Community-based rehabilitation for older adults post-stroke in Thailand: An ethnographic study.

Older adults’ functional and intrinsic abilities may decline with increasing age. The positive effects of comprehensive community-based rehabilitation services to maintain physical, mental, and social function are essential. Nevertheless, few tools are available to assess the community-based rehabilitation needs of older adults. Therefore, we aimed to construct a list for the comprehensive evaluation of community-based rehabilitation needs of older adults. The International Classification of Functioning, Disability, and Health (ICF) was used to construct a first draft of the assessment list. From September to November 2023, 18 experts from five provinces and nine tertiary hospitals and institutions of higher education in China participated in this Delphi study. The older adult community-based rehabilitation needs evaluation list included six dimensions and 29 items. The weights of the six dimensions, from high to low, included mental function rehabilitation need (0.30), body function rehabilitation need (0.24), social participation need (0.18), individual activity rehabilitation need (0.14), environmental rehabilitation need (0.09) and rehabilitation information need (0.05). Using the Delphi method, an assessment list of older adult community-based rehabilitation needs based on ICF was developed. Future work should evaluate the list’s reliability and validity and its application in managing community-based rehabilitation for older adults.

Many older adults rely on informal care networks to overcome challenges in life and maintain well-being. The composition and function of the informal care network may change as existing caregivers leave and new caregivers join the network over time. The majority of prior studies on caregiving to older adults are based on cross-sectional data and thus cannot examine changes in older adults’ informal care networks. Although some have followed older adults’ informal caregivers over time, they usually focus on primary caregivers, rather than the entire informal care network longitudinally. The newly available panel data on a nationally representative sample of caregivers from the National Study of Caregiving (NSOC) provide an excellent opportunity for researchers to understand how older adults’ informal care networks change over time and what factors relate to discontinuation of care. Using the NSOC 2015 and 2017, we found that 70% of older adults (N = 1,395) experienced changed in informal care networks within two years. Only a small portion of spouses (6%) discontinued giving care to older adults, whereas 21% adult children, 56% other kin, and 77% nonkin stopped caregiving by 2017. We further examined how older adults’ needs for support, caregivers’ resources and constraints, and caregiving experiences were associated with discontinuation of care. This study is expected to advance gerontological research by broadening our understanding of informal caregiving in late life and providing practical implications on how to sustain informal care.

The escalating global aging population underscores the need to effectively manage geriatric diseases, constituting a significant public health concern. Community-based rehabilitation has emerged as a crucial and accessible paradigm for the rehabilitation of older adults. In China, however, the practical implementation of community-based rehabilitation faces formidable challenges, including a dearth of specialized rehabilitation therapists, substantial disparities between demand and supply, and suboptimal satisfaction rates. We aimed to develop a community-based rehabilitation management platform for older adults centered around digital health technology, with the plan to conduct a cluster randomized controlled trial to gather more evidence to explore the best practices and service models of community-based rehabilitation based on digital health technology. This cluster randomized controlled trial will be conducted in Zunyi City, China. We will recruit 286 adults aged ≥60 years and randomly allocate 20 subdistricts in a 1:1 ratio into either the intervention group, which will use the Rehabilitation Journey application, or the control group, which will be given a Rehabilitation Information Booklet for Older Adults. Both groups will undergo a 12-month rehabilitation management program, encompassing six months of guidance and an additional six months of follow-up through online and offline methods. The evaluation indicators will be assessed at enrollment and at 3rd, 6th, and 12th month. This study endeavors to furnish novel insights to develop a tailored community-based rehabilitation management program for older adults, delivering customized, intelligent, and precise rehabilitation services.

Interface of Law and Psychiatric Problems in the Elderly.

To evaluate rehabilitation outcome in a representative sample of older and younger SCI patients. Case series, consecutive sample, survey. Tertiary care, spinal cord injury unit (National Spinal Injuries Centre), Stoke Mandeville Hospital. One hundred and forty-seven male and 45 female newly injured in-patients (consisting of 152 younger adults, age range=16 to 54, and 40 older adults, age range=55 to 85) admitted between 1995 and 1999. All patients were actively participating in a comprehensive, multidisciplinary Goal Planning and Needs Assessment rehabilitation programme. The Needs Assessment Checklist. Specifically designed and developed for the spinal cord injured population, this clinical assessment tool provides a way of assessing and ensuring that rehabilitation programmes are geared toward each patient's individual needs, providing the patient with the skills appropriate to their level of lesion. As part of ongoing psychometric analyses of the Needs Assessment Checklist, internal consistency reliability coefficients are reported for this measure. The type and cause of injury for the older adult group in this study was comparable with previous research. Older adults' rehabilitation gains were comparable to those of the younger age group. Younger adults were more mobile initially after their injury. However, when the two groups were matched for injury characteristics etc. the only differences in final outcome between older and younger adults were in skin management ability. Both groups showed significant improvements in all areas of need in the period between mobilisation and entering the pre-discharge ward. These results highlight important considerations for the rehabilitation of older adults and emphasise the need for active, individually tailored rehabilitation programmes. There are specific areas of need (i.e. skin management) where older adults do not achieve comparable levels of independence. Special attention needs to be paid to the problems presented by SCI older adults and efforts should be made to better prepare rehabilitation professionals to adapt to age specific differences.

Objective: Although the negative effects of polypharmacy on older adults are well-documented, studies exploring its relationship with frailty and quality of life within the framework of community-based rehabilitation (CBR) remain scarce. In this context, the aim of this study was to compare frailty and quality of life levels between older adults with and without polypharmacy and to examine the relationship between these parameters from a CBR perspective. The ultimate purpose of this study was to determine the usefulness of CBR. Method: A total of 120 community-dwelling older adults (60 with polypharmacy, 60 without polypharmacy), aged 65-75 years (mean age = 68.18 ± 3.50), were included in a community-based assessment carried out under the coordination of Lokman Hekim University in Ankara, Turkey. The use of five to nine medications was taken as a reference for those with polypharmacy, and the use of less than two medications was taken as a reference for those without polypharmacy. The quality of life of the older adults in the study was assessed with the Nottingham Health Profile (NHP), and frailty was assessed with the Edmonton Frailty Scale (EFS). In line with CBR principles, the findings were interpreted with a focus on promoting community-wide strategies to support older adults. Results: The study found a statistically significant difference in NHP and EFS results between older adults with and without polypharmacy (p < 0.05). In addition, a statistically significant relationship was found between NHP and all subdomains of NHP and EFS (p < 0.05). Conclusion: Older adults with polypharmacy had higher levels of frailty and lower quality of life, and an increase in frailty was significantly associated with a decrease in quality of life in both groups. These findings highlight the importance of community-level preventive interventions to support healthy aging. Within the framework of CBR, strategies such as creating accessible physical activity areas at the neighborhood level; organizing informative seminars on frailty, quality of life, medication use and health literacy in collaboration with volunteer health professionals and local authorities; and creating volunteer support networks to increase social interaction can contribute to the control of these symptoms in older adults.

The use of a reduced impact, aquatic environment for physical activity and rehabilitation in older adults has become a focus of recent literature. PURPOSE The present study sought to evaluate the mechanical specificity of countermovement jumps performed on land and in water in older adults. METHODS Fifty-six young (22.0±3.9years) adults and twelve healthy older (57.3±4.4yr) adults were asked to perform maximal countermovement jumps on land and in chest-deep water. Kinetic and kinematic measures of jump performance were obtained using a tri-axial force platform and two dimensional videography, respectively. RESULTS As expected, peak (PP) and mean mechanical power (MP) outputs were greater (p<.001) for jumps performed by young vs older adults (PP:7322±4035W;MP:3049±1771W) and for jumps performed by all subjects in water (PP:9387±3981W;MP:3781±1864W) vs land. Compared to young adults, older adults experienced less of an increase in bodyweight normalized PP and MP for jumps performed in water vs land (p<0.05). Peak movement velocities in older adults tended to be slower, with older adults spending 55% greater time in body unweighting. Compared to land, unweighting time increased more in the water for older adults (Land: 0.5±0.3s;Water:1.2±0.7s) than young adults (Land:0.4±0.1s;Water:0.7±0.2s). Across ages, amortization rate was 26% greater for jumps performed in water and, in comparison with younger adults, amortization time in older adults was 20% longer in duration. A 1444% increase in peak dorsiflexion velocity for jumps performed in water (66±34°/s vs. 4±7°/s), suggests that loading strategy during amortization is likely unique from land-based jumping. CONCLUSION The aquatic environment produces jumping movements that are mechanically distinct from jumping movements performed on land. The results of the present study suggest that jumping in an aquatic environment may be beneficial in older adults training to improve mechanical power output and lower-extremity neuromuscular function.

IntroductionWe aimed to prioritize and culturally adapt patient decision aids (PtDAs) for older adults receiving home care in Quebec.MethodA steering committee comprising older adults, caregivers, health professionals, policy makers, community...

BackgroundIn 1991, Riakona Community Rehabilitation Programme initiated community-based rehabilitation (CBR) in the Vhembe District of Limpopo Province. Subsequently, the South African government adopted the programme.AimThe aim of the study was to suggest an improvement in the model of providing CBR services.SettingThe study was conducted in six rehabilitation centres located in hospitals in the Vhembe District in Limpopo Province of South Africa.MethodA mixed-mode research design with qualitative and quantitative elements was used to conduct the study. Content analysis, the chi-square test for Goodness of Fit and the Kruskal–Wallis and Mann–Whitney non-parametric tests were conducted.ResultsThe key determinants of client satisfaction with the services that the community rehabilitation workers rendered included provision of assistive devices and the adoption of a holistic approach to their work. Overall, satisfaction per domain for each one of the five domains of satisfaction scored less than 90%. More than 80% of clients were satisfied with empathy (83%) and assurance (80%) domains. Tangibles, reliability and responsiveness domains had scores of 78%, 72% and 67%, respectively. These results, together with the reasoning map of conceptual framework description, were used as the building blocks of the CBR model.ConclusionThe improved CBR model is useful for putting the programme into practice. This is particularly so for the CBR managers in the districts of the Limpopo Province.

Exercise-based training decreases hospitalizations in heart failure patients but such patients have exercise intolerance. The objectives of the study were to evaluate the effect of 12 weeks of Tai Chi exercise and lower limb muscles' functional electrical stimulation in older chronic heart failure adults. A total of 1,084 older adults with chronic systolic heart failure were included in a non-randomized clinical trial (n=271 per group). The control group did not receive any kind of intervention, one group received functional electrical stimulation of lower limb muscles (FES group), another group practiced Tai Chi exercise (TCE group), and another received functional electrical stimulation of lower limb muscles and practiced Tai Chi exercise (FES & TCE group). Quality of life and cardiorespiratory functions of all patients were evaluated. Compared to the control group, only FES group had increased Kansas City Cardiomyopathy Questionnaire (KCCQ) score (P<0.0001, q=9.06), only the TCE group had decreased heart rate (P<0.0001, q=5.72), and decreased peak oxygen consumption was reported in the TCE group (P<0.0001, q=9.15) and FES & TCE group (P<0.0001, q=10.69). FES of lower limb muscles and Tai Chi exercise can recover the quality of life and cardiorespiratory functions of older chronic heart failure adults (trial registration: Research Registry 4474, January 1, 2015).

Few systematic reviews have been conducted regarding aural rehabilitation for adults with hearing loss, with none specifically targeting the older adult population. With prevalence rates of hearing loss being highest in older adults, examining the effects of aural rehabilitation on this population is warranted. To evaluate the effects of aural rehabilitation on quality of life in an older adult population presenting with hearing loss. Studies with adults presenting with hearing loss, ≥50 yr of age, with or without hearing aids, receiving interventions such as auditory training, speech-reading, communication strategies training, speech tracking, counseling, or a combination of approaches, and measuring outcomes related to quality of life, in an individual or group format, with or without significant others and with no limitations as to year of publication. Searches in six databases, as well as results from hand-searching, gray literature, and cross-referencing of articles, yielded 386 articles. Of the 145 assessed as full-text articles for eligibility, 8 studies met inclusion criteria. A component-based risk of bias assessment, as recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. No effect sizes were found in group interventions measuring outcomes related to quality of life, such as mental and emotional functions, environmental factors, participation restrictions, and activity limitations. An intervention effect regarding participation was found for a self-administered home training program, but an effect size was unavailable. Small-to-medium effect sizes were found in one of two individual communication training programs, for which outcomes related to quality of life, such as emotional functions, activities, participation, and environmental factors were measured. The results of the component-based risk of bias assessment indicated that the quality of reporting was poor, thus compromising the internal validity of included primary studies. Our results indicate that the combined body of evidence in support of aural rehabilitation for older adults with hearing loss is not sufficient to draw any firm conclusions. We identify a need for more rigorous research to guide clinical decision-making.

Primary healthcare professionals face an increasing number of geriatrics patients, and patient care often involves different disciplines. eHealth offers opportunities to support interprofessional collaboration (IPC). This exploratory study aimed to gain insight in 1) IPC in community-based rehabilitation, 2) facilitators and barriers for technology-based IPC and 3) technological IPC solutions envisioned by the primary healthcare professionals An focus group with six primary healthcare professionals and a design thinking session with four participants were conducted. Data analysis was based upon an IPC model. Results indicate that facilitators and barriers for IPC can be clustered in three categories: human, organization and technology, and provide some requirements to develop suitable IPC technological solutions Primary healthcare professionals recognise the urgency of working collaboratively. Current barriers are understanding each other's professional vocabulary, engaging the older adults, and using technology within the patient's environment. Further research is needed to integrate IPC components in a technological solution.

The impact of hospitalization on sleep in late-life is underexplored. The current study examined patterns of sleep quality before, during, and following hospitalization, investigated predictors of sleep quality patterns, and examined predictors of classification discordance between two suggested clinical cutoffs used to demarcate poor/good sleep. This study included older adults (n = 163; mean age 79.7 ± 6.9 years, 31% female) undergoing inpatient post-acute rehabilitation. Upon admission to inpatient post-acute rehabilitation, patients completed the Pittsburgh Sleep Quality Index (PSQI) retrospectively regarding their sleep prior to hospitalization. They subsequently completed the PSQI at discharge, and 3 months, 6 months, 9 months, and 1 year post discharge. Patient demographic and clinical characteristics (pain, depression, cognition, comorbidity) were collected upon admission. Using latent class analysis methods, older adults could be classified into (1) Consistently Good Sleepers and (2) Chronically Poor Sleepers based on patterns of self-reported sleep quality pre-illness, during, and up to 1 year following inpatient rehabilitation. This pattern was maintained regardless of the clinical cutoff employed (> 5 or > 8). Logistic regression analyses indicated that higher pain and depressive symptoms were consistently associated with an increased likelihood of being classified as a chronic poor sleeper. While there was substantial classification discordance based on clinical cutoff employed, no significant predictors of this discordance emerged. Clinicians should exercise caution in assessing sleep quality in inpatient settings. Alterations in the cutoffs employed may result in discordant clinical classifications of older adults. Pain and depression warrant detailed considerations when working with older adults on inpatient units when poor sleep is a concern.

Trust and compassion in willingness to share mobility and sheltering resources in evacuations: A case study of the 2017 and 2018 California Wildfires

IntroductionThe increasing ageing population has become a substantial challenge for both healthcare and social services in many Asian countries. There is a high incidence of chronic diseases and comorbidities in...