Skip to main content
SpringerLink
Log in

A comorbidity prognostic effect on post-hospitalization outcome in a geriatric rehabilitation setting: the pivotal role of functionality, assessed by mediation model, and association with the Brass index

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

Discharge planning is a critical feature of hospital’s care in geriatric rehabilitation centers. The aim of this study was to evaluate the effects of comorbidity and functionality in identifying patients who are at risk of discharge problems. We also evaluate the association between Blaylock Risk Assessment Screening Score, BRASS index (BI), and post-hospitalization outcome (PHO).

Methods

Eighty patients (58 women and 22 men, with mean age equal to 83.28 ± 6.77 years) at geriatric rehabilitation division admission were screened with Geriatric Multidimensional Assessment (GMA). Then, BI and PHO were evaluated (mean follow-up time was 205.1 ± 95.8 days). By Structural Equation Model, we evaluated the existing causal relationships between comorbidity, functionality and PHO, elements of GMA, and the association between PHO and BI.

Results

Comorbidity acted on PHO through functionality with indirect effect only (+0.703, P = 0.019). So, the functionality assumes a pivotal role of the causal relationship comorbidity to PHO. BI is positively associated with PHO: correlation returned was equal to +0.313 (P = 0.019).

Conclusions

The comorbidity has a role in getting worse PHO, but its effect is possible only through the mediation of functional status. The study also demonstrated the positive association between BI and PHO.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Berr C, Balard F, Blain H et al (2012) How to define old age: successful aging and/or longevity. Med sci 28:281–287

    Google Scholar 

  2. Verbrugge LM, Lepkowski JM, Imanaka Y et al (1989) Comorbidity and its impact on disability. Milbank Q 67:450–484

    Article  CAS  PubMed  Google Scholar 

  3. Guralnik JM, La Croix AZ, Everett DF et al (1989) Aging in the eighties: the prevalence of comorbidity and its association with disability. Vital Health Stat Ser 3(170):1–8

    Google Scholar 

  4. Fuchs Z, Blumstein T, Novikiv I et al (1998) Morbidity, comorbidity, and their association with disability among community-dwelling oldest-old in Israel. J Gerontol 53A:M447–M455

    Article  Google Scholar 

  5. Patel KV, Peek MK, Wong R et al (2006) Comorbidity and disability in elderly Mexican and Mexican American adults. J Aging Health 18:315–329

    Article  PubMed  Google Scholar 

  6. Boult C, Kane RL, Louis TA et al (1994) Chronic conditions that lead to functional limitation in the elderly. J Gerontol 49:M28–M36

    Article  CAS  PubMed  Google Scholar 

  7. Kriegsman DMW, Deeg DJH, Stalman WAB et al (2004) Comorbidity of somatic chronic diseases and decline in physical functioning: the Longitudinal Aging Study Amsterdam. J Clin Epidemiol 57:55–65

    Article  PubMed  Google Scholar 

  8. Wolff JL, Boult C, Boyd C et al (2005) Newly reported chronic conditions and onset of functional dependency. J Am Geriatr Soc 53:851–855

    Article  PubMed  Google Scholar 

  9. Strawbridge WJ, Kaplan GA, Camacho T et al (1992) The dynamics of disability and functional change in an elderly cohort: results from the Alameda County Study. J Am Geriatr Soc 40:799–806

    Article  CAS  PubMed  Google Scholar 

  10. Ho SC (1991) Health and social predictors of mortality in an elderly Chinese cohort. Am J Epidemiol 133:907–921

    CAS  PubMed  Google Scholar 

  11. Di Bari M, Virgillo A, Matteuzzi D et al (2006) Predictive validity of measures of comorbidity in older community dwellers: the Insufficienza Cardiaca negli Anziani Residenti A Dicomano Study. J Am Geriatr Soc 54:210–216

    Article  PubMed  Google Scholar 

  12. Tas U, Verhagen AP, Bierma-Zeinstra SMA et al (2007) Incidence and risk factors of disability in the elderly: the Rotterdam Study. Prev Med 44:272–278

    Article  PubMed  Google Scholar 

  13. Kiely DK, Morris JN, Morris SA et al (1997) The effect of specific medical conditions on functional decline. J Am Geriatr Soc 45:1459–1463

    Article  CAS  PubMed  Google Scholar 

  14. Walter LC, Brand RJ, Counsell SR et al (2001) Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 285:2987–2994

    Article  CAS  PubMed  Google Scholar 

  15. Conde-Martel A, Hemmersbach-Miller M, Marchena-Gomez J et al (2012) Five-year survival and prognostic factors in a cohort of hospitalized nonangerians. Eur J Intern Med 23:513–518

    Article  PubMed  Google Scholar 

  16. Bernardini B, Pagani M, Corsini C et al (2008) Diagnosi sindromica e percorsi clinici post-acuti dei pazienti con ictus. Eur J Med Phys 44:S1–S3

    Google Scholar 

  17. Jagger C, Clarke M, Davies RA (1986) The elderly at home: indices of disability. J Epidemiol Comm Health 40:139–142

    Article  CAS  Google Scholar 

  18. Blaylock A, Cason CL (1992) Discharge planning predicting patients’ needs. J Gerontol Nurs 18:5–10

    Article  CAS  PubMed  Google Scholar 

  19. Chaboyer W, Kendall E, Foster M et al (2002) Use of the Brass to identify ICU patients who may have complex hospital discharge needs. Nurs Crit Care 7:71–75

    Google Scholar 

  20. Mistianen P, Duijnhouwer E, Prins-Hoekstra A et al (1999) Predictive validity of the BRASS index in screening patients with post-discharge problems. Blaylock Risk Assessment Screening Score. J Adv Nurs 30:1050–1056

    Article  Google Scholar 

  21. Panella L, La Porta F, Caselli S et al (2012) Predicting the need for institutional care shortly after admission to rehabilitation: Rasch analysis and predictive validity of the BRASS index. Eur J Phys Rehab Med 48:443–454

    CAS  Google Scholar 

  22. Parmelee PA, Thuras PD, Katz IR et al (1995) Validation of the Cumulative Illness Rating Scale in a geriatric residential population. J Am Geriatr Soc 43:130–137

    Article  CAS  PubMed  Google Scholar 

  23. Conwell Y, Forbes NT, Cox C et al (1993) Validation of a measure of physical illness burden at autopsy: the Cumulative Illness Rating Scale. J Am Geriatr Soc 41:38–41

    Article  CAS  PubMed  Google Scholar 

  24. Giaquinto S, Palma E, Maiolo I et al (2001) Importance and evaluation of comorbidity in rehabilitation. Disabilil Rehabil 23:296–299

    Article  CAS  Google Scholar 

  25. Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65

    CAS  PubMed  Google Scholar 

  26. Katz A, Ford AB, Moskowitz RW et al (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA 185:914–919

    Article  CAS  PubMed  Google Scholar 

  27. Laake K, Laake P, Ranhoff AH et al (1995) The Barthel ADL index: factor structure depends upon the category of patient. Age Aging 24:393–397

    Article  CAS  Google Scholar 

  28. Pearl J (2014) Interpretation and identification in causal mediation analysis. Psychol Methods 19(4):459–481

    Article  PubMed  Google Scholar 

  29. Bollen KA (1989) Structural equations with latent variables. Wiley Series in Probability and Mathematical Statistics, New York

    Book  Google Scholar 

  30. Miller M, Paradis CF, Houck PR et al (1992) Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatr Res 41:237–248

    Article  CAS  Google Scholar 

  31. Shah S, Vanclay F, Cooper B et al (1989) Improving the sensitivity of the Barthel index for stroke rehabilitation. J Clin Epidemiol 42:703–709

    Article  CAS  PubMed  Google Scholar 

  32. Agresti A (2010) Analysis of ordinal categorical data, 2nd edn. Wiley, New York

    Book  Google Scholar 

  33. Bagozzi RP, Yi Youjae (2012) Specification, evaluation, and interpretation of structural equation models. J Acad Mark Sci 40:8–34

    Article  Google Scholar 

  34. Development Core Team (2012) A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  35. Rossell Y, An R (2012) Package for structural equation modeling. J Stat Softw 48:1–36

    Google Scholar 

  36. Ferrucci L, Guralnik JM, Baroni A et al (1991) Value of combined assessment of physical health and functional status in community-dwelling aged: a prospective study in Florence, Italy. J Gerontol 46:M52–M56

    Article  CAS  PubMed  Google Scholar 

  37. Leong IY, Chan SP, Tan BY et al (2009) Factors affecting unplanned readmissions from community hospitals to acute hospitals: a prospective observational study. Ann Acad Med Singapore 38:113–120

    PubMed  Google Scholar 

  38. Colombo M, Guaita A, Cottino M et al (2004) The impact of cognitive impairment on the rehabilitation process in geriatrics. Arch Gerontol Geriatr Suppl 9:85–92

    Article  PubMed  Google Scholar 

Download references

Conflict of interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

Human and Animal Rights

The study was approved by the regional ethics committee at University of Pavia and was therefore performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

All subjects provided written consent to participate.

Author information

Authors and Affiliations

  1. Section of Biostatistics, Neurophysiology and Psychiatry, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy

    Davide Guido

  2. Section of Human Nutrition, Department of Public Health, Experimental and Forensic Medicine, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy

    Simone Perna, Gabriella Peroni & Mariangela Rondanelli

  3. Section of Geriatrics, Department of Internal Medicine and Therapeutics, Azienda di Servizi alla Persona di Pavia, University of Pavia, Pavia, Italy

    Fabio Guerriero

Authors
  1. Davide Guido
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simone Perna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriella Peroni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabio Guerriero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mariangela Rondanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simone Perna.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guido, D., Perna, S., Peroni, G. et al. A comorbidity prognostic effect on post-hospitalization outcome in a geriatric rehabilitation setting: the pivotal role of functionality, assessed by mediation model, and association with the Brass index. Aging Clin Exp Res 27, 849–856 (2015). https://doi.org/10.1007/s40520-015-0360-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-015-0360-1

Keywords

Search

Navigation