Cognitive status and ambulatory rehabilitation outcome in geriatric patients

To determine the effect of admission cognitive status on gait and stair climbing rehabilitation outcome in geriatric patients. Before-after trial. A total of 179 geriatric patients (139 women and 40 men; age range 67-97 years) consecutively admitted to a geriatric inpatient rehabilitation regimen (mean length of stay 28.7 (standard deviation 13.9) days). Assessment of admission cognitive status by the Mini-Mental State Examination (MMSE); determination of the ambulatory status before and after rehabilitation by the Performance-Oriented Mobility Assessment (POMA) and standardized judgements about stair climbing ability. Approximately two-thirds of the patients demonstrated functional ability improvements in at least 5 points at the individual level during rehabilitation (as measured by the total POMA scale (POMA-T)). However, at rehabilitation discharge cognitively impaired patients still demonstrated a 3.4 times (95% confidence interval=1.4-8.6) higher chance of increased fall risk and only 24% of the cohort was able to negotiate stairs with slight or no limitations. Although cognitively impaired patients demonstrated an functional overall intervention response comparable with cognitively intact patients the present study evidenced that the geriatric cohort with reduced mental status (MMSE >17) are at greater risk of falling and have a greater need for supervision, both in hospital and at discharge.