Effectiveness of the “Elderly Activity Performance Intervention” on elderly patients’ discharge from a short-stay unit at the emergency department: a quasi-experimental trial

Figures & data

Figure 1 Overview of the Elderly Activity Performance Intervention.

Abbreviation: OT, occupational therapist.

Figure 2 Flowchart of the study population.

Table 1 Baseline characteristics of the study population (N=375)

Characteristics	Intervention (n=144)	Usual practice (n=231)	Test for difference
Mean age, years (SD)	81 (7.9)	78 (8.6)	p=0.003
Female, n (%)	79 (55)	122 (53)	p=0.699
Marital status, n (%)			p=0.171
Widowed	48 (33)	68 (29)
Divorced	33 (23)	41 (18)
Married	56 (39)	99 (43)
Single	7 (5)	23 (10)
Diagnosis at discharge, n (%)			p=0.968
Infectious and parasitic diseases	2 (1.4)	1 (0.4)
Neoplasms	13 (9.0)	21 (9.1)
Diseases of the blood	1 (0.7)	1 (0.4)
Endocrine and metabolic diseases	7 (4.9)	12 (5.2)
Diseases in the nervous system	4 (2.8)	7 (3.0)
Diseases of the eye and adnexa	7 (4.9)	5 (2.2)
Diseases of the ear and mastoid process	3 (2.1)	8 (3.5)
Diseases in the circulatory system	17 (11.8)	30 (13.0)
Diseases in the respiratory system	8 (5.6)	12 (5.2)
Diseases of the digestive system	4 (2.8)	9 (3.9)
Diseases of the skin	2 (1.4)	2 (0.8)
Musculoskeletal diseases	13 (9.0)	25 (10.8)
Diseases of the genitourinary system	3 (2.1)	8 (3.5)
Symptoms and abnormal clinical findings	13 (9.0)	22 (9.5)
Injury	10 (6.9)	20 (8.7)
Factors influencing health status	37 (25.7)	48 (20.8)
Comorbidity, n (%)a			p=0.183
Low: score 0–1	75 (52)	131 (57)
Moderate: score 2–3	45 (31)	62 (27)
High: score >4	24 (17)	38 (16)
Days of admission, median (IQR)	0.94 (0.74; 1.33)	0.82 (0.57; 1.09)	p=0.002

Note:

a Charlson’s Comorbidity Index.

Abbreviation: IQR, interquartile range.

Table 2 Comparison of risk of readmission and risk of mortality for the study population (N=375)

Outcomes	Intervention (n=144)	Usual practice (n=231)	Risk difference		Risk ratio
			Crude (95% CI)	Adjusteda (95% CI)	Crude (95% CI)	Adjusteda (95% CI)
Readmission 26 weeks, n (%)	64 (44)	99 (42)	0.02 (−0.08; 0.12)	0.02 (−0.09; 0.12)	1.05 (0.83; 1.33)	1.07 (0.84; 1.36)
Readmission 30 days, n (%)	25 (18)	55 (23)	−0.05 (−0.13; 0.03)	−0.04 (−0.12; 0.04)	0.78 (0.51; 1.19)	0.83 (0.51; 1.35)
Mortality 26 weeks, n (%)	14 (10)	23 (10)	−0.00 (−0.06; 0.06)	−0.01 (−0.09; 0.8)	0.98 (0.52; 1.83)	1.06 (0.68; 1.66)

Note:

a Adjusted for age, gender, admission time, marital status, and comorbidity measured with CCI.

Abbreviation: CCI, Charlson’s Comorbidity Index.

Figure 3 Plots of cumulative incidence proportion for readmission within 26 weeks for the study population (N=375).

Table 3 Contacts to GP and the ED within 26 weeks for the study population (N=375)

Contacts	Intervention (n=144)	Usual practice (n=231)	Test for difference
Contacts to ED
n (%)	30 (21)	39 (17)	p=0.337
Median (IQR)	0 (0–0)	0 (0–0)
Contacts to GP
n (%)	139 (97)	228 (99)	p=0.157
Median (IQR)	9 (5–14)	9 (5–13)

Abbreviations: ED, emergency department; GP, general practitioner; IQR, inter-quartile range.

Table 4 Number of patients receiving each component of the EAP-intervention and results from the performance-based assessment in component 1 (n=144)

Intervention components	n (%)	Score
Component 1a
Assessment of activity limitations	144 (100)
Assessment with TUGb, median (IQR)	120 (83)	11.8 (8.8–17.7)
Assessment with 30s-CSTc, median (IQR)	126 (88)	7 (0–10)
Assessment with AMPSd motor, mean (SD)	96 (67)	1.02 (0.79)
Assessment with AMPS process, mean (SD)		0.93 (0.80)
Component 2
Rehabilitation plan	87 (60)
Component 3
Follow-up visit	69 (48)

Notes:

a All patients in the intervention group were assessed with at least one of the performance-based measures in component 1.

b Score for TUG is in seconds. A score >12 seconds reflects limitations.³⁵

c Score for 30s-CST reflects how many times a person can rise from a chair in 30 seconds. A score <8 reflects limitations.³⁶

d Score for AMPS is in logits. A score <1.50 logits in motor ability and >1.00 logits in process ability reflect limitations.³³

Abbreviations: AMPS, Assessment of Motor and Process Skills; CST, Chair Stand Test; EAP, Elderly Activity Performance; IQR, interquartile range; TUG, Timed Up and Go.

Table 5 Risk of readmission in the intervention group (n=144)

Readmission	Need for components 2 and 3a (n=87)	Only component 1 necessaryb (n=57)	Risk difference (95% CI)	Risk ratio (95% CI)
Readmission 26 weeks, n (%)	45 (51)	19 (33)	0.18 (0.02; 0.35)	1.55 (1.02; 2.36)

Notes:

a Need for components 2 and 3: based on the assessment in component 1, the patient was identified with limitations in performing daily activities and a need for further rehabilitation.

b Component 1: assessment of performance of daily activities.

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