The clinical characteristics of the cohort can be found in Table 1. The mean duration of inpatient stay at the University Hospital Essen for the entire cohort was 13.3 ± 13.6 days. A total of 135 out of 468 patients (28.8%) were in need of supportive intensive care treatment. 124 patients (26.5%) died during the hospital stay; 85 persons (18.2%) passed away within the first year after discharge (March 2022). Thus, a total of 209 of the 402 patients reached (52%) died, while 193 patients (48.0%) survived one year after hospital discharge (Table 1; Fig. 1).
Care at the geriatric hospital
A total of 74 patients were admitted to the Geriatric Department for early complex geriatric rehabilitation (Table 2). The mean age among these patients was 81.8 ± 6.6 years, with 29 (39.2%) males and 45 (60.8%) female patients. The mean inpatient stay was 18.6 ± 10.3 days, with men staying for 16.9 ± 9.7 days and women for 19.6 ± 10.6 days.
Three patients (4.1%) died in the hospital, 16 (21.6%) died during the first year after discharge from the hospital and 48 (71,6%) survived the first year after discharge (Table 1); seven of the patients in this group were not reachable; thus, the survival status is uncertain.
We assessed the Barthel index at both admission to the hospital and discharge. The mean Barthel index increased from 39 ± 23.7 to 53.3 ± 31.3 points (p = 0.007). When stratified by sex, the male group improved from 32.8 ± 24.5 to 42.1 ± 31.9 points (p = 0.267), and the female group improved from 42.5 ± 22.8 to 59.3 ± 29.7 points (p = 0.004).
The TUG test (mean duration) at the time of admission to the hospital was 22.3 ± 13.1 s, and at discharge, it was 21.0 ± 12.8 s. Interestingly, male performance worsened from admission to discharge (27.5 ± 25.7 vs. 33.0 ± 22.7 s) (p = 0.730), while female performance improved from 20.6 ± 6.5 s to 18.0 ± 7 s (p = 0.273).
Regarding the GDS, the mean value at the time of admission was 3.0 ± 2.7 points. Notably, males had a slightly higher score of 3.4 ± 3.3 points compared to females, who had a mean score of 2.9 ± 2.4 (p = 0.497) (Table 2).
The MMST at admission revealed a mean value of 20.1 ± 7.7 points, with males scoring 15.9 ± 8.8 points and females scoring 22.3 ± 6.1 points.
Clinical situation at 12 months after discharge from the hospital
In our study 193 persons, who fulfilled the criteria for geriatric patients, were alive at the 12 month evaluation. Of these, 51 agreed to participate in the study (Fig. 1). We divided these 51 patients (mean age: 80.2 ± 6.4 y; 26 females) into two groups: one group who had received “early complex geriatric rehabilitation” at the Department of Geriatrics after their discharge from the university hospital (n = 16; mean age: 80.9 ± 7.6 years; 11 females), and the second group who had not received this additional treatment (n = 35; mean age: 79.8 ± 5.8 years; 15 females) (Table 3).
Following hospital treatment patients were dismissed either to the respite care, to their homes or residency care. No difference could be found among the two groups. The majority of persons lived at home (n = 41, 80.4%) with ten persons (19.6%) residing in nursing homes (Table 4). In the group without early complex geriatric rehabilitation, more persons lived at home (n = 30, 85.7%) than in the group with early complex geriatric rehabilitation (11, 68.7%).
When evaluating the care provision of the persons one year after discharge from the hospital in the follow-up cohort, 25 (49%) did not require any additional care. Moreover, in Germany there is a distinction between level of care and financial support (“Pflegegrad”, PG) based on the level of assistance needed, ranging from I-V. (no PG: 26 persons (51%); PG-I: 2 (3,9%); PG-II: 9 (17,6%); PG-III: 8 (15,7%); PG-IV: 5 (9,8%); PG-V: 1 (2%)). The level of care also differed between the two subgroups. In the group without early complex geriatric rehabilitation, more persons had no PG compared to the group with early complex geriatric rehabilitation (20, 57.1%; 6, 37.5%) (Table 3).
To evaluate the basic activities of daily living, the Barthel Index at 12 months was assessed resulting in a mean of 84.8 ± 21.9 points. Interestingly, the mean value was higher in the cohort without early complex geriatric rehabilitation than in the group who had received early complex geriatric rehabilitation (87.9 ± 17.5 vs. 78.1 ± 29.1 points). However, it showed no significant difference. This index is influenced by several different factors, and in this case, age plays a considerable role (Tables 5, 6 and 7) The Barthel Index in this group of persons that received complex treatment rose from 39.0 ± 23.7 at the time of admission to the geriatric hospital to 53.3 ± 31.3 at the time of discharge (p = 0.030) and to 78.1 ± 29.1 (p = 0.335) at the time of data collection one year after discharge. Unfortunately, no data was collected for the group of persons, that did not receive complex geriatric treatment, at the time of in-patient care.
The mean TUG time was 19.2 ± 19.7 s. The cohort without early complex geriatric rehabilitation had a approximately 33.6% faster TUG time than the cohort with early complex geriatric rehabilitation (16.8 ± 13.2 vs. 25.3 ± 34.5 s). This potentially due to the latter cohort, more people were living in a nursing home and were sitting in a wheelchair or were confined to bed, where they were not able to participate in the TUG test. Moreover, they had more comorbidities. However, it should be noted that the results are not significant.
Drug consumption at 12 months was also different between the two groups. We divided the number of medications to be taken into groups: 1–4 medications, 5–9 medications, and over 10 medications. The group with early complex geriatric rehabilitation had to take less often over 10 medications but instead more 1–4 medications compared to the group without early complex geriatric rehabilitation (with: 1–4: 9, 56.25%; 5–9, 6, 37.5%; over 10, 1, 6.25%) (without: 1–4: 12, 34.28%; 5–9, 12, 34.28%; over 10, 6, 17.14%) (no significance) (Table 3).
To score the emotional feelings of the patients, we used the GDS. The whole study group had a mean value of 4.2 ± 3.5 points. The group with early complex geriatric rehabilitation had a around 58.33% higher score (5.7 ± 4.1 points) than the group without geriatric care (3.6 ± 3.1 points) (Table 5) (not significant). In terms of apathy or lack of motivation, the mean AES score was 33.5 ± 11.7 points, with both groups remaining below the cut-off value. In the group with geriatric care (35.7 ± 13.7 points), higher values were found compared to the group without early complex geriatric rehabilitation (32.4 ± 10.8 points) (Table 5) (no significance).
Finally, we evaluated health status using the EQ-5D-5 L-VAS (EuroQol visual analogue scale). The group achieved a mean value of 60.4 ± 19.9 points. The patients in the group without early complex geriatric rehabilitation scored higher (65.4 ± 15.5 points) than the patients with early complex geriatric rehabilitation (49.4 ± 24 points). The group without early complex geriatric rehabilitation scored approximately 24.5% lower, compared to the group without complex geriatric treatment. (Table 5) (p = 0.006).
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