Assessing and restoring function in elderly people - more than rehabilitation

Objective: To quantify the medical component of assessing and restoring function in the elderly and to determine if a subset who did not require medical input could be identified. Design: Prospective consecutive sample. Setting: Inpatient assessment, treatment and rehabilitation unit for the elderly in New Zealand. Patients: Two hundred patients aged 60-98 years. Main outcome measures: (1) Proportion of elderly people receiving rehabilitation who also required treatment of medical problems. (2) Characteristics of those not requiring medical input. Results: One hundred and seventy-two (86%) of people required some medical input during their hospital stay for rehabilitation. Forty-nine per cent had medical conditions which had a direct impact on their rehabilitation. Rehabilitation was delayed for a mean 16.8 (13.0-20.6)% of hospital stay when significant medical problems required treatment. People with previously undiagnosed conditions affecting rehabilitation tended to be older. The referral diagnoses most likely to result in an uncomplicated inpatient stay (i.e. rehabilitation only or rehabilitation with treatment of minor medical problems) were postsurgical treatment (55% uncomplicated), stroke (47% uncomplicated) or amputation (55% uncomplicated). However, 45-53% of people with these problems had a major medical component to their stay. People with other referral diagnoses or those admitted from institutions for the elderly were more likely to have a medical component to their stay. Conclusion: Restoration of function in the elderly requires a combination of both medical and rehabilitation skills. Reliable predictors of those not requiring medical input could not be found.