Effectiveness of comprehensive ambulatory outpatient rehabilitation for cognitively impaired elders / Fang Yu.

Format:

Book

Manuscript

Microformat

Thesis/Dissertation

Author/Creator:

Yu, Fang

Contributor:

Sullivan-Marx, Eileen, advisor.

University of Pennsylvania.

Language:

English

Subjects (All):

Penn dissertations--Nursing.

Nursing--Penn dissertations.

Nursing.

Academic Dissertations as Topic.

Medical Subjects:

Nursing.

Academic Dissertations as Topic.

Local Subjects:

Penn dissertations--Nursing.

Nursing--Penn dissertations.

Physical Description:

xiv, 152 pages ; 29 cm

Production:

2003.

Summary:

Little is known about outpatient rehabilitation outcomes for cognitively impaired elders, even though a growing body of evidence shows that they could achieve similar functional gain to their cognitively intact counterparts from participating in inpatient rehabilitation programs. Using clinical and administrative records, this retrospective cohort study explored rehabilitation outcomes for cognitively impaired elders admitted to a comprehensive ambulatory outpatient rehabilitation facility because of degenerative joint disease, gait disturbance, difficulty walking, muscle disuse atrophy and arthritis. Cognitively impaired elders were found to differ from their cognitively intact counterparts. Elders with cognitive impairment were more often black, worse off financially, lived with caregivers, completed less education, had lower baseline functional levels, and had more Omaha cognition and dentition problems. Age &ge; 80 years, admission functional status and the statistical interaction of age &ge; 80 years and admission functional status predicted functional gain (p < 0.0001) and rehabilitation efficiency (p < 0.0001). Older age, being black and having a greater number of medical comorbidities predicted days of service (p = 0.0016). Nothing predicted discharge destination. Regardless of their cognitive status, all elders achieved significant functional gain from admission to discharge (p < 0.0001). The level of functional gain (p = 0.6287), rehabilitation efficiency (p = 0.6637), days of service (p = 0.8323) and discharge destination (p = 0.6859) did not differ between cognitively intact elders and cognitively impaired elders. Older age and being black predicted dose of services (p = 0.0031), and nothing predicted the intensity of service. Depression, race and admission functional status predicted disciplinary mix (p < 0.0001). No differences in dose of service (p = 0.4027), disciplinary mix (p = 0.9683) and intensity of services (p = 0.3313) were found between cognitively intact elders and cognitively impaired elders. No difference was detected in the percent of elders who received each category of Omaha interventions between the cognitively intact group and the cognitively intact group. In conclusion, cognitively impaired elders were referred to rehabilitation services with more advanced functional disability than their cognitively intact counterparts. Even so, they still achieved significant functional gain through participating in this comprehensive outpatient rehabilitation service. Such improvement did not demand a longer length of stay or intensified individualized service.

Notes:

Adviser: Eileen Sullivan-Marx.

Thesis (Ph.D. in Nursing) -- University of Pennsylvania, 2003.

Includes bibliographical references.

Local Notes:

University Microfilms order no.: 3109237.

OCLC:

244973747