104COGNITIVELY FRAIL PATIENTS CAN BE REHABILITATED

Abstract

Topic: NICE (NG74, 2017) state that when considering rehabilitation, a patient shouldn't be discriminated on the grounds of a pre-existing condition such as dementia. We highlighted our current Intermediate Care (IMC) appears set up for those with a reduction of physical functioning, however those with reduction in cognitive function were often refused. This leads to prolonged acute stays creating patient flow issues and additional risk exposure for vulnerable patients. Intervention(s): We designed a facility to service this cohort of patients and meet their rehabilitation needs. We purchased a 41-bedded care home adjacent to the acute site, creating a specialist rehabilitation setting led jointly by nurses and therapists with regular geriatrician input for patients with a cognitive impairment or lack of motivation. We focused on nutrition, socialising and both physical and cognitive active therapy. Improvement: We retrospectively analysed nutritional status and mobility over a 6-month period looking at changes from admission to discharge. 177 patients were admitted to the unit in this period. The median age was 85, 63.3% were female. 67% of patients increased in weight, on average by 1 kg. Between admission and discharge on average the Bartel score increased from 9 to 12, with an average increase in 6m walking speed by 0.2 seconds. Discussion(s): We have established a service for a challenging subset of patients who are physically and cognitively frail, do not fit the traditional IMC criteria and are at risk of long deconditioning acute stays. If you develop the appropriate environment and set up, an improvement in their nutritional and physical functioning can be achieved, creating benefit from a rehabilitation process. This demonstrates making a service to fit a section of patients rather than trying to make them fit existing services can be successful, if local resources allow.