Original article| Volume 91, ISSUE 10, P1505-1510, October 2010

Rehabilitation Outcomes in a Population of Nonagenarians and Younger Seniors With Hip Fracture, Heart Failure, or Cerebral Vascular Accident


      Conner D, Barnes C, Harrison-Felix C, Reznickova N. Rehabilitation outcomes in a population of nonagenarians and younger seniors with hip fracture, heart failure, or cerebral vascular accident.


      To compare rehabilitation characteristics and patient outcomes between nonagenarians and younger seniors with hip fracture (HFx), heart failure (HF), or cerebral vascular accident (CVA).


      Data only, retrospective cohort.


      Seven skilled nursing facilities providing rehabilitation services to a managed care organization.


      Subjects (N=2563; age, ≥65y) with HFx, HF, or CVA receiving rehabilitation services.


      Not applicable.

      Main Outcome Measures

      Patient and rehabilitation characteristics influencing FIM score at discharge and the proportion of patients discharged to the community were compared between nonagenarians and younger seniors with HFx, HF, or CVA.


      Patients with higher admission FIM scores were discharged with better function. Different patient characteristics were important for successful rehabilitation for different conditions and outcomes. Except for HFx, nonagenarians had admission and discharge characteristics similar to those of younger seniors, although fewer were discharged to the community. Nonagenarians and younger seniors with CVA were most similar for all measures.


      Fewer nonagenarians were admitted from the community and fewer were discharged to the community, even if admitted from the community. Nonagenarians with HFx differed most strikingly from their younger counterparts in admission and discharge measures, as well as total discharge FIM score and discharge to the community. Nonagenarians and younger seniors with CVA were most similar for all measures. Our results suggest that a large proportion of the nonagenarian population can benefit from rehabilitation efforts for these 3 conditions; however, more rehabilitation resources may be required for some conditions to achieve similar outcomes.

      Key Words

      List of Abbreviations:

      CVA (cerebral vascular accident), HF (heart failure), HFx (hip fracture), MCO (managed care organization), SNF (skilled nursing facility)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hardy S.E.
        • Gill T.M.
        Recovery from disability among community-dwelling older persons.
        JAMA. 2004; 291: 1596-1602
        • Lieberman D.
        • Lieberman D.
        Rehabilitation following stroke in patients aged 85 and above.
        J Rehab Res. 2005; 42: 47-54
        • Bagg S.
        • Paris Pumbo A.
        • Hopman W.
        Effect of age on functional outcomes after stroke rehabilitation.
        Stroke. 2002; 33: 179-185
        • Couser Jr, J.I.
        • Githmann R.
        • Abdugany H.M.
        • Kane C.S.
        Pulmonary rehabilitation improves exercise capacity in older elderly patients with COPD.
        Chest. 1995; 107: 730-734
        • Austin J.
        • Williams R.
        • Ross L.
        • Moseley L.
        • Hutchison S.
        Randomized controlled trial of cardiac rehabilitation in elderly patients with heart failure.
        Eur J Heart Fail. 2005; 7: 411-417
        • Penrod J.D.
        • Litke A.
        • Hawkes W.G.
        • et al.
        Heterogeneity in hip fracture patients: age, functional status, and comorbidity.
        J Am Geriatr Soc. 2007; 55: 407-413
        • Cruise C.M.
        • Sasson N.
        • Lee M.H.M.
        Rehabilitation outcomes in the older adult.
        Clin Geriatr Med. 2006; 22: 257-267
        • Nakayama H.
        • Jørgensen H.S.
        • Raaschou H.O.
        • Olsen T.S.
        The influence of age on stroke outcome: the Copenhagen Stroke Study.
        Stroke. 1994; 25: 808-813
        • Von Strauss E.
        • Fratiglioni L.
        • Viitanen M.
        • Forsell Y.
        • Winblad B.
        Morbidity and comorbidity in relation to functional status: a community-based study of the oldest old (90+ years).
        J Am Geriatr Soc. 2000; 48: 1462-1469
        • Lindgren A.-M.
        • Svärdsudd K.
        • Tibblin G.
        Factors related to perceived health among elderly people: the Albertina Project.
        Age Ageing. 1994; 23: 328-333
        • Ferrara N.
        • Corbi G.
        • Bosimini E.
        • et al.
        Cardiac rehabilitation in the elderly: patient selection and outcomes.
        Am J Geriatr Cardiol. 2006; 15: 22-27
        • U.S. Bureau of the Census
        Current population reports: special studies, 65 plus in the United States.
        Government Printing Office, Washington (DC)1996
        • U.S. Bureau of the Census
        Population projections of the United States by age, sex, race, and Hispanic origin: 1995 to 2050.
        Government Printing Office, Washington (DC)1996
        • Kevorkian C.G.
        • Ergeletzis D.
        • Rintala D.
        Nonagenarians on a rehabilitation unit: characteristic, progress and outcomes.
        Am J Phys Med Rehabil. 2004; 83: 266-272
        • Senior Metrix Inc.
        Postacute rehabilitation database.
        Senior Metrix Inc, Nashville, TN1998
        • Dodds T.A.
        • Martin D.P.
        • Stolow W.C.
        • et al.
        A validation of the functional independence measurement and its performance among rehabilitation patients.
        Arch Phys Med Rehabil. 1993; 74: 531-536
        • Owens W.D.
        • Felts J.A.
        • Spitznagel Jr, E.L.
        ASA physical status classifications: a study of consistency ratings.
        Anesthesiology. 1978; 49: 239-243
        • Han M.K.
        • Postma D.
        • Mannjino D.M.
        • et al.
        Gender and chronic obstructive pulmonary disease: why it matters.
        Am J Crit Care Med. 2007; 176: 1179-1184
        • Sircar P.
        • Godkar D.
        • Mahgerefteh S.
        • Chambers K.
        • Niranjan S.
        • Cucco R.
        Morbidity and mortality among patients with hip fractures surgically repaired within and after 48 hours.
        Am J Ther. 2007; 14: 508-513
        • Honig H.
        • Rubenstein L.V.
        • Sloane R.
        • Horver R.
        • Kahn K.
        What is the role of timing in the surgical and rehabilitation care of community-dwelling older persons with acute hip fracture.
        Arch Intern Med. 1997; 157: 513-520
        • Majumdar S.R.
        • Beaupre L.A.
        • Johnston D.W.
        • Dick D.A.
        • Cinats J.G.
        • Jiang H.X.
        Lack of association between mortality and timing of surgical fixation in elderly patients with hip fracture: results of a retrospective population-based cohort study.
        Med Care. 2006; 44: 552-559
        • Formiga F.
        • Lopez-Soto A.
        • Sacanella E.
        • Coscojuela A.
        • Suso S.
        • Pujol R.
        Mortality and morbidity in nonagenarian patients following hip fracture surgery.
        Gerontology. 2003; 49: 41-45
        • Fattirolli F.
        • Burgisser C.
        • Guarducci
        • Rinaldi L.A.
        • Mosotti G.
        • Marchionni N.
        Cardiac rehabilitation in the elderly.
        Ital Heart J Suppl. 2005; 6: 788-795
        • Pasquali S.K.
        • Alexander K.P.
        • Peterson E.D.
        Cardiac rehabilitation in the elderly.
        Am Heart J. 2001; 142: 748-755
        • Vigorito C.
        • Incalzi R.A.
        • Acanfora D.
        • Marchionni N.
        • Fattirolli F.
        Recommendations for cardiovascular rehabilitation in the very elderly.
        Monaldi Arch Chest Dis. 2003; 60: 25-39
        • Cruise C.M.
        • Sasson N.
        • Lee M.H.M.
        Rehabilitation outcomes in the older adult.
        Clin Geriatr Med. 2006; 22: 257-267
        • Granger C.V.
        • Hamilton B.B.
        • Fiedler R.C.
        Discharge outcome after stroke rehabilitation.
        Stroke. 1992; 23: 978-982
        • Ween J.E.
        • Alexander M.P.
        • D'Esposito M.
        • Roberts M.
        Factors predictive of stroke outcome in a rehabilitation setting.
        Neurology. 1996; 47: 388-392
        • Osberg J.S.
        • DeJong G.
        • Haley S.M.
        • Seward M.L.
        • McGinnis G.E.
        • Germaine J.
        Predicting long-term outcomes among post-rehabilitation stroke patients.
        Am J Phys Med Rehabil. 1988; 67: 94-103
        • Inouye M.
        • Kishi K.
        • Takada M.
        • et al.
        Prediction of functional outcomes after stroke rehabilitation.
        Am J Phys Med Rehabil. 2000; 79: 513-518
        • Di Carlo A.
        • Lamassa M.
        • Pracucci G.
        • et al.
        Stroke in the very old: clinical presentation and determinants of a 3-month functional outcome: a European perspective.
        Stroke. 1999; 30: 2313-2319
        • Smith P.M.
        • Ottenbacher K.J.
        • Cranely M.
        • et al.
        Predicting follow-up living setting in patients with stroke.
        Arch Phys Med Rehabil. 2002; 83: 764-770
        • Tesio L.
        • Franchignoni F.P.
        • Perucca L.
        • Porta G.L.
        The influence of age on length of stay, functional independence and discharge destination of rehabilitation inpatients in Italy.
        Disabil Rehabil. 1996; 18: 502-505