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Reduction of hospital admissions after geriatric COPD- rehabilitation

Reduction of hospital admissions after pulmonary rehabilitation of geriatric patients with COPD

Stephanie Blindenbach

De abstractcommissie heeft op verzoek van de congrescommissie negen abstracts geselecteerd die tijdens het Verenso najaarscongres 'Start & Stop' op 26 november 2015 middels een flitspresentatie gepresenteerd worden. Onderstaande abstract is daar een van.

Introduction

Pulmonary rehabilitation has been proven effective in the management of patients with Chronic Obstructive Pulmonary Disease (COPD).1-5 However, geriatric patients are frequently not accepted for regular pulmonary rehabilitation programs due to low physical condition and serious  comorbidities. Recently, rehabilitation programs for geriatric patients with COPD have been developed, taking place in nursing homes. The effects of such programs are largely unknown.

Aims

To assess the effects of pulmonary rehabilitation of geriatric COPD-patients in a nursing home setting on future hospital admissions.

Design

Prospective observational study.

Methods

Seventy-nine participants of the geriatric pulmonary rehabilitation program were included from October 2011 to April 2013. The follow up was 12 months after discharge from rehabilitation. Data were collected from hospital en nursing home databases. Outcome was measured as a decrease or stagnation in the number of hospital admission days due to COPD-related illness during the follow-up period compared to the year before participating in the rehabilitation program.

Results

Fifty-six patients survived the first year after discharge and five patients died during the rehabilitation period. The mean number of hospital  admission days in the year before rehabilitation was 23.3 (SD 16.9.) and in the year after rehabilitation 8.8 (SD 10.3). The mean difference was 14.5 days (SD 19.3; p<0.001). Eighteen patients died during follow up. For these patients, the number of hospital admission days in the year before rehabilitation was 20.1 (SD 11.0)  and after rehabilitation until death 11.3 (SD 18.0).

Discussion

This study shows for the first time a reduction of hospital admissions in geriatric COPD patients after pulmonary rehabilitation. Amount of hospital admissions is a clinically relevant outcome. Comparable results has been found earlier in studies with instable COPD patients.2 Despite this results are based on observational data, this study shows that frail COPD patients can benefit from participating in specific geriatric rehabilitation programs.

Conclusions

Pulmonary rehabilitation in the nursing home setting seems to reduce hospital admissions in frail COPD patients. 

Auteur(s)

  • Drs. Stephanie Blindenbach, specialist ouderengeneeskunde, Novicare. Onderzoek verricht als aios Gerion VU MC Amsterdam/ Axioncontinu

Co-auteurs

  • J.E. Elgersma MSc, University Medical Center Utrecht
  • J.v.d. Zeijden MD
  • H.J. Reesink MD PhD, St. Antonius Ziekenhuis Utrecht
  • F. Brijker MD PhD, Diakonessenhuis Utrecht
  • M. Smalbrugge, MD, PhD Department of general practice and elderly care medicine, VU University Medical Center, Amsterdam
  • J.W.F.A. Vrancken MD, Axioncontinu Utrecht

Literatuur

  1. Dam v.-Isselt v. EF, Spruit M, Groenewegen-Sipkema KH, Chavannes NH, Achterberg WP. Health status measured by the Clinical COPD Questinnaire (CCQ) improves following post-acute pulmonary rehabilitation in patients with advanced COPD: a prospective observational study. Primary Care Respiratory Medicine 2014; 24: online publication.
  2. Puhan MA, Gimeno-Santos E, Scharplatz M et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (Review). The Cochrane Collaboration 2011; Issue 10.
  3. Anzueto A. Primary Care Management of Chronic Obstructive Pulmonary Disease to Reduce Exacerbations and Their Consequences. The American Journal of Medical Sciences 2010; 340: 309-18.
  4. Ries AL, Bauldoff GS, Carlin BW et al. Pulmonary rehabilitaion: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest 2007; 131: 4S-42S.
  5. Casaburi R, ZuWallack R. Pulmonary Rehabilitation for management of Chronic Obstructive Pulmonary Disease. N Enl J Med 2009 ; 360 :1329-35.
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