Wiley

To determine whether instrumental activity of daily living (IADL) limitation stages can distinguish among elderly, community‐dwelling persons with high likelihoods to have fallen once and more than once.

A cross‐sectional survey.

A nationally representative sample from the Second Longitudinal Study of Aging (LSOA II).

Included were 7401 community‐dwelling persons 70 years of age and older.

The association of falling once and more than once within the past 12 months and 5 stages of increasing IADL limitation were explored by using a multinomial logistic regression model that controlled for demographics, education, perceived lack of home accessibility features, and health conditions. Sample proportions were weighted to reflect the prevalence in the U.S. population of 1994.

Subject recall of fall history. There were 3 categories for this variable: no fall, falling once, and falling more than once in the past 12 months.

Compared with IADL stage 0, the adjusted relative risk ratio of falling once peaked in individuals at IADL stage II at 2.0 (95% confidence interval [CI], 1.5‐2.6), and those at IADL stage III had a relative risk ratio of 1.8 (95% CI, 1.3‐2.6). The relative risk ratio of falling more than once was 2.1 (95% CI, 1.7‐2.6), 4.0 (95% CI, 3.0‐5.3), 3.7 (95% CI, 2.8‐5.0), and 2.7 (95% CI, 1.5‐4.9) for IADL stages I, II, III, and IV, respectively, when treating IADL stage 0 as reference.

IADL limitation stages could represent a powerful and practical tool for screening patients in the U.S. elderly population according to fall risk. Clinical implementation and prospective testing for validation as a screening tool would be necessary.

To investigate the benefits of comprehensive inpatient rehabilitation for patients after left ventricular assist device (LVAD) implantation.

A retrospective cohort study.

An urban academic inpatient rehabilitation hospital.

This study included 58 patients admitted to inpatient rehabilitation after LVAD implantation between 2009 and 2012.

Chart review of demographic, clinical, and functional data for patients admitted to inpatient rehabilitation after LVAD implantation was performed.

Length of stay, admission and discharge Functional Independence Measure (FIM), and FIM efficiency.

The study included 47 male and 11 female patients ages 21.8‐84.1 years (mean [standard deviation {SD}], 64.2 ± 11.2 years). The mean (SD) length of time between LVAD implantation and admission to rehabilitation was 27.0 ± 15.3 days. Twenty‐one patients (36%) required transfer to an acute care hospital. Ten patients returned after transfer and completed inpatient rehabilitation. For the 47 total patients who completed inpatient rehabilitation, the mean (SD) length of stay was 20.3 ± 10.8 days (range, 7‐50 days). Mean (SD) admission and discharge FIM scores were 68.4 ± 13.6 and 91.7 ± 11.8, respectively, with a mean (SD) difference between admission and discharge FIM scores of 23.4 ± 11.2. The mean (SD) FIM efficiency was 1.33 ± 0.65. Complications during rehabilitation included anemia that required transfusion, respiratory distress, epistaxis, gout flare, automated implantable cardioverter defibrillator firing, and gastrointestinal bleeding.

Patients with LVADs demonstrate functional gains in inpatient rehabilitation. However, there is a high incidence of complications in this population, which often requires transfer to an acute care setting.