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Long-Term Outcomes in LTCH Patients: Examining Function and Cognition

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Survival and quality of life after hospitalization in long-term acute care hospitals (LTCHs) remain critical concerns for middle-aged and older adults. A recent study highlights the significant impact of pre-admission health status on long-term outcomes, shedding light on the importance of early intervention and informed decision-making for patients with prolonged acute illnesses.

Study Overview

The retrospective cohort study focused on individuals aged 50 and above who were part of the Health and Retirement Study (HRS) and had linked fee-for-service Medicare claims. The participants, who had LTCH admissions between January 1, 2003, and December 31, 2016, were monitored for their functional and cognitive status through biennial HRS interviews. The primary outcome measured was death or severe impairment, defined by dependencies in two or more activities of daily living (ADLs) or dementia, within 2.5 years post-LTCH hospitalization.

Key Findings

Out of 396 participants, with a median age of 75 years, 51% were women. The study revealed that 80% of the participants either died or experienced severe impairment within 2.5 years following their LTCH stay. The analysis identified that acute illness characteristics, along with prehospitalization survival prognosis (Lee index score) and pre-LTCH impairment status, were significant predictors of adverse outcomes. Specifically, a 5-point increase in the Lee index score was associated with a 3.2-fold increase in the odds of death or severe impairment, while severe baseline impairment raised the odds 4.5 times.

Implications for Care

These findings underscore the critical need for healthcare providers to consider patients’ baseline health status when planning LTCH admissions and post-discharge care. Improved preadmission assessments and targeted interventions could potentially mitigate long-term adverse outcomes.

Inferences for Healthcare Providers

– Proactive pre-admission assessments using tools like the Lee index score can help identify at-risk patients.
– Early interventions focusing on functional and cognitive support may improve long-term outcomes.
– Personalized care plans based on individual prognosis and impairment status can enhance patient quality of life.
– Consideration of patient history and severity of illness should guide decision-making processes.

The study concludes that a better preadmission survival prognosis and functional and cognitive status are significantly associated with a lower risk of adverse outcomes. These insights are crucial for informing healthcare strategies and decision-making for older adults facing prolonged acute illnesses.

Original Article: JAMA Netw Open. 2024 May 1;7(5):e2413309. doi: 10.1001/jamanetworkopen.2024.13309.

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