Authors (including presenting author) :
Yeung LH(1), Fok TY(1), Yeung C(1), Law WY(1), Wong YCJ(1)
Affiliation :
(1)Occupational Therapy Department, Princess Margaret Hospital
Introduction :
Fall is a prevalent cause of injury among community-dwelling older adults, leading to a substantial decline in self-care ability and quality of life. The incidence of fall-related traumatic brain injury and its associated hospitalization rate has increased rapidly. Functional decline and prolonged hospitalization pose unique challenges for patients and their families. Occupational Therapy plays a pivotal role in facilitating patients’ successful transition from hospital to home. By understanding the predicting factors of successful home discharge, Occupational Therapists could thereby implement tailored interventions to enhance patients’ discharge readiness.
Objectives :
To identify the factors that predict or correlate with successful home discharge among older adults with fall-related traumatic brain injury.
Methodology :
This study is a longitudinal cohort study among 85 community-dwelling older adults aged 65 or above. All subjects were admitted due to fall-related traumatic brain injury and were referred to Occupational Therapy for rehabilitation. The impact of 10 relevant factors, including sex, age, living situation, availability of caregiver, dementia history, confusion, presence of intracranial hemorrhage, premorbid functional status, cognitive function and independence in ADL, measured by Modified Barthel Index (MBI), was investigated. Multivariate Logistic Regression and Point-Biserial Correlation were used for statistical analysis.
Result & Outcome :
The mean age of the patients was 77.3 years old. 77.6% of the patients were discharged home successfully. Among the 10 factors analyzed, independence in ADL at discharge and availability of caregiver were significantly associated with successful home discharge. Lower level of independence in ADL (OR, 0.900; 95% CI, 0.855-0.948; P<0.0001) and unavailability of caregiver at home (OR, 0.037; 95% CI, 0.004-0.361; P=0.005) increased the likelihood of institutional care. All patients with MBI score ≥75 were successfully discharged home regardless of caregiver availability, whereas caregivers were necessary for those discharged home with MBI score <70. There was also a significant correlation between cognitive function and discharge destination, rpb(39)=-0.336, p=0.036. In conclusion, independence in ADL and availability of caregiver are two crucial factors that predict successful home discharge for older adults with fall-related traumatic brain injury. Better cognitive function also correlates with successful home discharge. Healthcare professionals should consider patients’ ADL performance, caregiver availability and cognitive function when triaging patients for home discharge. MBI score ≥75 could be considered as an indicator for triaging patients for home discharge, and caregiver availability should be taken into consideration if patients’ MBI score is <70.
