The maintenance of functional mobility, with regard to the fundamental functions of daily living, is a relevant resource for the maintenance of independence, autonomy, and quality of life in older individuals (Mollenkopf & Flaschenträger, 2001). The loss of functional status is a major risk factor of disability and/or nursing care dependency, and thus for admittance to a long-term nursing home (Brunnett, Hasseler, Strupeit, & Deneke, 2009). The multimorbid elderly are particularly at risk of functional impairments because acute conditions associated with impairments of the musculoskeletal system such as stroke or hip fractures most commonly occur in this population (Günster, 2011; Tinetti, Speechley, & Ginter, 1988). Required clinical rehabilitation can have positive effects on the functional status and quality of life of those affected (Saxena, Ng, Koh, Yong, & Fong, 2007; Shyu, Maa, Chen, & Chen, 2009). However, research into the functional status and quality of life after rehabilitation shows different results. Most of the research that focuses on the long-term effects of functional mobility impairments after discharge from rehabilitation has been conducted on stroke survivors. Several studies have focused on functional status as a main outcome. Functional status in stroke survivors over time has been reported as (relatively) good (Shen et al., 2011) or improved (compared with time at admission; (Saxena et al., 2007) at 6 months of follow-up). Other studies have indicated a partial decrease in functional status 13 months after discharge, but stable or increased functional status in some stroke survivors (Wagle et al., 2011). These results may indicate a decrease in functional status after a longer period postdischarge. Depression (Saxena et al., 2007), discharge positive emotion (Ostir, Berges, Ottenbacher, Clow, & Ottenbacher, 2008), cognitive function (Saxena et al., 2007; Wagle et al., 2011), old age, gender (Appelros, Stegmayr, & Terent, 2010; Lai, Duncan, Dew, & Keighley, 2005), and malnutrition (Shen et al., 2011) have been associated with physical functioning.
Other studies have focused on quality of life as a main outcome (Patel et al., 2006). At a 7-year follow-up, quality of life was measured as either poor or relatively good (Leach, Gall, Dewey, Macdonell, & Thrift, 2011). The results from studies with up to 12 months of follow-up have been heterogeneous. Some results have indicated severe distress (Horgan, O'Regan, Cunningham, & Finn, 2009), poor quality of life (Patel et al., 2006), or a partial decrease in quality of life domains (Kwok et al., 2006; Lalu, 2003; Pan, Song, Lee, & Kwok, 2008). Other results have shown a continuous improvement of most quality of life domains 12 months after discharge (Shyu et al., 2009). At 6 months of follow-up, quality of life has been reported as having declined since discharge (Hopman & Verner, 2003). Summarizing these findings, quality of life appears to decrease after a longer period from discharge in most cases. However, results are heterogeneous but may not be comparable overall because different methods have been used. Factors that have been associated with long-term quality of life include activities of daily living (Kwok et al., 2006; Leach et al., 2011; Shyu et al., 2009), handicap (Leach et al., 2011; Patel et al., 2006), depression (Kwok et al., 2006; Pan et al., 2008), severity of stroke (Gosman-Hedstrom, Claesson, & Blomstrand, 2008), disability (Patel et al., 2006), and gender (Gargano & Reeves, 2007).
In summary, evidence regarding long-term effects on functional status and quality of life in older individuals with functional mobility impairments remains unclear. Moreover, little is known on this topic from studies in the German healthcare setting (Lalu, 2003). Thus, there is a need for knowledge concerning long-term effects in older individuals with functional impairment, especially in the German healthcare setting. Due to the demographic changes in Germany, the significance of functional status promotion will increase; life expectancy and the number of older individuals will increase, and thus, more individuals will be at risk of functional impairment in the future.
To target useful programs and measures, healthcare professionals should be aware of the long-term outcomes and predictors.
The aim of this study was to assess quality of life and functional status in elderly individuals with functional mobility impairment that had been admitted to an aged care rehabilitation facility at admission, 6 months, and 12 months. Another aim was to evaluate if gender or age are associated with functional status and if gender, age, cognitive status, educational level, self-efficacy, or functional status are associated with quality of life.