A cohort study of the effects of multidisciplinary in-patient primary care in older adults

Key summary points

AbstractSection Aim

To evaluate to the effects of a multifactorial, multidisciplinary in-patient municipality intervention on functioning, need-of-care, and quality of life in functionally declining older adults.

AbstractSection Findings

Following the intervention, patients had increased quality of life, which remained at the post-intervention level even after 6 months. Further, participants had lower need-of-care and increased performance in physical function tests.

AbstractSection Message

A well-structured multifactorial and multidisciplinary in-patient intervention may lead to long-term clinically relevant improvements in functionally declining older adults.

Abstract

Purpose

To evaluate short and long-term effects of a multifactorial and multidisciplinary in-patient municipality intervention including training of activities of daily living, cardiovascular exercise, resistance training and social activities on quality-of-life, need-of-care, and physical function in older adults at risk of further functional decline.

Method

A cohort study including data collected rigorously during 3.5 years at an in-patient municipality rehabilitation center in Aalborg, Denmark. Patients received a multifactorial and multidisciplinary intervention. Outcomes were quality-of-life (EQ5D), weekly need-of-care hours, and test of physical functioning (sit-to-stand, 6-min walking test, tandem balance).

Results

Data was collected from 532 patients (63.3% women). The median [5; 95 percentiles] age was 79 [55; 92] years with a length-of-stay of 21 [8; 55] days. The mean (95% CI) EQ5D index score showed a clinically relevant improvement from admission 0.46 (0.44; 0.48) to discharge 0.69 (0.67; 0.71) and there was no decline 6-month postdischarge 0.67 (0.64; 0.70). The weekly need-of-care decreased significantly by 7.2 (6.6, 7.9) h from a mean of 9.8 h before admission to 2.6 h 6-month postdischarge. Sit-to-stand improved from 6.3 (6.0; 6.7) to 9.3 (8.9; 9.6) repetitions, 6-min walking test from 147 (138; 156) to 217 (207; 227) m, and tandem balance from 20.7 (19.8; 21.6) to 25.2 (24.8; 26.2) s.

Conclusion

Our results were remarkable and highlight that a well-structured multifactorial and interdisciplinary intervention with a clear aim and inclusion criteria related to functional decline may lead to long-term clinically relevant improvements in functionally declining older adults. Future studies should, however, explore similar interventions in comparable populations preferably in randomized controlled designs.

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Data availability

Upon reasonable request data from the current study can be made available.

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Correspondence to Johannes Riis.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflicts of interest.

Ethics approval

This cohort study was assessed by the Danish Regional Ethics Committee who stated that no approval was required (mail correspondence on April 28, 2018).

Informed consent

In Denmark, research consisting of retrospective analysis of data stored in registries of routine care does not require informed consent and as a result, participants were not aware they were being studied. All data were pseudo anonymized following the recommended procedures by the Danish Data Protection Agency.

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Jorgensen, M.G., Rodrigo-Domingo, M., Andersen, S. et al. A cohort study of the effects of multidisciplinary in-patient primary care in older adults. Eur Geriatr Med 11, 677–684 (2020). https://doi.org/10.1007/s41999-020-00321-2

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Keywords

  • Need-of-care
  • Quality of life
  • Physical functioning
  • Frailty
  • Multidisciplinary rehabilitation intervention
  • In-patient care