The importance of early inpatient geriatric rehabilitation on outcomes in dialysis patients.

Abstract

OBJECTIVE\nTo report short-term functional outcomes of incident dialysis patients undergoing inpatient rehabilitation within three months of dialysis initiation.\n\n\nDESIGN\nRetrospective observation study using prospectively collected data SETTING: Single centre, hospital based Geriatric Dialysis Rehabilitation Unit.Using a retrospective observational design, all incident hemodialysis patients admitted to the Geriatric Dialysis Rehabilitation Unit between May 2002 and April 2016 were identified. Clinical and demographic data were collected prospectively and linked, using the unique hospital number and dates of admission and discharge, to Functional Independence Measure (FIM)® scores (used to assess functional recovery) at admission and discharge.\n\n\nPARTICIPANTS\nPatients newly started onto hemodialysis (within 3 months) INTERVENTIONS: Inpatient rehabilitation care; short daily dialysis therapy with nephrologist support; geriatrician assessment MAIN OUTCOMES: Change in FIM® score; discharge location RESULTS: A total of 449 patients aged 74±9 years, were admitted within 3 months of hemodialysis initiation. The median length of stay in the rehabilitation program was 43 days (25th and 75th quartile 33-55 days). Of those with complete data (n=370) 95% had improvement in FIM®scores (median changes in total FIM® score 25 quartiles 16, 33; in motor FIM 23 quartiles 15,32; and in cognitive FIM 1 quartiles 0,3 respectively). Most improvement was seen in transfer abilities, grooming and mobility . A total of 324 (72%, 95% CI 68-76%) patients were discharged to a private home. An additional 11 were discharged to a senior s residence.\n\n\nCONCLUSION\nThe data suggest that older incident dialysis patients with functional decline respond well to specialized rehabilitation care and suggest this may be a novel approach to dialysis initiation.