Geriatric Rehabilitation Program Research Articles

Predictors of Hospital Readmission, Institutionalization, and Mortality in Geriatric Rehabilitation Following Hospitalization According to Admission Reason.

Older adults following an inpatient geriatric rehabilitation (GR) program commonly experience adverse health outcomes such as hospital readmission, institutionalization, and mortality. Although several studies have explored factors related to these outcomes, the influence of admission reason on the predictive factors of adverse health outcomes in the rehabilitation process remains unclear. Therefore, this study aimed to identify predictive factors for adverse health outcomes in inpatients attending GR according to their admission reason. This retrospective study included patients with orthogeriatric (OG) conditions and patients with hospital-associated deconditioning (HAD) admitted to GR after an acute hospitalization between 2016 and 2020. Patients were evaluated by a comprehensive geriatric assessment at admission, including sociodemographic data, social resources, clinical data, cognitive, functional and nutritional status, and physical performance measurements. Adverse health outcomes were collected (hospital readmission, institutionalization, and mortality). Univariate analyses and multivariate backward binary logistic regressions were used to determine predictive factors. In this study, 290 patients were admitted for OG conditions, and 122 patients were admitted due to HAD. In patients with OG conditions, lower Mini-Mental State Examination (MMSE) predicted institutionalization and mortality. Lower Mini Nutritional Assessment-Short Form predicted institutionalization, whereas lower Barthel Index and lower Tinetti-Performance-Oriented Mobility Assessment scores were associated with higher mortality. In patients with HAD, higher age-adjusted comorbidity index predicted hospital readmission and mortality, and lower Short Physical Performance Battery scores predicted institutionalization and mortality. Finally, lower MMSE scores, worse values in Older Americans Resources and Services Scale and male gender were associated with a higher risk of institutionalization. Predictive factors for hospital readmission, institutionalization, and mortality in patients with OG conditions and HAD during GR were different. Some of those predictors, such as nutritional status and physical performance, are modifiable. Understanding predictive factors for adverse outcomes, and how these factors differ by admission diagnosis, improves our ability to identify patients most at risk. Early identification of these patients could assist with prevention efforts and lead to a reduction of negative outcomes.

Evaluating the Effectiveness of Geriatric-Specific Cancer Rehabilitation Programs on Patient Health Outcomes.

This study evaluated a specialized rehabilitation program's impact on senior cancer patients' quality of life. one hundred and thirty patients aged ≥65 years with various cancer types undergoing/recovering from treatment were enrolled in oncology clinics in Al-Ahsa, Saudi Arabia. The intervention arm (n=65) participated in a tailored geriatric cancer rehabilitation program. The control group (n=65) received standard oncology care. The Functional Assessment of Cancer Therapy-General (FACT-G) tool assessed the quality of life across physical, social, emotional, and functional domains. T-tests and multivariate regression analyses compared outcomes. Total FACT-G scores showed a significantly higher quality of life for the geriatric cancer rehabilitation group versus standard care. Rehabilitation patients also demonstrated meaningful improvements across physical, social, and functional subscales. Rehabilitation involvement was the most predictive factor for optimized outcomes. Specialized geriatric cancer rehabilitation meaningfully improved several quality of life domains in older patients over standard care. Despite persistent barriers, rehabilitation programming optimized older cancer patients' physical and psychosocial health. Oncology and geriatrics must collaborate to ensure evidence-based rehabilitation access meets older cohorts' unique needs.

Feasibility of a Novel Geriatric Rehabilitation Program for People With COPD-induced Malnutrition and Muscle Wasting: A Qualitative Study.

Background and Purpose: Patients with COPD-induced malnutrition and muscle wasting are often frail. Consequently, traditional rehabilitation may be even counterproductive due to energy costs and there is a need for specialized rehabilitation programs, which are lacking for these patients. We developed such a program, which includes resistance training, following Nonlinear Periodized Exercise principles and physical energy management, in combination with a restriction of physical activities. The purpose of the study was to investigate the feasibility and the potential effects of this program. Methods: Patients who are eligible for the program are those with COPD gold III/IV and a fat free mass index below standard. We conducted a qualitative feasibility study and interviewed both patients and healthcare professionals (HCPs), using a deductive approach. The open interviews were qualitatively analyzed focussing on six areas of Bowens' feasibility model: acceptability, demand, implementation, practicality, limited efficacy, and integration. Results and discussions: Seven patients and seven HCPs were interviewed. For patients, key factors that helped to adhere to the program were knowledge about energy management, alternative skills to cope with COPD, and social support. They found the program beneficial. However, several patients considered a limitation of walking and ADL activities challenging. HCPs considered the program feasible and beneficial especially for those patients who accept they need a behavior change and who adhere to the program. For HCPs, key factors were the consistent approach and coaching skills of the multidisciplinary team members, and the monitoring role of the nurses. The limitation of physical activity and endurance training deviates from existing geriatric rehabilitation programs which propagate functional activity and training. Still, evidence from the current study suggests that our tailored approach for these patients might be more appropriate and also potentially effective without harm for physical function. Conclusions: Our novel, multidisciplinary rehabilitation program is considered feasible and clinically relevant by both patients and healthcare professionals. The next step is to explore its effects on muscle strength, physical functioning, and quality of life.

Development and feasibility of the Geriatric Activity Program Pellenberg with the Caregiver as an exercise partner (GAPP+Care).

The Geriatric Activation Program Pellenberg (GAPP), among other programs for geriatric rehabilitation, improves patient functioning. However, hospitalized patients rarely move enough to meet the WHO recommendation of 300 minutes of moderate-intensity exercise per week.
 Increasing exercise time by physiotherapy is hindered by staffing and financial restrictions both being dependent on health care and hospital financing. Integrating unpaid caregivers in an geriatric rehabilitation program could close this gap.
 Along with the physiotherapist, we wish to make the patient's informal caregiver an exercise partner. We want to teach the caregiver how to literally support their family member in hands-on sessions and to enable them to take part in the pluridisciplinary geriatric rehabilitation team.
 The development of the Geriatric Activity Program Pellenberg with the Caregiver as an exercise partner (GAPP+Care) was founded on three aspects: 1) the WHO daily activity guideline; 2) the current program GAPP; and 3) a systematic review on the effect of informal caregiver involvement on self-efficacy of hospitalized older adults.
 We conducted semi-structured interviews to determine the overall perception of patients and caregivers toward the GAPP+Care concept. Based on the findings, GAPP+Care was finalized. The questions were divided into 3 domains: 1) reasons to participate, 2) exercise moments (number, duration and time), and 3) the exercise booklet. The interview started with explaining GAPP+Care and a prototype of the exercise booklet was given. Sixteen patients from UZ Leuven's geriatric rehabilitation ward, as well as 15 informal caregivers, took part in the study. 75% of patients and 80% of family caregivers stated that they would participate in the GAPP+Care exercise program. The main motivations for participating were activation of the patient, to follow their progress, as well as to learn more about their abilities. The main reasons for refusal were a lack of time, greater care load for the caregiver, and the patient's lack of motivation. Although 52% of participants agreed to four additional exercise moments per week, 45% prefers less moments. All participants reported that the instruction booklet was clear, easy to read, and simple to use. With some adjustment GAPP+Care appears to be acceptable for implementation on a geriatric rehabilitation ward.
 The GAPP+Care program consists of GAPP plus three additional 30-minute exercise sessions each week led by an informal caregiver (+Care). One of these three exercise sessions is always carried out in partnership with a physiotherapist, while the other two can be independently given by the caregiver at any time, such as in the evening or on the weekend. These +Care practice sessions, in addition to the individual physiotherapy treatment, continue in the patient's home for the first six weeks following discharge.
 GAPP+Care requires an integrated approach towards patients and their family caregivers. We initiated a feasibility study of GAPP+Care (March 2022 - March 2023). In this study we are investigating: 1) the feasibility, appropriateness, barriers and facilitators of GAPP+Care, 2) the fidelity to GAPP+Care, and 3) the percentage (proportion) of eligible individuals and their willingness to participate in GAPP+Care.

Healthy Aging in Algoma: Tests of Change Program

Introduction: In Algoma District, Ontario, Canada, approximately 25% of the population is 65 years of age and older. The Ontario Provincial Geriatrics Leadership Office (2020) predicts that by 2040 this number will increase to 32% and that 29% of older adults will be living with frailty. In February of 2022, Tests of Change (ToC) Program work commenced to bring an integrated care approach to healthy aging in Algoma. Healthcare member organizations of the Algoma Ontario Health Team (AOHT) and community patient, family, and caregiver advisors identified older adults living with frailty as the target population. A driver diagram of change ideas was conceptualized to support improving care for the identified population. To enact the recommended changes, three priority projects - Outpatient Geriatric Rehabilitation Capacity, Coordinated Access to Geriatric Services and Early Frailty Identification - complement each other with the common purpose of improving early frailty intervention and increasing access to the most appropriate care.
 Aims: The ToC Program entails:
 Embedding a frailty screening tool into electronic medical records for use in primary care;
 Initiating coordinated access to geriatric services leveraging eReferral and a common platform for electronic referral management; and
 Designing an outpatient geriatric rehabilitation program.
 This Program aims to advance the following elements:
 Design upstream engagement strategies (e.g., screening, prevention, disease self-management) for the target population;
 Increase patient access to the appropriate level of care; and
 Transform care coordination, transitions and recovery at home.
 Highlights: The AOHT has engaged partners from across the continuum of care who provide services for frail older adults. Partners include: community support services, home and community care support services, primary care, acute care, specialized geriatric services, and patient advisors. These critical partners assume leadership roles in program design, implementation and evaluation.
 Conclusions: Early frailty identification can improve quality of life, increase intervention success, and delay the need for specialist care. This program is predicated on the establishment of foundational processes enabled by digital tools to identify frailty early, streamline referrals for access to the most appropriate geriatric services, and provide patients with the opportunity to fully participate in interventions such as outpatient geriatric rehabilitation to increase their ability to live independently in the community. By taking an integrated collaborative approach to program planning and execution, overall patient outcomes will be improved.
 Transferability: The WHO Guidelines on Integrated Care for Older People (ICOPE) recommend advancing integrated care through community collaboration, a patient centered approach and supportive leadership. In 2019, the Ontario Health Team (OHT) model was introduced provincially as a way for healthcare providers to partner to deliver coordinated, integrated care. Of significance, several of the 54 approved OHTs have identified older adults living with frailty as a target population. Globally, as older adults are living longer lives, it is anticipated that there will be proportionally more older adults living with frailty. Through collaboration and sharing of the ToC program results, program scalability can be achieved at the OHT level and support the global knowledge base on efforts to strengthen integrated care for older adults.

Exercise testing and training in frail older adults with an orthopedic impairment participating in a geriatric rehabilitation program: an international Delphi study

Key summary pointsAimTo obtain expert-consensus-based recommendations for exercise testing and prescription for orthopedic geriatric rehabilitation.FindingsFor endurance training existing guidelines of the American College of Sports Medicine can be strived for but adapted as needed and for muscle strength training only lower intensities are agreed upon.MessageIn orthopedic geriatric rehabilitation, endurance and muscle strength testing should be pragmatic and is preferably performed in functional activities.

#4687 CORRELATION OF FRAILTY SELF-ASSESSMENT WITH MEASURED FRAILTY USING THE FRIED CRITERIA IN PATIENTS ON DIALYSIS

Abstract Background and Aims Frailty describes a complex syndrome of reduced resistance to stress factors as a consequence of age-related degeneration in various organ systems and is associated with poor clinical outcomes [1]. The European Renal Best Practice Guideline on the management of older patients with CKD recommends a regular assessment of functional status with the intention to identify those who would benefit from a more in-depth geriatric assessment and rehabilitation program [2]. Different frailty screening tools have been evaluated in CKD patients whereas the optimal tool for routine clinical application is not defined. The aim of this study was to evaluate an instrument that can be easily implemented in clinical practice and that can simplify the identification of vulnerable patients on dialysis. Method This cross-sectional, multicenter, prospective study included 123 adult patients on hemodialysis. Frailty status was assessed based on modified Fried criteria: self-reported exhaustion, weakness, slow walking speed, low physical activity level and unintentional weight loss [1]. Patients were categorized as frail meeting 3 of the 5 criteria. Patients were also asked to self-assess their frailty status on a 5-point visual analogue scale (VAS). Patients were considered robust selecting “1”, pre-frail “2 and 3”, and frail “4 and 5”. For data-analysis pre-frail and robust patients both using self-assessment and Fried criteria were categorized as “non-frail”. Correlation between Fried-criteria and self-assessment was measured using a contingency table and rank correlation (spearman´s coefficient). Results The median age was 68 years, 71% were male and 40% were considered frail using the Fried criteria (Table 1). One patient was on intermittent peritoneal dialysis, all other patients received hemodialysis. There was no difference in frailty status assessed by Fried-criteria according to age, sex, body mass index (BMI) or dialysis vintage. Patients receiving dialysis using a central venous dialysis catheter were more likely to be frail than patients with an arterio-venous fistula or graft. Patients who assessed themselves as frail on the basis of the VAS were significantly more likely to be assigned to this group when measured according to the Fried-criteria. The same applies to the non-frail group (Table 2). The specificity of the VAS was 95%, the sensitivity 39%. This means agreement with the Fried-criteria for patients who considered themselves as non-frail was very high, whereas patients frequently misjudged themselves as frail although they were assigned to the non-frail group when measured according to Fried. Spearman's correlation showed a positive correlation coefficient (0.419) and a significant correlation (2-sided, p < 0.001) between patient self-assessment using the VAS and the Fried-criteria. Conclusion Frailty is very common among patients on dialysis and occurs independent of age. The self-assessment by VAS simplifies frailty-screening in patients on dialysis by identifying more robust patients who do not need a time-consuming further evaluation.

POSTSCRIPTUM: Protocol of Geriatric Rehabilitation in Patients Aged 60 Years and Older Living in Moscow Boarding houses or Nursing homes. Protocol of Multicentral Prospective Study

Background: GR with implementation of additional geriatric rehabilitation stage has been shown in a number of studies to be efficient in daily functional activities as well as in reducing hospital readmissions and mortality. However, better integration of geriatric care models into clinical practice requires further investigations.Aim: to assess the influence of geriatric rehabilitation on functional activity.Methods: рrotocol POSTSCRIPTUM suggests Multicentral Prospective Study on different protocols for Geriatric Rehabilitationл in Moscow boarding houses or nursing homes. The study consists of 21-days period of active treatment based on the results of complex geriatric assessment and 12-months follow-up period. The study enrolls patients aged 60 years and older, who have indications for geriatric rehabilitation.Conclusion: POSTSCRIPTUM — the 1st Russian study on efficacy of geriatric rehabilitation programs that based on complex geriatric assessment.

The quality of geriatric rehabilitation from the patients’ perspective: a scoping review

the efficacy and outcomes of geriatric rehabilitation (GR) have previously been investigated. However, a systematic synthesis of the aspects that are important to patients regarding the quality of GR does not exist. the aim of this scoping review was to systematically synthesise the patients' perspective on the quality of GR. we followed the Scoping Review framework and gathered literature including a qualitative study design from multiple databases. The inclusion criteria were: a qualitative study design; a geriatric population; that patients had participated in a geriatric rehabilitation programme and that geriatric rehabilitation was assessed by the patient. The results sections of the included studies were analysed using a thematic analysis approach. twenty articles were included in this review. The main themes identified were: (i) the need for information about the rehabilitation process, (ii) the need for telling one's story, (iii) the need for support (physical, psychological, social and how to cope with limitations), (iv) the need for shared decision-making and autonomy, (v) the need for a stimulating rehabilitation environment and (vi) the need for rehabilitation at home. in this study, we identified the aspects that determine the quality of rehabilitation from the patient's perspective, which may lead to a more holistic perspective on the quality of GR.

Impact of an early geriatric rehabilitation program in acutely hospitalised vulnerable patients: a real-life study in an ACE unit in Switzerland.

Early geriatric rehabilitation programs are potential means to prevent acute hospitalisation-associated functional decline. The objectives were to measure the impact of an interdisciplinary rehabilitation program on patients' administrative in hospital data and on functional trajectories. With a before-and-after design, we compared all patients admitted from January to August 2018 into the Acute Care for Elders (ACE) unit of an Academic hospital in Switzerland who received this type of program to those admitted during the same period in 2016 and 2017. We considered vulnerable patients aged 75 or older. Functional independency level was assessed at baseline, admission, and discharge according to Katz's basic activities daily living (BADL). In total, 378/1,073patients (mean age 86.6 ±6.4; 74.6% women; 84% admitted from the emergency department) were prospectively admitted into the ACE unit in 2018. With an adherence rate of 74.0% to functional therapies and compared to the prior years, the program reduced transfers to rehabilitation settings (28.5 vs. 24.3%, p=0.04) and increased direct discharges to home (46.8 vs. 42.4%, p=0.04). Rates of early-unplanned readmission were similar. Between admission to discharge, 89.9% of the patients engaged in the program remained functionally stable or enhanced. Whatever the BADL score at the admission, 46.5% improved their status for at least one BADL. Even though no clinical determinant was identified, patients who engaged ≥ 5 sessions of functional therapy per week were more likely to improve their functional level (OR = 3.05; 95% CI 1.76-5.27). This real-life study demonstrates arguments to implement early interdisciplinary rehabilitation program in ACE units in particular to prevent functional decline in vulnerable patients. These findings support consideration regarding the interest of switching from the traditional disease-centred approach in acute care for older patients to a modern one, that also put the emphasis on maintaining functional capacities.

Auditory Spatial Training-Induced Changes in the Release of Informational Masking in Older Adults

Background and Aim: Generally, in noisy environments more informational masking occurs. Older adults benefit less than younger adults from spatial hearing and they have more problems of understanding speech in the presence of distracting speeches. This study was conducted to examine the effect of auditory spatial training on informational masking release in the elderly.
 Methods: Thirty-two 60-75-year-olds with normal hearing, who complain about difficulty in speech perception in noise, participated in control and intervention groups (16 people in each group). The intervention included fifteen sessions of auditory spatial training. The informational masking measurement test scores were compared before the intervention, one session after the intervention, and one month after between the two groups.
 Results: There was a significant improvement in informational masking measurement scores in the intervention group compared to the control (p<0.02). The results showed no significant differences between the informational masking measurement scores before and after the intervention in the control group (p>0.05) and a significant difference in most signal to noise ratio i.e. 0, -5 and -10, in the intervention group (p≤0.006). No significant difference was found between the results of the two assessments one session and one month after the intervention in any of the positions (p>0.05), which suggests that both groups’ scores remained highly stable one month after the intervention
 Conclusion: This study introduced a spatial training program to improve speech perception in noise in normal-hearing elderly listeners. It was recommended that this kind of training be included in geriatric population auditory rehabilitation programs.
 Keywords: Informational masking; energetic masking; elderly; speech perception in noise

Is there a relationship between intensity of occupational therapy and functional outcomes in hospitalised older patients? A prospective cohort study.

Delivering high-intensity occupational therapy can improve functional outcomes for patients and reduce length of stay. However, there is little published evidence of this in the aged rehabilitation setting. This study aims to explore the association between intensity of occupational therapy interventions and functional outcomes in geriatric rehabilitation inpatients. A prospective cohort study was conducted with adult inpatients admitted to a geriatric rehabilitation program. The intervention was the intensity of occupational therapy measured as high (≥30 minutes per day) versus low (<30 minutes per day). The primary outcome measured was change in functional performance, defined as a minimum of half a point improvement in the Katz Index of Activities of Daily Living (ADL) and/or the Lawton and Brody Scale of Instrumental ADL (IADL) at admission to rehabilitation, discharge and 3months post-discharge. A total of 693 patients were included in the analysis. The mean age was 82.2years (standard deviation [SD] = 7.9), 57% were females, and 64% had cognitive impairment. Patients (n = 210) who received greater than or equal to 30 minutes of occupational therapy daily were more likely to have clinically relevant functional improvements.; for both ADL (odds ratio [OR] = 1.87, 95% confidence interval [CI]: 1.24-2.83) and IADL (OR = 3.00, 95% CI: 1.96-4.61), after adjusting for age, sex, severity of function (ADL ≤ 2) at admission, frailty and cognitive impairment. Improvements in ADL and IADL were maintained for at least 3months following discharge. This study found that geriatric rehabilitation inpatients who received higher intensity of occupational therapy interventions were more likely to functionally improve than those who received lower intensity. Further research is required to determine if other factors, such as therapy type, influence functional outcomes.

Effectiveness of an integrated multidisciplinary geriatric rehabilitation programme for older persons with stroke: a multicentre randomised controlled trial

BackgroundAlmost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate ambulatory aftercare in the community. Therefore, we developed an integrated multidisciplinary rehabilitation programme that includes aftercare for older persons with stroke. We evaluated the effectiveness of this newly developed rehabilitation programme in comparison to usual care.MethodsA multicentre randomised controlled trial was conducted in eight geriatric rehabilitation stroke units and their collaborating partners in primary care. The study population involved stroke patients and their informal caregivers who were aged 65 or over, living in the community before admission to geriatric rehabilitation, and expected to be able to return home after discharge. The programme consisted of three modules: inpatient neurorehabilitation, home-based self-management training, and stroke education. For patients, daily activity (FAI) was assessed as primary outcome and functional dependence (Katz-15), perceived quality of life (SSQoL) and social participation (IPA) as secondary outcomes. Additionally, among informal caregivers perceived care burden (self-rated burden VAS), objective care burden (Erasmus iBMG), and quality of life (CarerQol), were assessed as secondary outcomes.ResultsIn total 190 patients and 172 informal caregivers were included. Mean age of the patients in the intervention group was 78.9 years (SD = 7.0) and in the usual care group 79.0 years (SD = 6.5). Significant favourable effects for the programme were observed for the subscale autonomy outdoors of the IPA (− 2.15, P = .047, and for the informal caregivers perceived care burden (1.23, P = .048. For the primary outcome daily activity and the other secondary outcomes, no significant effects were observed.ConclusionThe integrated multidisciplinary programme had no effect on daily activity of older stroke patients. However, patients participating in the programme had a higher level of perceived autonomy of outdoor activities and their informal caregivers perceived a lower care burden. The programme might be promising in providing adequate (after) care, although adaptation of the programme is recommended to increase its feasibility and improve its effects.Trial registrationCurrent Controlled Trials ISRCTN62286281. Registered 19-3-2010.

MyPath to Home Web-Based Application for the Geriatric Rehabilitation Program at Bruyère Continuing Care: User-Centered Design and Feasibility Testing Study.

BackgroundWhen older adults return home from geriatric rehabilitation in a hospital, remembering the plethora of medical advice and medical instructions provided can be overwhelming for them and for their caregivers.ObjectiveThe overall objective was to develop and test the feasibility of a novel web-based application called MyPath to Home that can be used to manage the personalized needs of geriatric rehabilitation patients during their transition from the hospital to home.MethodsThis study involved (1) co-designing a patient- and clinician-tailored web-based application and (2) testing the feasibility of the application to manage the needs of geriatric rehabilitation patients when leaving the hospital. In phase 1, we followed a user-centered design process integrated with the modern agile software development methodology to iteratively co-design the application. The approach consisted of three cycles in which we engaged patients, caregivers, and clinicians to design a series of prototypes (cycles 1-3). In phase 2, we conducted a single-arm feasibility pilot test of MyPath to Home. Baseline and follow-up surveys, as well as select semistructured interviews were conducted.ResultsIn phase 1, semistructured interviews and talk-aloud sessions were conducted with patients/caregivers (n=5) and clinicians (n=17) to design the application. In phase 2, patients (n=30), caregivers (n=18), and clinicians (n=20) received access to use the application. Patients and their caregivers were asked to complete baseline and follow-up surveys. A total of 91% (21/23) of patients would recommend this application to other patients. In addition, clinicians (n=6) and patients/caregivers (n=6) were interviewed to obtain further details on the value of the web-based application with respect to engaging patients and facilitating communication and sharing of information with the health care team.ConclusionsWe were successful at designing the MyPath to Home prototype for patients and their caregivers to engage with their clinicians during the transition from geriatric rehabilitation to home. Further work is needed to increase the uptake and usage by clinicians, and determine if this translates to meaningful changes in clinical and functional outcomes.International Registered Report Identifier (IRRID)RR2-10.2196/11031

Information needs of older patients living with chronic obstructive pulmonary disease (COPD) indicated for a specific geriatric rehabilitation programme: a prospective cohort study.

Post-acute rehabiitation is recommended in the treatment of chronic obstructive pulmonary disease (COPD). It enhances the sense of control by education, which should focus on patient information needs. However, it is unknown whether a geriatric rehabilitation programme for older patients with advanced COPD and severely impaired health status (the GR-COPD programme) does fit these patient information needs. The study aimed to identify the information needs of patients who were eligible for the GR-COPD programme, and investigated if health-related knowledge improved during rehabilitation. All patients indicated for the GR-COPD programme were eligible for this study. The information needs were measured with the Lung Information Needs Questionnaire (LINQ). The 158 patients (mean age 70.8 years; FEV1 %predicted: 35.5) showed relatively high baseline information needs (mean LINQ overall score: 8.6 [SD 3.1]), with the greatest need in the domains 'diet' and 'self-management'. After follow-up, the mean LINQ overall score significantly improved in patients who completed the GR-COPD programme (p=0.001). Patients' knowledge showed a statistically significant improvement in some areas during the GR-COPD programme.

Hemodynamic Effects of a Multidisciplinary Geriatric Rehabilitation Program.

BackgroundGeriatric rehabilitation programs primarily aim at an increase of mobility and functional autonomy of the elderly. The cardiovascular effects of these programs, however, remain elusive. Since regular physical exercise is associated with numerous beneficial cardiovascular effects including a reduction of blood pressure (BP), the present prospective study investigates the hemodynamic effects of a representative standardized rehabilitation program.MethodsA total of 74 subjects who were hospitalized in a German university hospital for geriatric rehabilitation were enrolled in the study. Peripheral BP, central aortic BP, 24h-ambulatory BP, heart rate and pulse wave velocity as a measure of arterial stiffness were assessed at admission and before discharge from the hospital. The program contained 4–5 sessions of physical activity of individualized intensity per week (≥30 min/session, eg, walking, cycling, stair rising).ResultsThe mean age of the study population was 82.4±6.9 years; all patients suffered from arterial hypertension (stage 2–3) with a median number of three antihypertensive drugs. The most frequent cause for admission was injurious falls. The mean duration of the rehabilitation program was 17 days and comprised at least 20 physical activity sessions including occupational therapy. The program led to a significant improvement of mobility (Timed Up & Go 29.5±18.5 vs 19.1 ±9.3 s, p<0.001) and Barthel index of activities of daily living score (46.6±19.1 vs 69.8±16.5, p<0.001). Peripheral systolic BP decreased from 135.4±19.0 mmHg at baseline to 129.0±18.4 mmHg at follow-up (p=0.03), whereas peripheral diastolic BP, central aortic BP, 24h-ambulatory BP, heart rate and pulse wave velocity as a measure of arterial stiffness were not significantly altered (p>0.05 each).ConclusionThe present representative standardized geriatric rehabilitation program was able to improve mobility, which showed a mild effect on systolic BP but did not affect 24h-ambulatory BP.

Feasibility of an integrated multidisciplinary geriatric rehabilitation programme for older stroke patients: a process evaluation

BackgroundAlmost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate aftercare aimed at reducing the impact of persisting problems after discharge from a geriatric rehabilitation unit. Therefore, we developed an integrated multidisciplinary rehabilitation programme consisting of inpatient neurorehabilitation treatment using goal attainment scaling, home based self-management training, and group based stroke education for patients and informal caregivers. We performed a process evaluation to assess to what extent this programme was performed according to protocol. Furthermore, we assessed the participation of the patients in the programme, and the opinion of patients, informal caregivers and care professionals on the programme.MethodsIn this multimethod study, process data were collected by means of interviews, questionnaires, and registration forms among 97 older stroke patients, 89 informal caregivers, and 103 care professionals involved in the programme.ResultsA part of patients and informal caregivers did not receive all key elements of the programme. Almost all patients formulated rehabilitation goals, but among two thirds of the patients the goal attainment scaling method was used. Furthermore, the self-management training was considered rather complex and difficult to apply for frail elderly persons with stroke, and the percentage of therapy sessions performed in the patients’ home environment was lower than planned. In addition, about a quarter of the patients and informal caregivers attended the education sessions. However, a majority of patients, informal caregivers and care professionals indicated the beneficial aspects of the programme.ConclusionThis study revealed that although the programme in general is perceived to be beneficial by patients, and informal and formal caregivers, the feasibility of the programme needs further attention. Because of persisting cognitive deficits and specific care needs in our frail and multimorbid target population, some widely used methods such as goal attainment scaling, and self-management training seemed not feasible in their current form. To optimize feasibility of the programme, it is recommended to tailor these elements more optimally to the population of frail older patients.

Evaluation of an ambulatory geriatric rehabilitation program - results of a matched cohort study based on claims data

BackgroundAmbulatory geriatric rehabilitation (AGR) is a multidisciplinary outpatient prevention program designed to decrease hospitalisation and dependence on nursing care in multimorbid patients ≥70 years of age. We evaluated the effectiveness of AGR compared to usual care on progression of nursing care levels, nursing home admissions, hospital admissions, incident fractures, mortality rate and total cost of care during a one-year follow-up period.MethodsAnalyses were based on claims data from the health insurance company AOK Nordost. Propensity Score matching was used to match 4 controls to each person receiving the AGR intervention.ResultsA total of 632 AGR participants and 2528 matched controls were included. The standardized mean difference of matching variables between cases and controls was small (mean: + 1.4%; range: − 4.4/3.9%). In AGR patients, the progression of nursing care levels (+ 2.2%, 95%CI: − 0.9 /5.3), nursing home admissions (+ 1.7%, 95%CI: − 0.1/3.5), hospital admissions (+ 1.1%, 95%CI: − 3.2/5.4), incident fractures (+ 11.1%, 95%CI: 7.3/15) and mortality rate (+ 1.2%, p = 0.20) showed a less favourable course compared to controls. The average total cost per AGR participant was lower than in the control group (− 353€, 95%CI: − 989€/282€), not including costs for AGR.ConclusionsAnalysis based on claims data showed no clinical benefit from AGR intervention regarding the investigated outcomes. The slightly worse outcomes may reflect limitations in matching based on claims data, which may have insufficiently reflected morbidity and psychosocial factors. It is possible that the intervention group had poorer health status at baseline compared to the control group.Trial registrationGerman Clinical Trials Register DRKS00008926, registered 29.07.2015.

Reference values and associated factors of hand grip strength in elderly Saudi population: a cross-sectional study

BackgroundHand grip strength (HGS) is an important function of upper extremities for older adults. Several studies have shown the importance of measuring HGS in different settings. Current established normative values of HGS are applicable for Western countries. However, there is limited information of normative values of HGS after considering demographics in Saudi population. Therefore, this study aimed to establish normative values of HGS stratified by age and gender, and to determine the association of anthropometric measurements with the HGS in Saudi population.MethodsA cross-sectional study included a total of 1048 participants (mean age 73 ± 5 years). Grip strength was calculated by the average peak force of three trials for the dominant hand using a dynamometer. Sociodemographic data on age, gender, marital status, educational levels were collected. Anthropometric measurements including height, body mass index, arm circumference, and upper arm length were obtained. The sample was categorized into three age groups: 65–69 years, 70–74 years, and 75–80 years. Linear regression analysis was used to assess the association between the sociodemographic and anthropometric data and HGS.ResultsThe mean values of HGS (kg) for men for each age group were 36.9 ± 8.3 for the younger group, 35.7 ± 7.4 for the 70–74 years group and 30.5 ± 7.1 for the older group. The mean values of HGS for women for each group were 23.2 ± 4.7 for the younger group, 21.1 ± 4.6 for the 70–74 years group and 18.8 ± 4.9 for the older group. The HGS was negatively associated with the age for men (B = -.40, 95% confidence interval (CI) [−.52, −.29], p < 0.001) and women (B = -.30, 95% CI [− 0.38, − 0.22], p < 0.001), and positively associated with the arm length in men (B = .87, 95% CI [.60, 1.15], p < 0.001). The HGS was positively associated with the educational level in men (B = .66, 95% CI [.09,1.21], p = .02), but negatively associated in women (B = -.42, 95% CI [− 0.75, − 0.08], p = .01).ConclusionThis study is the first that established normative values of HGS for older adults in Saudi Arabia. Future research may benefit from the current normative value of HGS in Saudi population for geriatric rehabilitation programs.

Executive functions and working memory in motor control: Does the type of MCI matter?

The purpose of this study was to evaluate the association between functional mobility performance and executive functions in older adults with the amnestic (aMCI) and nonamnestic (naMCI) type of mild cognitive impairment (MCI), as well as in a control group. A cross-sectional study was conducted among 800 older adults (147 with MCI) who participated in a longitudinal study consisting in an interdisciplinary geriatric assessment and rehabilitation program in Kraków. Motor performance was measured with the Timed Up and Go test (TUG), while standard neuropsychological tests were used to assess different cognitive domains. Analysis of the entire sample showed that almost all cognitive domains and the presence of MCI are associated with functional mobility. Executive functions, letter fluency, and working memory were associated with TUG in the MCI group. The MCI type was not a significant moderator of the relationship between cognitive and motor performance. In group analyses, various cognitive predictors for TUG in the aMCI group, naMCI, and control group were demonstrated. Our results suggest that executive functions and working memory in aMCI and letter fluency in naMCI are independently associated with functional mobility performance. Executive functions are important for gait control in MCI.