Geriatric Rehabilitation Care Research Articles

Factors influencing interprofessional collaboration in general and during multidisciplinary team meetings in long-term care and geriatric rehabilitation: a qualitative study

BackgroundInterprofessional collaboration is essential to maintain high-quality care in long-term care and geriatric rehabilitation. However, little is known regarding perceived factors influencing interprofessional collaboration by people involved in care. This concerns both long-term care and geriatric rehabilitation. Moreover, knowledge of using patient outcome measures to enhance interprofessional collaboration during multidisciplinary team meetings is insufficient. This study examined the perceived facilitators of and barriers to interprofessional collaboration in general and during multidisciplinary team meetings, specifically according to healthcare professionals, patients, and informal caregivers. Differences between long-term care and geriatric rehabilitation were also investigated. Finally, it was examined which patient outcome measures were used in multidisciplinary team meetings.MethodsA constructivist qualitative study using 10 focus groups and 18 semi-structured interviews with 14 patients, 13 informal caregivers,10 managers, and 22 healthcare professionals from eight Dutch long-term care and geriatric rehabilitation facilities. A combined inductive and deductive approach to a thematic analysis was performed.ResultsThe perceived influencing factors of interprofessional collaboration were classified into two general themes: (1) ‘Involvement of patient, informal caregiver, and healthcare professional’, categorised into: ‘participation of patients and informal caregivers’, ‘behaviour and attitude of team members’, ‘expectations of team members towards each other’, and ‘exchange of information, knowledge, and reciprocity in communication’; and (2) ‘A systematic approach to providing care for older people’, consisting of: ‘coordination of team procedures’, and ‘coordination of organisational procedures’. Also, one theme for multidisciplinary team meetings was identified: ‘Organised participation of patient, informal caregiver, and healthcare professional in multidisciplinary team meeting, categorised into: ‘team procedures’, ‘working systematically’, and ‘participation in multidisciplinary team meetings. Standardised patient outcome measures were scarcely used in multidisciplinary team meetings.ConclusionPeople involved in long-term care and geriatric rehabilitation indicated that, apart from working systematically, being involved in care and multidisciplinary team meetings are essential factors for interprofessional collaboration. These factors must be taken into consideration to provide valuable, high-quality care to older people residing in long-term care and geriatric.Trial registrationNot applicable.

National survey evaluating patient and organisational characteristics of short-term residential care facilities in the Netherlands.

Background: Short-term residential Care (STRC) is a recent, bed-based care concept for older adults aimed to avoid nursing home admission in the Netherlands. 
 Objective: To describe characteristics of patients admitted to STRC and the main organizational differences between facilities. 
 Methods: Patient characteristics were identified using a national STRC database (2018 and 2019). Organizational comparisons of STRC facilities were collected through an cross-sectional email survey sent to all facilities.
 Results: Of the 68,682 older adults admitted to STRC, patients were mostly female (35%), living alone (64%), with at least 10 medications prescribed (60%). Of the 36660 patients admitted in 2018, 43.4% died within 24 months and 25.5% is living in a nursing home. Of the 176 STRC facilities that responded, 30.1% delivered care at an independent ward, 27.3% was within a geriatric rehabilitation care ward, and 33.5% at a ward in long-term care. The median number of beds was 8, with a range from 1 to 40. Most facilities admitted patients in evenings, nights, or weekends. Almost all wards employed registered nurses and paramedics. 
 Conclusions: Patients admitted to STRC have multiple medical problems, suggested by the high number of medication, and often have palliative care needs. Facilities providing STRC differ by the location of the ward, the number of beds, and frequency of medical rounds and multidisciplinary consultations. There is a pressing need to develop standards for STRC to effectively deliver care.

Nursing home geriatric rehabilitation care and interprofessional collaboration; a practice-based study

BackgroundFrailty and multimorbidity are common among patients in geriatric rehabilitation care (GRC). Proper care of these patients involves multiple professionals which requires optimal interprofessional collaboration to provide the best possible support. Interprofessional collaboration (IPC) goes beyond multi-professional collaboration. It requires professionals to think beyond the expertise of their own discipline and work on joint outcomes in which the patient is actively involved. This study describes the development of the GRC teams of an elderly care organization towards the IPC.MethodsMixed method pre-post study of 15 months. The interprofessional training program comprised team trainings, webinars, and online team sessions. Data was aggregated by administering the Extended Professional Identity Scale (EPIS) and QuickScan Interprofessional Collaboration (QS) measurements to GRC staff and by observations of the multi-professional team consultation (MPC) meetings of six GRC teams of an organization for elderly care in Drachten and Dokkum in the Netherlands. ADL independence (Barthel Index) and number of inpatient days were analyzed before and after the project.ResultsPretest healthcare professional response was 106, patients for analyses was 181; posttest response was 84, patients was 170. The EPIS shows improvement on “interprofessional belonging” (P = .001, 95%CI: 0.57–2.21), “interprofessional commitment” (P = .027, 95%CI: 0.12–1.90), and overall “interprofessional identity” (P = .013, 95%CI: 0.62 − 5.20). On the QS, all domains improved; “shared values” (P = .009, 95%CI: 0.07 − 0.47), “context” (P = .005, 95%CI: 0.08 − 0.44), “structure & organization” (P = .001, 95%CI: 0.14 − 0.56), “group dynamics & interaction” (P < .001, 95%CI: 0.18 − 0.58), and “entrepreneurship & management” (P = .039, 95%CI: 0.01 − 0.48). A qualitative analysis of the reflection responses and MPC observations indicate a shift from multi-professional to more IPC. Differences in ADL over time were not statistically significant. The mean number of inpatient days was reduced by 11.8 (P < .001, 95%CI: -17.34 - − 6.31) days.ConclusionsWithin the GRC teams, there was a shift observed to more IPC and better representation of the patient’s wishes and needs. ADL independence did not change, yet we found a statistically significant decrease in the number of inpatient days. The basis for IPC was well established, however, it remains necessary that the teams continue to develop and invest in the collaboration with each other and the patient to further improve it.

Experiences, wishes and needs of patients with regard to patient participation during geriatric rehabilitation

Person-centered care is the result of shared goal setting and monitoring progress during rehabilitation in geriatric rehabilitation care (GR). It requires active patient involvement. Collaboration between health care professionals and patients is valuable in formulating goals and contributes to person-centered care. With this study we investigate how active participation is implemented in practice, what wishes GR patients have and what tools are needed for this. For this purpose, cross-sectional semi-structured interviews were conducted with 23 GR patients for 1 year. The research shows that patients want to be actively approached and supported by professionals for active patient participation. The extent to which and the way in which this is done are different, requiring a flexible approach that considers the needs and possibilities of the patient and his environment. Recommendations for practice have been formulated based on this study.

High Sarcopenia Awareness Contrasts a Lack of Clinical Implementation Among Geriatric Rehabilitation Health Care Professionals in the Netherlands: EMPOWER-GR.

Despite being associated with serious adverse outcomes, such as mortality, sarcopenia remains largely undiagnosed in older individuals. This study aimed to assess the awareness, practices, and barriers and enablers to clinical implementation of sarcopenia diagnosis and treatment among geriatric rehabilitation health care professionals in the Netherlands. As part of EMPOWER-GR, a cross-sectional survey among geriatric rehabilitation health care professionals working in the Netherlands was undertaken between September 23, 2020, and January 28, 2021. Professionals were recruited via a geriatric rehabilitation care provider, health care professional associations, professional networks of the research team, and social media. Descriptive statistics were used to assess the study outcomes. Of the 501 geriatric rehabilitation health care professionals, 12.2% were physicians, 23.0% physical therapist/occupational therapists, 30.3% dietitians, 19.6% nurses, and 11.0% health care assistants. The concept of sarcopenia was known by 83.8% of the participants, 92.5% correctly identified sarcopenia as low muscle mass and strength (and low physical performance), and 73.8% identified sarcopenia as very important in the management of older adults admitted for rehabilitation. Although 26.2% and 18.9% of the participants reported screening and diagnosing sarcopenia, respectively, in their current practice, only 3.0% adequately used the (revised) definition of the European Working Group on Sarcopenia in Older People. When sarcopenia has been diagnosed, 65.0% reported initiating treatment consisting of resistance exercise training (78.7%), food fortification/high-energy or protein diet (85.4%), and oral nutritional supplements (70.4%). Most important barriers to screening and diagnosis were lack of knowledge, access to tools, and equipment and time, while enablers were protocol implementation, access to training, and clear responsibilities. Sarcopenia awareness is high among geriatric rehabilitation health care professionals in the Netherlands, but adequate screening and diagnosis is almost nonexistent in current clinical practice, which hampers interventions. Better knowledge, clear responsibilities, and access to tools and protocols, as well as prioritization, are needed for sarcopenia to be diagnosed and treated in geriatric rehabilitation in the Netherlands.

Geriatric rehabilitation care after hip fracture

Key summary pointsAimTo describe the care provided in the Netherlands in geriatric rehabilitation (GR) after a hip fracture, using care pathways and diagnosis treatment combinations from various geriatric rehabilitation facilities.FindingsCare provided in GR after hip fracture is difficult to define due to the diversity in care pathways and large practice variation.MessageFurther research is needed to investigate whether a standardized care pathway is effective for GR.

How to Conduct International Geriatric Rehabilitation Research?

With an ageing global population and an increasing focus on aging in place, the number of people in need of geriatric rehabilitation (GR) is rapidly increasing. As current GR practice is very heterogenous, cross-country comparisons could allow us to learn from each other and optimise the effectiveness of GR. However, international GR research comes with many challenges. This article summarises the facilitators and barriers relating to the recruitment of rehabilitation centres, the inclusion of patients, and data collection, as experienced by experts in the field of international GR research. The three most important methodological recommendations for conducting cross-national collaborative research in the field of GR are (1) make use of existing (inter)national networks and social media to aid recruitment of GR centres; (2) clearly define the GR treatment, setting, and patient characteristics in the inclusion criteria; and (3) use a hierarchical study structure to communicate transparently and regularly with both national and local coordinators. International GR research would greatly benefit from the implementation of a core dataset in regular GR care. Therefore, future studies should focus on developing an international consensus regarding the outcomes and corresponding cross-culturally validated measurement instruments to be used during GR.

Knowledge about different rehabilitation options in geriatric population

Aim: The purpose of the present research was to evaluate the need for rehabilitation and various options for consideration amongst the geriatric population. Methodology: One hundred and three geriatric subjects aged between 65 to 90 years were enrolled. The data were collected using a structured questionnaire designed to obtain information regarding home care and geriatric rehabilitation care. Results: Sixty (58.2%) were females and 43 (41.7%) were males. The majority were &lt;80 years of age, 82 (79.6%). Around 52 (50.5%) subjects knew about rehabilitation care and most believed that geriatric rehabilitation care is beneficial. Sixty-four (62.1%) subjects were involved in socialization once a week, 29 (28.2%) once in a month, 6 (5.8%) biannually and 4 (3.9%) marked not at all. Among all, 41% reported being isolated, and 86% were getting enough psychiatric/physical care at home. Conclusion: Although 52 (50.5%) of the study subjects reported knowing geriatric rehabilitation care due to limited education as well as lack of access led to more neglect of the elderly. There is a need to design and conduct rehabilitation programs to control morbidity and improve the quality of the geriatric population.

Physical and Functional Clinical Profile of Older Adults in Specialized Geriatric Rehabilitation Care Services in Saguenay-Québec: A Retrospective Study at La Baie Hospital

Musculoskeletal disorders, cardiovascular and neurological diseases were the most commonly debilitating conditions and risk factors associated with pain, mobility limitations, increased risk of falls and disability. Studies barely address the profile of older adults in care within a specialized geriatric rehabilitation service (SGRS) to provide subsidies for new actions within the public healthcare to reduce falls and improve management in health investments. This study aimed to establish a clinical physical and functional profile of the patients with neuromusculoskeletal and cognitive disorders and fallers in interventions within SGRS. From a retrospective study design, 127 medical records were compiled and analyzed to determine the physical and functional profile of older adults and differences according to sex, age groups and the benefits for local physical therapy intervention. The users were between 76 and 85 years of age, with diverse clinical diagnoses and debilitating conditions and impairments. A higher proportion presented gait and balance impairments and had two or more falls in 12 months. A significant effect for advanced age was observed. Overall, real benefits were reported with intervention for functional improvement, although the absence of a control group. These results have direct implications for a better understanding of a local SGRS and provide subsidies for developing new approaches for the assessment and treatment of older adults with high a risk of falls in order to reduce costs for the public health system.

More than a fleeting conversation: managing medication communication across transitions of care.

Tailored medication communication is key to preventing patient harm across transitions of care Older patients are likely to have complex medication regimens, which need to be carefully managed as they move across and within diverse settings, including primary care, acute care, geriatric rehabilitation, and aged care facilities. These movements often involve different health professionals, such as general practitioners and medical specialists. Problems with medication communication across transitions of care are the key reasons for increased risk of medication-related problems and hospital readmissions.1-3 Discussions with older patients and families are often not prioritised across transitions of care; instead, fleeting conversations take place at irregular time points and for short periods just before or after transfers.4 These conversations are rarely organised in a goal-directed way where medication communication is conveyed accurately, clearly and comprehensively. The impact of fleeting conversations is that even if medication information is conveyed, patients and families may not be involved in key decisions about newly prescribed, ceased or changed medications, or may not voice their concerns and preferences about the medication regimen.5 There is lack of recognition that “the one person who remains constant is the patient, who has the most to lose in a disconnected health system”.6 Communication for shared medication decision making across transitions of care is largely disorganised and serendipitous.7, 8 Shared medication decision making involves health professionals, older patients and families communicating together to define the medication problem, outlining available options, checking understanding, eliciting patient and family values, supporting patient and family deliberation, and reaching mutual agreement.9 Currently, older patients and families have to display extensive fortitude and perseverance to express their view.7, 8 For many health professionals, medication communication comprises information-giving and information-receiving activities,10 where they do not enquire about older patients’ experiences, beliefs and attitudes about medication .7, 8 Eliciting patient and family priorities and preferences in medication decision making is often perceived as challenging, impractical and time consuming.7, 8 Nevertheless, if medication communication is to facilitate shared decision making, a shift is needed from information-giving and information-receiving consultations to interactive, tailored and deliberate conversations along the continuum of care.11 Although not all patients and families may want to be involved, creating opportunities will help to reduce fear and anxiety and to support those unwilling or unable to participate. Many factors contribute to health professionals’ ability to facilitate engagement with older patients and families.5 Older patients with complicated medication regimens, those with mental health problems, those from lower socio-economic backgrounds or low literacy, and Aboriginal and Torres Strait Islander and migrant populations are particularly at risk.6 Older patients may wish to evade responsibility for fear of making inappropriate decisions, or may believe they lack the ability to participate because of language, cultural, cognitive, and disease-related barriers.8 Related to medication decision making is the ethical and legal requirement to obtain informed consent before prescribing medication.12 If the older patient lacks decision-making capacity, their substitute decision maker such as a family member should make the decision. They have the right to decline prescribed medication, even if this view is contrary to medical recommendations. Similarly, they may change their mind and withdraw consent about prescribed medication at any time.12 Fostering engagement among older patients and families and creating opportunities for decision making about medications are crucial for improved safety and quality across transitions of care. Challenging fleeting conversations is key to reducing the risk of medication-related problems and patient harm. We acknowledge funding support relating to this paper, from the Australian Research Council through the Discovery Project Grant scheme (DP170100308). The funding source had no role in the planning, writing or publication of the work. Open access publishing facilitated by Deakin University, as part of the Wiley - Deakin University agreement via the Council of Australian University Librarians. No relevant disclosures. Not commissioned; externally peer reviewed.

Referral to geriatric rehabilitation: a scoping review of triage factors in acutely hospitalised older patients.

ObjectiveOld or frail acutely hospitalised patients can benefit from geriatric rehabilitation but criteria concerning referral decisions are unclear. This review presents an overview of clinical factors associated with referral to geriatric rehabilitation that may further consensus between hospital and rehabilitation professionals on triage.DesignScoping review.MethodsA review was conducted following Arksey and O’Malley’s framework. The search included literature concerning a broad spectrum of acutely hospitalised patients and factors associated with their referral to geriatric rehabilitation.ResultsSelected abstracts were categorised into distinct geriatric rehabilitation care pathways such as stroke, hip fracture, amputation of lower limb, cardiac and oncologic rehabilitation. s on internal medical patients were further reviewed and 29 studies were included. A total of 13 studies focused on factors identifying rehabilitation needs and 16 on factors associated with outcome of geriatric rehabilitation. Triage factors were diverse and included frailty status, functional decline, cognitive symptoms and multimorbidity. Mood symptoms and living situation further specified post-acute care needs. In overview, triage factors could be characterised as demographic (n = 4), diagnosis-related (n = 8), mental (n = 6), functional (n = 10) or multi-domain (n = 12) and mapped in a transitional care pathway.Conclusions and implicationsFrailty and functional decline are characteristics frequently associated with referral to geriatric rehabilitation of acutely hospitalised internal medical patients. A comprehensive geriatric assessment or a simpler multi-domain set of tests reveals rehabilitation needs and approximates a functional prognosis. Professional consensus on factors and timing of triage in hospital is within reach.

Understanding the Needs of Geriatric Rehabilitation Care

Background: With the increasing age, the body undergoes several physical and psychiatric changes; it is important to address the healthcare management apprehensions among the elderly and promote geriatric rehabilitation care both socially and economically. Objective: To evaluate the need for rehabilitation amongthe geriatric population living in Pakistan. Design: Cross-sectional study Place and Duration of Study: Department of Medicine, Liaquat National Hospital, Karachi from 1st January 2020 to 30th June 2020 Methodology: One hundred and three geriatric subjects aged between 65 to 90 years were enrolled. The data were collected using a structured questionnaire designed to obtain information regarding home care and geriatric rehabilitation care. Results: Sixty (58.2%) were females and 43 (41.7%) were males. The majority were &lt;80 years of age, 82 (79.6%). Around 52 (50.5%) subjects knew about rehabilitation care and most believed that geriatric rehabilitation care is beneficial. Sixty four (62.1%) subjects were involved in socialization once a week, 29 (28.2%) once in a month, 6 (5.8%) biannually and 4 (3.9%) marked not at all. Among all, 41% reported being isolated, and 86% were getting enough psychiatric/physical care at home. Conclusion: Although 52 (50.5%) of the study subjects reported knowing geriatric rehabilitation care, due to limited resources and economic constraints in Pakistan, we have been unable to set up centers to rehabilitate the elderly. There is a need to design and conduct rehabilitation programs to control morbidity and improve the quality of the geriatric population. Keywords: Geriatric rehabilitation care (GRC), Home care, Geriatric population

163 EVALUATING THE ROLE OF THE GERIATRIC DAY HOSPITAL IN MEDICATION OPTIMISATION

Abstract Background The geriatric day hospital (GDH) provides outpatient geriatric medical, nursing and rehabilitation care to older adults. The aim of this study was to assess whether medication optimisation occurs in this setting. We believe the GDH would be an ideal location for mediation optimisation due to the stable community dwelling patients and close follow up by specialised physicians. Methods Electronic patient records of the new patients ≥65 years seen in the GDH over a 3-month period were reviewed. Potentially inappropriate prescriptions (PIPs) and potentially prescribing omissions (PPOs) were identified using the STOPP/START prescribing tool on admission to the GDH and again at discharge from the GDH. Results One-hundred and sixty-seven patient records were reviewed; mean age 80.8 (SD6.5) years, 62.9% female, median clinical frailty scale score 6 (IQR5–6), mean number of conditions 5.79 (SD3), mean number of medications 7.57 (SD3.7). Patients had a median of 4 (IQR2–7) consultations. The number of patients prescribed at least 1 STOPP-PIP reduced by 10% (42.4% vs 38%; p &amp;lt; 0.001). Vasodilator drugs in patients with orthostatic hypotension were deprescribed most frequently (6.5% vs 3%; p &amp;lt; 0.001). PPOs were reduced by 36% (47.5% vs 30.6%;p &amp;lt; 0.001). The largest improvement was identified in the prescription of vitamin D in patients experiencing falls (17.4% vs 13.8%;p &amp;lt; 0.001). Logistic regression was performed to ascertain the influence of age, gender, falls, dementia, co-morbidity number and medication number on the likelihood of a patient experiencing a PIP or PPO. For every medication prescribed, the odds of experiencing a PIP increased by 11.8% (OR1.187, 95%CI 1.052–1.339). Being female increased the odds of experiencing a PPO by 21.7% (OR2.17, 95%CI 10.53–4.468). Conclusion Medication optimisation is key in avoiding side effects from potentially inappropriate medications. The frequency of patient attendances coupled with geriatricians’ expertise makes the GDH an ideal setting for medication optimisation in multi-morbid frail community-dwelling older adults.

Feasibility of a multicomponent cognitive behavioral intervention for fear of falling after hip fracture: process evaluation of the FIT-HIP intervention

BackgroundThis study describes the process evaluation of an intervention developed to reduce fear of falling (FoF) after hip fracture, within an inpatient geriatric rehabilitation setting. This ‘FIT-HIP intervention’ is a multicomponent cognitive behavioral intervention, conducted by physiotherapists and embedded in usual care in geriatric rehabilitation in the Netherlands. A previous study (cluster randomized controlled trial) showed no beneficial effects of this intervention when compared to usual care. The aim of this study was to gain insight into factors related to the intervention process that may have influenced the effectiveness of the intervention.MethodsThis process evaluation was conducted using an observational prospective study design. Based on quantitative and qualitative data derived from session logs, evaluation questionnaires and interviews, we addressed: 1] recruitment and reach; 2] performance according to protocol; 3] patients’ adherence; and 4] opinions of patients and facilitators on the intervention. Participants in this study were: a) patients from 6 geriatric rehabilitation units, who were invited to participate in the intervention (39 adults aged ≥65 years with hip fracture and FoF) and; b) intervention facilitators (14 physiotherapists and 8 psychologists who provide coaching to the physiotherapists).ResultsThirty-six patients completed the intervention during inpatient geriatric rehabilitation. Apart from cognitive restructuring and telephonic booster (which was not provided to all patients), the intervention was performed to a fair degree in accordance with protocol. Patients’ adherence to the intervention was very good, and patients rated the intervention positively (average 8.1 on a scale 0–10). Although most facilitators considered the intervention feasible, a limited level of FoF (possibly related to timing of intervention), and physiotherapists’ limited experience with cognitive restructuring were identified as important barriers to performing the intervention according to protocol.ConclusionsThe FIT-HIP intervention was only partly feasible, which may explain the lack of effectiveness in reducing FoF. To improve the intervention’s feasibility, we recommend selecting patients with maladaptive FoF (i.e. leading to activity restriction), being more flexible in the timing of the intervention, and providing more support to the physiotherapists in conducting cognitive restructuring.Trial registrationNetherlands Trial Register: NTR5695 (7 March 2016).

Older Persons and Nursing Staff's Perspectives on Continence Care in Rehabilitation: A Qualitative Study.

The aim of the study was to understand continence care in geriatric rehabilitation from the perspectives of older persons and nursing staff. This is a qualitative descriptive study. Ten patients and 10 nursing staff participated in semistructured interviews. Observations of care were recorded in field notes. Content analysis was used to develop themes of patient and nursing staff perspectives. Three themes were developed: Perceptions of Assessment, Continence Management, and Rehab: The Repair Shop. Patients had limited insight into continence assessment and management by nursing staff. For older persons, incontinence was embarrassing and created dependence; independence in toileting meant gaining control. Staff viewed continence as an important part of rehabilitation nursing but focused on containment and regular toileting, with patients seeing absorbent pads as commonly suggested. Continence care approaches that engage older persons during rehabilitation are needed. Restoration of continence through patient-centered care is core to older person rehabilitation.

Comparison between the Global Leadership Initiative on Malnutrition and the European Society for Clinical Nutrition and Metabolism definitions for the prevalence of malnutrition in geriatric rehabilitation care.

The recently proposed Global Leadership Initiative on Malnutrition (GLIM) criteria may accurately reflect the nutritional status of older adults because they use information such as reduced muscle mass and chronic and acute disease to diagnose malnutrition. This study aimed to determine the prevalence and characteristics of malnutrition in older adults assessed by the GLIM and the European Society for Clinical Nutrition and Metabolism (ESPEN) diagnostic criteria for malnutrition (DCM) in post-acute geriatric care. This cross-sectional study included older patients admitted to rehabilitation care units. Malnutrition was evaluated using GLIM-DCM and ESPEN-DCM using a two-step process (initial screening and subsequent steps). The prevalence and differences observed between GLIM-DCM and ESPEN-DCM were reported, and the determinants of each criterion were identified. This study included 335 older patients (mean ± SD, age 80.0 ± 7.5 years; 54.0% women). The prevalence of older patients diagnosed with GLIM-DCM and ESPEN-DCM was 66.9% and 59.1%, respectively, and the agreement between ESPEN-DCM and GLIM-DCM was 80.9%. The results of multivariate analyses showed that all items of the phenotypic and etiologic criteria were independent determinants for GLIM-DCM, whereas disease burden/inflammation (P = 0.996), included in the etiologic criteria of GLIM-DCM, were not determinants of ESPEN-DCM. This study reported the prevalence of malnutrition according to GLIM-DCM and the differences in the characteristics of patients diagnosed with malnutrition based on GLIM-DCM and those diagnosed based on ESPEN-DCM in geriatric rehabilitation care units. Further studies are required to investigate the prevalence of malnutrition in different care settings. Geriatr Gerontol Int 2020; 20: 1221-1227.

Geriatric Interdisciplinary Home Rehabilitation After Hip Fracture in People with Dementia - A Subgroup Analysis of a Randomized Controlled Trial.

PurposeTo investigate if the effects of geriatric interdisciplinary home rehabilitation after hip fracture were different among people with dementia compared to those without dementia and to describe the overall outcome after hip fracture in people with dementia.Patients and MethodsA post hoc subgroup analysis of a randomized controlled trial was conducted including 205 people with hip fracture, aged ≥70, living in ordinary housing or residential care facilities. Early discharge followed by individually designed interdisciplinary home rehabilitation for a maximum of 10 weeks was compared to in-hospital geriatric care according to a multifactorial rehabilitation program. Outcomes were hospital length of stay (LOS), readmissions, falls, mortality, performance in activities of daily living (ADL), and walking ability.ResultsInterdisciplinary home rehabilitation vs in-hospital care had comparable effects on falls and mortality between discharge and 12 months and on ADL and walking ability at 3 and 12 months regardless of whether the participants had dementia or not (P≥0.05 for all). Among participants with dementia, postoperative LOS was a median of 18 days (interquartile range [IQR] 14–30) in the home rehabilitation group vs 23 days (IQR 15–30) in the control group (P=0.254) with comparable numbers of readmissions after discharge. Dementia was associated with increased risk of falling (odds ratio [OR] 3.86; 95% confidence interval [CI]: 2.05–7.27; P<0.001) and increased mortality (OR 4.20; 95% CI 1.79–9.92, P=0.001) between discharge and 12 months and with greater dependence in ADL and walking at 3 and 12 months compared to participants without dementia (P<0.001 for all).ConclusionThe effects of geriatric interdisciplinary home rehabilitation vs in-hospital geriatric care did not differ in participants with and without dementia. However, the statistical power of this subgroup analysis was likely insufficient to detect differences between the groups. Dementia was associated with a substantial negative impact on the outcomes following the hip fracture. Our findings support offering interdisciplinary home rehabilitation after hip fracture to people with dementia.

Development of an evaluation tool for geriatric rehabilitation care

BackgroundGeriatric rehabilitation care (GRC) is short-term and multidisciplinary rehabilitation care for older vulnerable clients. Studies were conducted about its effects. However, elements that influence the quality of GRC have not been studied previously.MethodsIn this study realist evaluation is used to find out which are the mechanisms and outcomes and which (groups of) persons are the context for GRC, according to GRC professionals. The mechanisms, outcomes and context of GRC were explored in three consecutive phases of qualitative data gathering, i.e. individual interviews, expert meeting, and focus groups.ResultsEight mechanisms — client centeredness, client satisfaction during rehabilitation, therapeutic climate, information provision to client and informal care givers, consultation about the rehabilitation (process), cooperation within the MultiDisciplinary Team (MDT), professionalism of GRC professionals, and organizational aspects — were found. Four context groups—the client, his family and/or informal care giver(s), the individual GRC professional, and the MDT—were mentioned by the respondents. Last, two outcome factors were determined, i.e. client satisfaction at discharge and rehabilitation goals accomplished.ConclusionsIn order to translate these insights into a practical tool that can be used by MDTs in the practice of GRC, identified mechanisms, contexts, and outcomes were visualized in a GRC evaluation tool. A graphic designer developed an interactive PDF which is the GRC evaluation tool. This tool may enable MDTs to discuss, prioritize, evaluate, and improve the quality of their GRC practice.

Effects of the FIT-HIP Intervention for Fear of Falling After Hip Fracture: A Cluster-Randomized Controlled Trial in Geriatric Rehabilitation

ObjectivesFear of falling (FoF) is common after hip fracture and can impede functional recovery because of activity restriction. The Fear of falling InTervention in HIP fracture geriatric rehabilitation (FIT-HIP intervention) was designed to target FoF and consequently to improve mobility. The aim of this study was to evaluate the effect of the FIT-HIP intervention in patients with FoF in geriatric rehabilitation (GR) after hip fracture. Design, setting, and participantsThis cluster-randomized controlled trial was performed in 11 post-acute GR units in the Netherlands (2016-2017). Six clusters were assigned to the intervention group, 5 to the usual care group. We included 78 patients with hip fracture and FoF (aged ≥65 years; 39 per group). Intervention(s)The FIT-HIP intervention is a multicomponent cognitive behavioral intervention conducted by physiotherapists, embedded in usual care in GR. The FIT-HIP intervention was compared to usual care in GR. MeasurementsFoF was assessed with the Falls Efficacy Scale–International (FES-I) and mobility, with the Performance Oriented Mobility Assessment (POMA). Data were collected at baseline, discharge, and 3 and 6 months postdischarge from GR. Primary endpoints were change scores at discharge. Linear mixed models were used to evaluate the treatment effect. ResultsNo significant between-group differences were observed for primary outcome measures. With the usual care group as reference, the FES-I estimated difference between mean change scores was 3.3 [95% confidence interval (CI) −1.0, 7.5, P = .13] at discharge from GR; −4.1 (95% CI –11.8, 3.6, P = .29) after 3 months; and −2.8 (95% CI –10.0, 4.4, P = .44) after 6 months. POMA estimated difference was −0.3 (95% CI –6.5, 5.8, P = .90). Conclusion/ImplicationsThe FIT-HIP intervention was not effective in reducing FoF. Possibly FoF (shortly) after hip fracture can to some extent be appropriate. This may imply the study was not able to accurately identify and accordingly treat FoF that is maladaptive (reflective of disproportionate anxiety).

The effectiveness of an integrated care pathway in geriatric rehabilitation among older patients with complex health problems and their informal caregivers: a prospective cohort study

BackgroundTo improve continuity and coordination of care in geriatric rehabilitation, an integrated care pathway was developed and implemented in The Netherlands. The purpose of this study was to assess the effects of this pathway on patients and informal caregivers.MethodsTwo cohorts of patients and their informal caregivers were prospectively recruited before implementation of the pathway (2011–2012) and after implementation of the pathway (2013–2014). Primary outcome measures were dependence in activities of daily living in patients (KATZ-15) and self-rated burden among informal caregivers (SRB-VAS). Secondary outcome measures were the frequency of performing extended daily activities, social participation, psychological well-being, quality of life and discharge location (patients) and quality of life and objective care burden (informal caregivers). Outcomes were measured at baseline, after three and after nine months.ResultsNo effect was shown on the KATZ-15 after three and nine months. However, a larger percentage of patients were discharged home in the care pathway cohort (83% vs 58.1% after three months and 88.6% vs 67.4% after nine months; p = 0.004). Furthermore, after three months, patients from the care pathway cohort performed more extended daily activities (p = 0.014) and informal caregivers experienced a lower self-rated burden (p = 0.05). After nine months, these effects disappeared. No differences were found for the other outcome measures.ConclusionsDue to the positive effects of the integrated care pathway, we are inclined to recommend implementing the care pathway in regular care. To have longer lasting effects among patients and informal caregivers, we suggest actively disseminating information about the pathway to primary care providers who are currently still unaware of its content.Trial registrationISRCTN90000867 (date of registration: 07-04-2016).