Inpatient Rehabilitation Units: Age and Comorbidities Are Not Relevant if Admission Fits the Mission

Abstract

The aging and disability epidemics are pressing the health-care system for the appropriate allocation of resources for the expensive inpatient rehabilitation. The key point is deciding whether old age and the associated comorbidities should determine the assignment to “geriatric” or “geriatric rehabilitation” units or to nursing homes provided with some rehabilitation services, rather than to specific hospital rehabilitation units. An extensive international epidemiologic research, based on sophisticated models of case-mix classification including demographic, biomedical, and disability indexes, showed that age and comorbidities are, themselves, not major determinants of the outcome in rehabilitation units. However, the core aspect is the admission policy. In the reality, admissions at rehabilitation units require a prognosis for (a) functional improvement in the short midterm (1–12 months) and (b) need and tolerance for specific motor, cognitive, and visceral-sphincteric exercise treatments. Units can be differentiated in order to fit the needs of long stay-low-tolerance cases of any age, yet retaining their rehabilitation identity. Downstream a correct admission, elderly/comorbid patients may benefit from specific rehabilitation units not less than younger patients.