11

Introduction. Early geriatric rehabilitation programs are potential means to prevent acute hospitalisation-associated functional decline. Methods. The objectives were to measure the impact of an interdisciplinary rehabilitation program on patients’ administrative in hospital data and on functional trajectories. With a before-and-after design, we compared all patients admitted from January to August 2018 into the Acute Care for Elders (ACE) unit of an Academic hospital in Switzerland who received this type of program to those admitted during the same period in 2016 and 2017. We considered vulnerable patients aged 75 or older. Functional independency level was assessed at baseline, admission, and discharge according to Katz’s basic activities daily living (BADL). Results. In total, 378/1,073 patients (mean age 86.6 ± 6.4; 74.6% women; 84% admitted from the emergency department) were prospectively admitted into the ACE unit in 2018. With an adherence rate of 74.0% to functional therapies and compared to the prior years, the program reduced transfers to rehabilitation settings (28.5 vs. 24.3%, p=0.04) and increased direct discharges to home (46.8 vs. 42.4%, p=0.04). Rates of early-unplanned readmission were similar. Between admission to discharge, 89.9% of the patients engaged in the program remained functionally stable or enhanced. Whatever the BADL score at the admission, 46.5% improved their status for at least one BADL. Even though no clinical determinant was identified, patients who engaged ≥ 5 sessions of functional therapy per week were more likely to improve their functional level (OR = 3.05; 95% CI 1.76–5.27). Conclusion. This real-life study demonstrates arguments to implement early interdisciplinary rehabilitation program in ACE units in particular to prevent functional decline in vulnerable patients. These findings support consideration regarding the interest of switching from the traditional disease-centred approach in acute care for older patients to a modern one, that also put the emphasis on maintaining functional capacities.

Introduction. Un programme de réadaptation gériatrique précoce lors d’une hospitalisation en court séjour gériatrique pourrait éviter le déclin fonctionnel y étant associé. Méthode. Les objectifs de cette étude étaient de mesurer l’impact d’un tel programme, implémenté en 2018 dans l’unité de court séjour gériatrique de Lausanne (Suisse), sur les données d’activité hospitalières et la trajectoire fonctionnelle des patients. Avec une étude de type avant/après, les patients admis entre le 1er janvier et le 31 août 2018 ont été comparés à ceux admis en 2016 et 2017. L’évolution des niveaux d’indépendance fonctionnelle selon les AVQ de Katz ont été analysés. Résultats. Sur les 8 mois d’étude en 2018, 378 patients ont été admis (âge moyen 86,6 ± 6,4 ans, 74,6 % de femmes, 84 % depuis le service d’accueil des urgences). En comparaison aux deux années précédentes, l’implémentation du programme a contribué à réduire les durées médiane et moyenne de séjour (p Conclusion. Cette étude permet de confirmer les bénéfices d’un programme de réadaptation précoce pour les personnes âgées hospitalisées en soins aigus.