Early-stage impairments and limitations of functioning from the geriatric ICF core set as determinants of independent living in older patients after discharge from post-acute rehabilitation

Objective: To identify the impairments and limitations that indicate loss of independence in older patients after discharge from post-acute rehabilitation. Design: Prospective cohort study. Subjects/patients: A total of 128 patients in the development cohort and 137 patients in the validation cohort. Methods: Data on functioning and previous living situation were collected at admission; data on prospective living situation were collected at discharge. Multivariable logistic and non-parametric (CART) analyses were carried out with the development cohort. The resulting models were validated in a validation cohort. Results: Development cohort: mean age was 80.3 years (95% confidence interval (CI) 79.1-81.6), 52% of patients experienced loss of independence. The International Classification of Functioning, Disability and Health (ICF) category d465, "moving around using equipment" (odds ratio (OR) = 2.7, 95% CI 1.2-5.8) and a dichotomous indicator variable for fractures or joint replacement (OR = 2.3, 95% CI 1.1-4.9) remained in the logistic model. CART yielded the ICF categories d465 "moving around using equipment", and b765 "involuntary movement functions" conditional on d465. Validation cohort: mean age was 72.6 years (95% CI 70.3-74.9). 40% experienced loss of independence. d465 (OR = 7.6, 95% CI 1.6-35.5) and b765 (OR = 5.9, 95% CI 2.6-13.4) were also significant predictors in the logistic model. Conclusion: Older patients who are not able to move around with the help of equipment at the beginning of post-acute rehabilitation are 3 times as likely to lose independence when discharged. It may be important for patients' independent living to encourage the use of wheelchairs and walking aids at very early stages of rehabilitation.