HorneyC.CappR.BoxerR.BurkeR. E. (2017). Factors associated with early readmission among patients discharged to post-acute care facilities. Journal of the American Geriatrics Society, 65, 1199-1205.
20.
HungC.Y.WuW.T.ChangK.V.WangT.G.HanD.S. (2017). Predicting the length of hospital stay of post-acute care patients in Taiwan using the Chinese version of the continuity assessment record and evaluation item set. PLoS One, 12, e0183612.
21.
JonesT.K.FuchsB.D.SmallD.S.HalpernS.D.HanishA.UmscheidC.A.. . . MikkelsenM.E. (2015). Post-acute care use and hospital readmission after sepsis. Annals of the American Thoracic Society, 12, 904-913.
22.
KomadinaN. C.TerpeningZ.HuangY.HallidayG. M.NaismithS. L.LewisS. J. (2011). Utility and limitations of Addenbrooke’s cognitive examination-revised for detecting mild cognitive impairment in Parkinson’s disease. Dementia and Geriatric Cognitive Disorders, 31, 349-357.
23.
LalicS.SluggettJ. K.IlomäkiJ.WimmerB. C.TanE. C.RobsonL.BellJ. S. (2016). Polypharmacy and medication regimen complexity as risk factors for hospitalization among residents of long-term care facilities: A prospective study. Journal of the American Medical Directors Association, 17(11), e1067.
24.
LandeiroF.LealJ.GrayA. M. (2016). The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs. Osteoporosis International, 27, 737-745.
25.
LarnerA. J. (2007). Addenbrooke’s Cognitive Examination-Revised (ACE-R) in day-to-day clinical practice. Age and Ageing, 36, 685-686.
26.
LowryE.WoodmanR. J.SoizaR. L.HilmerS. N.MangoniA. A. (2012). Drug burden index, physical function, and adverse outcomes in older hospitalized patients. Journal of Clinical Pharmacology, 52, 1584-1591.
27.
MajeedM. U.WilliamsD. T.PollockR.AmirF.LiamM.FoongK. S.WhitakerC. J. (2012). Delay in discharge and its impact on unnecessary bed occupancy. BMC Health Services Research, 12, Article 410.
28.
MayoN. E.Wood-DauphineeS.GaytonD.ScottS. C. (1997). Nonmedical bed-days for stroke patients admitted to acute-care hospitals in Montreal, Canada. Stroke, 28, 543-549.
29.
MioshiE.DawsonK.MitchellJ.ArnoldR.HodgesJ. R. (2006). The Addenbrooke’s Cognitive Examination Revised (ACE-R): A brief cognitive test battery for dementia screening. International Journal of Geriatric Psychiatry, 21, 1078-1085.
30.
MudgeA. M.KasperK.ClairA.RedfernH.BellJ. J.BarrasM. A.. . . PachanaN. A. (2011). Recurrent readmissions in medical patients: A prospective study. Journal of Hospital Medicine, 6, 61-67.
31.
NaylorM. D.BrootenD.CampbellR.JacobsenB. S.MezeyM. D.PaulyM. V.SchwartzJ. S. (1999). Comprehensive discharge planning and home follow-up of hospitalized elders. Journal of the American Medical Association, 281, 613-620.
32.
OlthofM.StevensM.BulstraS. K.van den Akker-ScheekI. (2014). The association between comorbidity and length of hospital stay and costs in total hip arthroplasty patients: A systematic review. The Journal of Arthroplasty, 29, 1009-1014.
33.
PoynterL.KwanJ.SayerA. A.VassalloM. (2011). Does cognitive impairment affect rehabilitation outcome?Journal of the American Geriatrics Society, 59, 2108-2111.
34.
RotomskisA.MargevičiūtėR.GermanavičiusA.KaubrysG.BudrysV.BagdonasA. (2015). Differential diagnosis of depression and Alzheimer’s disease with the Addenbrooke’s Cognitive Examination-Revised (ACE-R). BMC Neurology, 15, Article 57.
35.
Seematter-BagnoudL.MartinE.BülaC. J. (2012). Health services utilization associated with cognitive impairment and dementia in older patients undergoing post-acute rehabilitation. Journal of the American Medical Directors Association, 13, 692-697.
36.
Seematter-BagnoudL.FrascaroloS.BulaC. J. (2018). How much do combined affective and cognitive impairments worsen rehabilitation outcomes after hip fracture?BMC Geriatrics, 181(1), Article 71.
37.
WierL.PfuntnerA.SteinerC. (2010). Hospital utilization among oldest adults, 2008 (Statistical Brief #103, Healthcare Cost And Utilization Project Statistical Briefs). Rockville, MD: Agency for Health Care Policy and Research.
38.
WoznowskiA.Da CostaC.Turgeon-ProvostF.DagenaisK.Roy-MathieB.AggbanM.PreussR. (2015). Factors affecting length of stay in adult outpatient physical rehabilitation: A scoping review of the literature. Physiotherapy Canada, 67, 329-340.
39.
YohannesA. M.BaldwinR. C.ConnollyM. J. (2008). Prevalence of depression and anxiety symptoms in elderly patients admitted in post-acute intermediate care. International Journal of Geriatric Psychiatry, 23, 1141-1147.
40.
ZanocchiM.MaeroB.MainaP.PonzettoM.FrancisettiF.GionaE.. . . FabrisF. (2002). Factors predicting a prolonged hospital stay in elderly patients. Minerva Medica, 93, 135-143.
41.
ZulmanD. M.Pal CheeC.WagnerT. H.YoonJ.CohenD. M.HolmesT. H.. . . AschS. M. (2015). Multimorbidity and healthcare utilisation among high-cost patients in the US veterans affairs health care system. BMJ Open, 5(4), e007771.
