The functional prognosis of older adults in a postacute care center: the impact of dementia

Introduction: The functional recovery of older adults in postacute care units is influenced by demographic and clinical factors, including the presence of dementia. However, studies on this topic are scarce and do not often focus on this population. Objective: The objective was to determine the influence of different factors on the functional prognosis, mortality and need for support at discharge of patients admitted to a postacute care centre, controlling for the presence of dementia. Methods: We conducted a prospective observational study. We analysed the correlations between demographic and clinical factors and functional improvement (according to the Barthel Index, Tinetti test and Functional Ambulation Category scale), the need for support at discharge and mortality. We performed bivariate analysis followed by binary logistic regression or linear regression depending on the type of variable. Results: A total of 206 patients were included. The presence of dementia and delirium were related to most outcome variables, so the sample was stratified according to the presence of dementia. After multivariate analysis, functional outcome of people with dementia was influenced by their previous autonomy and degree of improvement in hospital, the presence of delirium and anaemia on admission, as well as having a hearing deficit. The risk of death was associated with malnutrition, inflammation, antipsychotic treatment and having more functional losses prior to admission. People without dementia had better baseline functioning, influenced by few clear factors, where those with higher education and not married had better prognosis in autonomy and risk of falls and only malnutrition was a risk factor for mortality. Conclusions: Dementia status is a determining factor for functional improvement, autonomy and mortality after admission to a postacute care unit. Differentiated risk algorithms for patients with and without dementia, would allow better targeting of functional rehabilitation.