Geriatric Rehabilitation Patients Research Articles

Trajectories of functional performance recovery after inpatient geriatric rehabilitation: an observational study.

ObjectiveTo identify functional performance trajectories and the characteristics of people who receive inpatient geriatric rehabilitation after hospital admissions.Design, setting, participantsREStORing health of acutely unwell adulTs (RESORT) is an observational, prospective, longitudinal inception cohort study of consecutive patients admitted to geriatric rehabilitation wards at the Royal Melbourne Hospital. Recruitment commenced on 15 October 2017.Main outcome measuresFunctional performance, assessed with the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales two weeks before acute hospitalisation, on admission to and discharge from geriatric rehabilitation, and three months after discharge from geriatric rehabilitation.ResultsA total of 618 rehabilitation patients were included in our analysis. For each of the two scales, three distinct functional performance trajectories were identified by latent class growth modelling: poor at baseline and 3‐month follow‐up (remained poor: ADL, 6.6% of patients; IADL, 42%), good at baseline but poor recovery (deteriorated: ADL, 33%; IADL, 20%), and good at baseline and good recovery (recovered: ADL, 60%; IADL, 35%). Higher Clinical Frailty Scale (CFS) score (v recovered, per point: odds ratio [OR], 2.51; 95% CI, 1.64–3.84) and cognitive impairment (OR, 6.33; 95% CI, 2.09–19.1) were associated with greater likelihood of remaining poor in ADL, and also with deterioration (CFS score: OR, 1.76; 95% CI, 1.45–2.13; cognitive impairment: OR, 1.87; 95% CI, 1.24–2.82). Higher CFS score (OR, 1.64; 95% CI, 1.37–1.97) and cognitive impairment (OR, 3.60; 95% CI, 2.31–5.61) were associated with remaining poor in IADL, and higher CFS score was also associated with deterioration (OR, 1.63; 95% CI, 1.33–1.99).ConclusionsBased on ADL assessments, most people who underwent inpatient geriatric rehabilitation regained their baseline functional performance. As higher CFS score and cognitive impairment were associated with poorer functional recovery, assessing frailty and cognition at hospital admission could assist intervention and discharge planning.

SARC-F Is Inaccurate to Identify Geriatric Rehabilitation Inpatients at Risk for Sarcopenia: RESORT

Introduction: Sarcopenia is highly prevalent in geriatric rehabilitation inpatients; screening using the Strength, Assistance in walking, Rise from a chair, Climb stairs, Falls history questionnaire (SARC-F) has been recommended. This study assessed the diagnostic accuracy of the SARC-F in identifying sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP), EWGSOP2, and Asian Working Group for Sarcopenia (AWGS) definitions in geriatric rehabilitation inpatients. Methods: REStOring health of acutely unwell adulTs (RESORT) is an observational, longitudinal cohort of geriatric rehabilitation inpatients. The SARC-F was completed for 2 time-points, status at preadmission (1 month before admission) and at admission; a score ≥4 was considered at risk for sarcopenia. Muscle mass (bioelectrical impedance analysis), handgrip strength (handheld dynamometry), and gait speed (4-m walk test) were measured at admission. Diagnostic accuracy was determined by sensitivity, specificity, and area under the curve (AUC). Results: The sarcopenia prevalence (n = 290, median age 84.0 years [IQR 79.0–89.0], 56.9% female) was 40.3% (EWGSOP1), 25.4% (EWGSOP2), and 38.8% (AWGS). For preadmission and admission status, respectively, the SARC-F identified 67.9 and 82.1% (EWGSOP), 66.0 and 81.0% (EWGSOP2), and 67.5 and 81.6% (AWGS) inpatients at risk for sarcopenia. The SARC-F showed fair sensitivity (67–74%), poor specificity (32–37%), and poor AUC (0.411–0.474) to identify inpatients at risk for sarcopenia at preadmission status, and fair-good sensitivity (79–84%), poor specificity (17–20%), and poor AUC (0.401–0.432) to identify inpatients at risk for sarcopenia at admission, according to EWGSOP, EWGSOP2, and AWGS definitions. Conclusion: The SARC-F showed poor diagnostic accuracy in identifying sarcopenia in geriatric rehabilitation inpatients. Assessment of sarcopenia is recommended without screening.

Geriatric Rehabilitation Inpatients Roam at Home! A Matched Cohort Study of Objectively Measured Physical Activity and Sedentary Behavior in Home-Based and Hospital-Based Settings

ObjectivesThis study aimed to describe objectively measured physical activity and sedentary behavior in geriatric rehabilitation patients receiving care in the home-based compared to the hospital-based setting. DesignObservational matched cohort study. Setting and ParticipantsHome-based (patient's home) or hospital-based (ward) geriatric rehabilitation was delivered to inpatients within the REStORing health of acutely unwell adulTs (RESORT) observational, longitudinal cohort of the Royal Melbourne Hospital (Melbourne, Victoria, Australia). MethodsPatients were asked to wear ActivPAL4 accelerometers for 1 week and were assessed by a comprehensive geriatric assessment at admission, discharge, and followed up after 3 months. Hospital-based patients were matched to home-based patients for sex and baseline physical function [Short Physical Performance Battery (SPPB), activities (instrumental) of daily living, and Clinical Frailty Scale]. Differences in patient characteristics and physical activity (total, standing and walking durations, number of steps and sit-to stand transitions) and sedentary behavior (total, sitting and lying durations) were assessed. ResultsA total of 159 patients were included: 18 home-based [mean age: 81.9 ± 8.6 years, 38.9% female, median (interquartile range [IQR]) SPPB: 7.0 (5.0-9.0)] and 141 hospital-based [mean age: 82.9 ± 7.8 years, 57.4% female, median (IQR) SPPB: 1.0 (0.0-4.0)] patients, of whom 18 were matched [mean age: 80.1 ± 7.4 years, 38.9% female, median (IQR) SPPB: 6.5 (4.8-10.0)]. Median physical activity measures were consistently higher in home-based patients compared to the total group of hospital-based patients. After matching, physical activity measures remained >2.4 times higher and were significantly different for all measures (total physical activity, standing and walking durations, and steps) except for sit-to-stand transitions. Sedentary behaviors were similar with home-based patients spending non-significantly more time sitting but significantly less time lying than hospital-based patients (matched and total). Conclusions and ImplicationsHome-based inpatients are more physically active than hospital-based inpatients independent of matching for sex and baseline physical function, which supports home-based geriatric rehabilitation.

Malnutrition is associated with poor trajectories of activities of daily living in geriatric rehabilitation inpatients: RESORT

Malnutrition is associated with poor functional performance in geriatric rehabilitation inpatients. However, it is unclear if malnourished patients have poor functional trajectories over time. This study aimed to determine the association between (the risk of) malnutrition at admission and trajectories of Activities of Daily Living (ADL) and Instrumental ADL (IADL) from pre-admission to post-discharge in geriatric rehabilitation inpatients. An observational, longitudinal study was conducted in the REStORing health of acutely unwell adulTs (RESORT) cohort of geriatric rehabilitation inpatients. A total of 618 patients (mean age 82.1 ± 7.8 years, 57.4 % females) were included. The prevalence of the risk of malnutrition, by Malnutrition Screening Tool (MST) was 41.3 % (n = 255) and malnutrition by the Global Leadership Initiative on Malnutrition (GLIM) and European Society for Clinical Nutrition and Metabolism (ESPEN) criteria were 53.5 % (n = 331) and 13.1 % (n = 81) respectively. Malnutrition by the GLIM criteria but not the ESPEN criteria nor the risk of malnutrition, was associated with ADL trajectories of ‘remained poor’ (OR: 3.33, 95 %CI: 1.21−9.19) and ‘deteriorated’ (OR: 1.68, 95 %CI: 1.13−2.52) compared to the ‘recovered’ trajectory. The risk of malnutrition and malnutrition were not associated with IADL trajectories. Malnutrition at admission was associated with poor ADL trajectories but not IADL trajectories in geriatric rehabilitation inpatients.

Depressive Symptoms and Associated Factors in Older Rehabilitation Inpatients: A Cross-Sectional Study

Aims To determine prevalence of depressive symptoms and their associated factors in geriatric inpatient rehabilitation. Methods A cross-sectional study was conducted with 118 older adult inpatients ≥ 65 years using the Geriatric Depression Scale to assess depressive symptoms. Results Average age of participants was 78.9 years old. Depressive symptoms were found in 46.6% of study participants. Multinomial logistic regression analysis was conducted to confirm the association between presence of depressive symptoms and each factor. Malnutrition was significantly associated with depressive symptoms (OR = 0.90, 95% CI: 0.87–0.96, p < 0.001). Similar results were obtained in model 1 (OR = 0.91, 95% CI: 0.87–0.95, p < 0.001) with the addition of age and gender confounders and in model 2 with additional adjustment for underlying disease, Functional Independence Measure (FIM) exercise items, and FIM cognitive items (OR = 0.92, 95% CI: 0.88–0.96, p < 0.001). Conclusions Prevalence of depressive symptoms is high in geriatric rehabilitation patients and is associated with malnutrition.

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).

A Patient-Reported Outcomes Measurement Information System Short Form for Measuring Physical Function During Geriatric Rehabilitation: Test-Retest Reliability, Construct Validity, Responsiveness, and Interpretability

ObjectivesTo study the test-retest reliability and measurement error, construct validity, responsiveness, interpretability, and floor/ceiling effects of a Patient-Reported Outcomes Measurement Information System (PROMIS) short form designed to measure physical function in geriatric rehabilitation patients (PROMIS-PF-GR). DesignProspective cohort. Setting and ParticipantsInpatient geriatric rehabilitation patients. MethodsWe evaluated the test-retest reliability by re-administering PROMIS-PF-GR 3 to 5 days after the admission measurement. The intraclass correlation coefficient (ICC) was calculated to determine test-retest reliability; an ICC of ≥0.70 was considered sufficient. Measurement error was established by calculating the standard error of measurement and smallest detectable change. Construct validity and responsiveness were determined by testing a priori formulated hypotheses (criterion: ≥75% hypothesis not rejected). Interpretability was evaluated by calculating the minimal important change using predictive modeling and a global rating as criterion for change. Floor/ceiling effects were established by calculating the percentage patients with the minimum/maximum raw score (criterion: ≤15%) at admission and discharge. ResultsA total of 207 patients participated in the study [mean ± standard deviation age (80 ± 8.3 years), 58% female]. More than one-half of patients (56%) reported to be improved during rehabilitation. The ICC was 0.79 (95% confidence interval 0.70–0.84), the standardized error of measurement was 3.8, and the smallest detectable change 10.6. None of the 4 hypotheses for construct validity were rejected; 2 out of 5 hypotheses for responsiveness were rejected. The minimal important change was 8.0 (95% confidence interval 4.1–12.5). No floor/ceiling effects were found. Conclusions and ImplicationsThe PROMIS-PG-GR showed sufficient test-retest reliability, measurement error, and construct validity. We did not find sufficient evidence for responsiveness, which may be due to the unexplained weak correlation between the PROMIS change score and the Global Rating Scale. We still recommend the use the PROMIS-PG-GR for measuring self-reported physical function in geriatric rehabilitation.

Coping strategies of older adults with a recent hip fracture within inpatient geriatric rehabilitation

Objectives Coping strategies may play an important role as facilitator or barrier for functional recovery after hip fracture. This study explored 1] active and passive coping strategies in hip fracture patients within inpatient geriatric rehabilitation (GR) 2] the association of these coping strategies with depression, anxiety, pain and health-related quality of life (HRQoL) Method Secondary data analysis (FIT-HIP trial). Participants were patients with hip fracture, aged 65+ years, admitted to post-acute GR units. Coping was assessed using the ‘Active Tackling’ and ‘Passive Reacting’ subscale of Utrecht Coping List (UCL). Depression, anxiety, pain and HRQoL was assessed using GDS-8, HADS-A, NPRS and EQ5D-VAS. Based on UCL norm tables - for both subscales - we dichotomized the group into (extremely) high use of this coping strategy i.e. ‘predominantly active coping’ (PAC), and ‘predominantly passive coping’ (PPC); versus their corresponding ‘residual groups’, i.e. the remaining participants. Results 72 participants were included. Participants mostly used active coping (PAC: 33.3%), however those engaging in passive coping (23.6%) had significantly more depression and anxiety symptoms (GDS-8 ≥ 3: 31.1% respectively 9.1%, p = 0.040; HADS-A ≥ 7: 58.8% vs 10.9%; p = 0.00). Conclusion Active tackling and passive reacting coping strategies are used by up to one-third of patients with recent hip fracture. Passive coping was associated with more symptoms of depression and anxiety, which in turn may influence rehabilitation negatively. Screening of (passive) coping strategies could contribute to prompt identification of hip fracture patients at risk for negative health outcomes.

Risk Factors of Readmissions in Geriatric Rehabilitation Patients: RESORT

ObjectiveTo evaluate the risk factors associated with 30- and 90-day hospital readmissions in geriatric rehabilitation inpatients. DesignObservational, prospective longitudinal inception cohort. SettingTertiary hospital in Victoria, Australia. ParticipantsGeriatric rehabilitation inpatients of the REStORing Health of Acutely Unwell AdulTs (RESORT) cohort evalutated by a comprehensive geriatric assessment including potential readmission risk factors (ie, demographic, social support, lifestyle, functional performance, quality of life, morbidity, length of stay in an acute ward). Of 693 inpatients, 11 died during geriatric rehabilitation. The mean age of the remaining 682 inpatients was 82.2±7.8 years, and 56.7% were women. InterventionsNot applicable. Main Outcome MeasuresThirty- and 90-day readmissions after discharge from geriatric inpatient rehabilitation. ResultsThe 30- and 90-day unplanned all-cause readmission rates were 11.6% and 25.2%, respectively. Risk factors for 30- and 90-day readmissions were as follows: did not receive tertiary education, lower quality of life, higher Charlson Comorbidity Index and Cumulative Illness Rating Scale (CIRS) scores, and a higher number of medications used in the univariable models. Formal care was associated with increased risk for 90-day readmissions. In multivariable models, CIRS score was a significant risk factor for 30-day readmissions, whereas high fear of falling and CIRS score were significant risk factors for 90-day readmissions. ConclusionsHigh fear of falling and CIRS score were independent risk factors for readmission in geriatric rehabilitation inpatients. These variables should be included in hospital readmission risk prediction model developments for geriatric rehabilitation inpatients.

Association between malnutrition and stages of sarcopenia in geriatric rehabilitation inpatients: RESORT

Malnutrition and sarcopenia coexist in older adults, yet they remain largely undiagnosed and untreated, despite available interventions. This study aimed to assess the prevalence, the coexistence of, and the association between malnutrition and sarcopenia in geriatric rehabilitation inpatients. REStORing health of acutely unwell adulTs (RESORT) is an observational, longitudinal cohort of geriatric rehabilitation inpatients. The association between malnutrition, diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and sarcopenia according to the revised definition of the European Working Group on Sarcopenia in Older People (EWGSOP2) (no sarcopenia, probable sarcopenia, confirmed sarcopenia and severe sarcopenia) was determined using multinomial logistic regression analyses, adjusted for age, sex, comorbidities and cognitive impairment. Out of 506 geriatric rehabilitation inpatients, 51% were malnourished, 49% had probable sarcopenia, 0.4% had confirmed sarcopenia (non-severe) and 19% had severe sarcopenia. Malnutrition and probable sarcopenia and malnutrition and confirmed/severe sarcopenia coexisted in 23% and 13% of the 506 patients respectively. Malnutrition was not associated with probable sarcopenia (OR=0.91, 95% CI=0.58-1.42, p=0.674) but with severe sarcopenia (OR=2.07, 95% CI=1.13-3.81, p=0.019). The prevalence, coexistence of, and the association between malnutrition and severe sarcopenia in geriatric rehabilitation inpatients warrant diagnosis at admission. Further research into feasible and effective interventions to counteract both conditions to improve geriatric rehabilitation outcomes is needed.

The association of comorbidity measures and mortality in geriatric rehabilitation inpatients by cancer status: RESORT

BackgroundMultimorbidity is highly prevalent in older adults, both those with and without cancer, and is associated with an increased risk of mortality. The aim of this study was to investigate if multimorbidity measures in geriatric rehabilitation inpatients differ in their association with mortality, dependent on a diagnosis of cancer.MethodsREStORing health of acutely unwell adulTs (RESORT) is an ongoing longitudinal inception cohort of geriatric rehabilitation inpatients. Comorbidity was measured at admission using the Charlson Comorbidity Index (CCI), age-adjusted CCI (CCI-A), Cumulative Illness Rating Scale–Geriatrics (CIRS-G) and the CIRS-G severity index. Patients were allocated to a cancer status group (no cancer, history of cancer, or active cancer). The association of comorbidity indices with mortality was analyzed using Cox regression analyses.ResultsOf the 693 patients (mean age 82.2 ± 7.5 years), 523 (75.4%) had no history of cancer, 96 (13.9%) past cancer, and 74 (10.7%) active cancer. Three months post-discharge, patients with active cancer had a higher mortality risk compared to patients with no cancer (HR = 3.57, 95% CI 2.03–6.23). CCI and CCI-A scores were significantly associated with higher mortality risk in all cancer status groups.ConclusionIn geriatric rehabilitation patients, incremental CCI and CCI-A scores were associated with higher mortality in all three cancer status groups. However, patients with active cancer had a significantly higher 3-month mortality compared to those with no or past cancer, and this is likely determined by the advanced nature of the malignancies in this group.

Critically appraised paper: Tailored prescription of digitally enabled rehabilitation may improve mobility, but not physical activity, in geriatric and neurological rehabilitation [commentary

Question: Does tailored prescription of digitally enabled rehabilitation using affordable devices improve mobility and physical activity in people with mobility limitations admitted to aged care or neurological rehabilitation? Design: Pragmatic, parallel-group, randomised controlled trial with concealed allocation and blinded outcome assessment. Setting: Three inpatient rehabilitation (aged care, neurological rehabilitation) hospitals in Australia. Participants: Adults with reduced mobility (defined using Short Physical Performance Battery score 12 months, anticipated length of stay at least 10 days from randomisation, and able to maintain standing position (assistance of one person permitted). Key exclusion criteria were cognitive or visual impairment likely to interfere with device use, inability to communicate in English, medical conditions prohibiting exercise and anticipated discharge to nursing home. Randomisation of 300 participants allocated 149 to usual care plus digitally enabled rehabilitation and 151 to usual care only. Interventions: Both groups received usual multidisciplinary rehabilitation care. In addition, the intervention group was prescribed 30 to 60 minutes of digitally enabled rehabilitation (virtual reality video games, activity monitors, tablet and smartphone exercise applications) 5 days a week in hospital and after discharge (using loaned devices) for 6 months. The digitally enabled rehabilitation was individually tailored and progressed by a physiotherapist. Outcome measures: Co-primary outcomes were mobility (performance-based Short Physical Performance Battery) and upright time as a proxy for physical activity (proportion of day upright measured by activPAL, averaged over 7 days) 6 months after randomisation. Secondary outcomes included performance- based and patient-reported measures of mobility and physical activity. Results: A total of 258 participants (129 control,129 intervention) completed the 6-month assessments. At the 6-month follow-up, the change in mobility score on the Short Physical Performance Battery was greater for the intervention group than the control group (MD0.2 points, 95% CI 0.1 to 0.3), but there was no evidence of a between-group difference in upright time (MD -0.2, 95% CI -2.7 to 2.3). Between-group differences favoured the intervention group across most secondary mobility outcomes, but there was no evidence of between-group differences for most other secondary outcomes including steps taken per day. Conclusion: Digitally enabled rehabilitation to promote mobility and physical activity in mobility-limited adults receiving geriatric or neurological inpatient rehabilitation can improve mobility, but does not appear to increase time spent upright.

Specific Motor and Cognitive Performances Predict Falls during Ward-Based Geriatric Rehabilitation in Patients with Dementia.

The aim of this study was to identify in-hospital fall risk factors specific for multimorbid hospitalized geriatric patients with dementia (PwD) during hospitalization. Geriatric inpatients during ward-based rehabilitation (n = 102; 79.4% females; 82.82 (6.19) years of age; 20.26 (5.53) days of stay) were included in a comprehensive fall risk assessment combining established clinical measures, comprehensive cognitive testing including detailed cognitive sub-performances, and various instrumented motor capacity measures as well as prospective fall registration. A combination of unpaired t-tests, Mann–Whitney-U tests, and Chi-square tests between patients with (“in-hospital fallers”) and without an in-hospital fall (“in-hospital non-fallers”), univariate and multivariate regression analysis were used to explore the best set of independent correlates and to evaluate their predictive power. In-hospital fallers (n = 19; 18.63%) showed significantly lower verbal fluency and higher postural sway (p < 0.01 to 0.05). While established clinical measures failed in discriminative as well as predictive validity, specific cognitive sub-performances (verbal fluency, constructional praxis, p = 0.01 to 0.05) as well as specific instrumented balance parameters (sway area, sway path, and medio-lateral displacement, p < 0.01 to 0.03) significantly discriminated between fallers and non-fallers. Medio-lateral displacement and visuospatial ability were identified in multivariate regression as predictors of in-hospital falls and an index combining both variables yielded an accuracy of 85.1% for fall prediction. Results suggest that specific cognitive sub-performances and instrumented balance parameters show good discriminative validity and were specifically sensitive to predict falls during hospitalization in a multimorbid patient group with dementia and an overall high risk of falling. A sensitive clinical fall risk assessment strategy developed for this specific target group should include an index of selected balance parameters and specific variables of cognitive sub-performances.

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

Hip Fracture Patients in Geriatric Rehabilitation Show Poor Nutritional Status, Dietary Intake and Muscle Health.

The aim of this study was to gain insight into the nutritional status, dietary intake and muscle health of older Dutch hip fracture patients to prevent recurrent fractures and to underpin rehabilitation programs. This cross-sectional study enrolled 40 hip fracture patients (mean ± SD age 82 ± 8.0 years) from geriatric rehabilitation wards of two nursing homes in the Netherlands. Assessments included nutritional status (Mini Nutritional Assessment), dietary intake on three non-consecutive days which were compared with Dietary Reference Intake values, and handgrip strength. Muscle mass was measured using Bioelectrical Impedance Analysis and ultrasound scans of the rectus femoris. Malnutrition or risk of malnutrition was present in 73% of participants. Mean energy, protein, fibre and polyunsaturated fat intakes were significantly below the recommendations, while saturated fat was significantly above the UL. Protein intake was <0.8 in 46% and <1.2 g/(kg·day) in 92%. Regarding micronutrients, mean intakes of calcium, vitamin D, potassium, magnesium and selenium were significantly below the recommendations. The prevalence of low muscle mass, low handgrip strength and sarcopenia were 35, 27 and 10%, respectively. In conclusion, a poor nutritional status, dietary intake and muscle health are common in older hip fracture patients in geriatric rehabilitation wards.

The attitude of patients in geriatric rehabilitation towards nursing homes

HintergrundMit Erreichen des höheren Lebensalters nehmen unterstützende Wohnformen eine immer wichtigere Rolle ein. Eingeschränkte Selbstständigkeit kann dazu führen, dass ein Umzug in ein Pflegeheim unabdingbar ist. Die Einstellung zu Pflegeheimen ist von großer Bedeutung sowohl für die Vorbereitung auf diesen Fall als auch für die psychische Reaktion auf sein Eintreten, wurde allerdings bisher kaum näher beforscht.Ziel der Arbeit (Fragestellung)Das Ziel dieser Untersuchung ist herauszufinden, wie Pflegeheime von älteren Menschen je nach ihrem subjektiven Kontrollerleben, ihrem Informationsstand und ihren Erfahrungen bewertet werden.Material und MethodenZu Einstellungen gegenüber Pflegeheimen wurden insgesamt 150 geriatrische Rehabilitationspatienten mit einer ersten Fragebogenversion (n = 64) oder einer revidierten Fassung (n = 86) befragt.ErgebnisseMittels Polaritätsprofil konnte eine eher positive Einstellung zu Pflegeheimen beobachtet werden, jedoch wurden bei freiem Antwortformat überwiegend negative Assoziationen geäußert. Der Großteil der Probanden hat eine ängstliche Haltung zu einem Umzug in ein Pflegeheim. Stärkeres Kontrollerleben, ein besserer Informationsstand und positive Erfahrungen mit Pflegeheimen stehen mit einer positiven Haltung zum Umzug in ein Pflegeheim im Zusammenhang.DiskussionMit Blick auf geäußerte Ängste, einen verbreitet geringen Informationsstand und die starke Abwehrhaltung einiger Befragter gilt es, die Betroffenen proaktiv zu informieren und stärker in die Entscheidungen für eine Wohnoption einzubinden. Neueste Entwicklungen zu aussagekräftigerer Qualitätsdarstellung der Pflegeheime können dabei unterstützen.

Behavioral and emotional quality of life of patients undergoing inpatient geriatric rehabilitation.

In the context of geriatric rehabilitation, 2 quality of life (QoL) facets are of particular importance: a behavioral, more objective facet, and an emotional, more subjective facet. This study looked at changes in these 2 QoL facets during rehabilitation, their relationship to each other and potential mediating processes. Ninety-two geriatric patients were assessed by the geriatric assessment and a structured face-to-face interview at admission to and discharge from an inpatient geriatric rehabilitation ward. Behavioral QoL was measured in terms of independence in the activities of daily living and mobile abilities, while positive and negative affect represented emotional QoL. As potential mediators, self-perceptions of health (self-rated health, subjective pain, temporal health comparison) were assessed. Statistical analysis comprised repeated-measures (multivariate) analyses of variance as well as regression and mediation analyses based upon a fixed effects-panel model. All behavioral and emotional QoL indicators showed significant prepost improvements. During rehabilitation, changes in behavioral QoL were significantly related to changes in emotional QoL. Multiple regression of changes in emotional QoL on changes in behavioral QoL and in self-perceptions of health revealed, however, that only health perceptions significantly predicted emotional QoL. Mediation analysis showed that self-perceptions of health fully mediated the relationship between behavioral and emotional QoL outcomes. During geriatric rehabilitation, significant progress can be made regarding QoL. The results indicate that the influence of physical progress on affective improvements is conveyed through self-perceptions of health, showing the importance of self-perceptions of health for emotional QoL in geriatric rehabilitation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation.

fear of falling and reduced fall-related self-efficacy are frequent consequences of falls and associated with poorer rehabilitation outcomes. To address these psychological consequences, geriatric inpatient rehabilitation was augmented with a cognitive behavioural intervention ("Step by Step") and evaluated in a RCT. one hundred fifteen hip and pelvic fracture patients (age = 82.5years, 70% female) admitted to geriatric inpatient rehabilitation were randomly allocated to the intervention or control group. The intervention consisted of eight additional individual sessions during inpatient rehabilitation, one home visit and four telephone calls delivered over 2 months after discharge. Both groups received geriatric inpatient rehabilitation. Primary outcomes were fall-related self-efficacy (short falls efficacy scale-international) and physical activity as measured by daily walking duration (activPAL3™ sensor) after admission to rehabilitation, before discharge and 1-month post-intervention. in covariance analyses, patients in the intervention group showed a significant improvement in fall-related self-efficacy (P = 0.025, d = -0.42), but no difference in total daily walking duration (P = 0.688, d = 0.07) 1-month post-intervention compared to the control condition. Further significant effects in favour of the intervention group were found in the secondary outcomes "perceived ability to manage falls" (P = 0.031, d = 0.41), "physical performance" (short physical performance battery) (P = 0.002, d = 0.58) and a lower "number of falls" (P = 0.029, d = -0.45). the intervention improved psychological and physical performance measures but did not increase daily walking duration. For the inpatient part of the intervention further research on the required minimum intensity needed to be effective is of interest. Duration and components used to improve physical activity after discharge should be reconsidered.

German version of the outcome expectations for exercise scale-2 : Psychometric properties in geriatric patients after hip or pelvic fractures with fear of falling.

Physical exercise is associated with many health benefits. Especially for older adults it is challenging to achieve an appropriate adherence to exercise programs. The outcome expectations for exercise scale2 (OEE-2) is a13-item self-report questionnaire to assess negative and positive exercise outcome expectations in older adults. The aim of this study was to translate the OEE‑2 into German and to assess the psychometric properties of this version. The OEE‑2 was translated from English into German including aforward and backward translation process. Psychometric properties were assessed in 115 patients with hip/pelvic fractures (76% female, mean age82.5 years) and fear of falling during geriatric inpatient rehabilitation. Principal component analyses could confirm atwo-factor solution (positive/negative OEE) that explained 58% of the total variance, with an overall internal reliability of α = 0.89. Cronbach'sα for the 9‑item positive OEE subscale was 0.89, for the 4‑item negative OEE subscale 0.79. The two subscales were correlated with rs = 0.49. Correlations of the OEE total score were highest with the perceived ability to manage falls, prefracture leisure time activities and prior training history (rs = 0.35-0.41). These results revealed good internal reliability and construct validity of the German version of the OEE‑2. The instrument is valid for measuring physical exercise outcome expectations in older, German-speaking patients with hip or pelvic fractures and fear of falling.

Considerations for Postacute Rehabilitation for Survivors of COVID-19.

Coronavirus disease (COVID-19), the infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported on December 31, 2019. Because it has only been studied for just over three months, our understanding of this disease is still incomplete, particularly regarding its sequelae and long-term outcomes. Moreover, very little has been written about the rehabilitation needs of patients with COVID-19 after discharge from acute care. The objective of this report is to answer the question “What rehabilitation services do survivors of COVID-19 require?” The question was asked within the context of a subacute hospital delivering geriatric inpatient and outpatient rehabilitation services. Three areas relevant to rehabilitation after COVID-19 were identified. First, details of how patients may present have been summarized, including comorbidities, complications from an intensive care unit stay with or without intubation, and the effects of the virus on multiple body systems, including those pertaining to cardiac, neurological, cognitive, and mental health. Second, I have suggested procedures regarding the design of inpatient rehabilitation units for COVID-19 survivors, staffing issues, and considerations for outpatient rehabilitation. Third, guidelines for rehabilitation (physiotherapy, occupational therapy, speech-language pathology) following COVID-19 have been proposed with respect to recovery of the respiratory system as well as recovery of mobility and function. A thorough assessment and an individualized, progressive treatment plan which focuses on function, disability, and return to participation in society will help each patient to maximize their function and quality of life. Careful consideration of the rehabilitation environment will ensure that all patients recover as completely as possible.