Outcomes of inpatient rehabilitation for older adults with debility

Objective: To determine the functional outcomes and discharge setting of older patients receiving inpatient rehabilitation for debility (ICD-9-CM, 799.3). Design: Retrospective cohort study of 63,1171 individuals >= 65 yrs old with a primary (23%),or comorbid (77%) debility diagnosis from the Uniform Data System for Medical Rehabilitation (UDSMR) database for 2002-2003. Results: Patients with a primary diagnosis of debility (PDD) had a lower mean rehabilitation efficiency score (functional change per day) as compared with the rest of the subjects (1.7 vs. 1.9, P < 0.001), including those with a Centers for Medicare & Medicaid Services (CMS) 75016 rule primary diagnosis (1.8, P < 0.001). The PDD group was less likely to be discharged home (68% vs. 73%, P < 0.001) and more likely to be discharged to a hospital (13% vs. 11 %, P < 0.001). Conclusions: From a clinical perspective, the functional recovery of older patients with debility is essentially the same, regardless of whether this is a primary or comorbid diagnosis. Their functional improvement is also comparable with that reported for other CMS 75% rule diagnoses, although the debility patients are less likely to be discharged home. More than 10% of these patients were discharged to acute hospital settings. Further research is warranted to identify the most appropriate rehabilitation setting for patients with debility.