Rehabilitation For Older Adults Research Articles

Positive Self-perceptions of Aging Increase Physical Resilience to Facilitate Social Re-engagement of Older Adults Who Fall: Analysis Based on Health and Retirement Study Data

ObjectiveTo determine whether self-perceptions of aging (SPAs) predict physical resilience after a fall and whether SPA and physical resilience affect subsequent social engagement in older adults with a fall. DesignProspective cohort study. SettingGeneral community. ParticipantsOlder adults who reported a fall within 2 years after baseline data collection (N=1707, mean age 72.9 years, 60.9% women). Main Outcome MeasurePhysical resilience indicates the ability to resist or recover from functional decline from a stressor. The change in frailty status from directly after the fall to up to 2 years of follow-up was used to generate 4 physical resilience phenotypes. Social engagement was dichotomized based on the presence at 1 of the 5 social activities at least once a month. The 8-item Attitudes Toward Own Aging Scale was used to assess SPA at baseline. Multinomial logistic regression and nonlinear mediation analysis were used. ResultsPositive prefall SPA predicted more resilient phenotypes after a fall. Both positive SPA and physical resilience affected subsequent social engagement. Physical resilience partially mediated the association between SPA and social re-engagement (mediated percentage of 14.5%, P=.004). This mediation effect was fully driven by those with previous falls. ConclusionPositive SPA promotes physical resilience in older adults with a fall, both of which affect subsequent social engagement. Physical resilience partially mediated the effect of SPA on social engagement but only for previous fallers. Multidimensional recovery incorporating psychological, physiological, and social aspects should be stressed in the rehabilitation of older adults who fall.

Establishing Healthy Eating 'Habits': A Pilot Randomised Controlled Trial of a Habit-Based Dietary Intervention following Oral Rehabilitation for Older Adults.

An ageing population presents significant nutritional challenges, particularly for partially dentate adults. This two-armed pilot randomised controlled trial (RCT) compared habit formation (automaticity) for healthy eating behaviours between control and intervention groups after participation in a habit-based dietary intervention for older adults, following oral rehabilitation in the United Kingdom (UK). n = 54 participants were randomised to receive a habit-based dietary intervention (intervention group n = 27, IG) or standard dietary advice in a leaflet (control group n = 27, CG). The IG attended three sessions over six weeks, which focused on habit formation for three healthy eating behaviours (increasing fruit and vegetables, wholegrains, and healthy proteins). Participants were assessed for habit strength (using the Self-Report Behavioural Automaticity Index (SRBAI)) alongside health and nutrition outcomes at six weeks, four months and eight months. Forty-nine participants completed all follow-up visits. The IG compared to the CG had significant increases in automaticity at six weeks, four months (primary outcome) and eight months for eating ≥3 portions of fruit and vegetables; choosing wholegrain sources over white alternatives, and choosing healthy protein sources over red/processed meat. The mean change in the Mini Nutritional Assessment total score was greater in the IG compared with the CG at six weeks only (p = 0.03). A habit-based dietary intervention following oral rehabilitation increased automaticity for healthy dietary behaviours, which could translate into clinically meaningful benefits in this cohort of older adults.

Exergame-Assisted Rehabilitation for Preventing Falls in Older Adults at Risk: A Systematic Review and Meta-Analysis

Introduction: Exergaming is increasingly employed in rehabilitation for older adults. However, their effects on fall rate and fall risk remain unclear. Methods: We conducted a systematic review and meta-analysis that included randomized controlled trials (RCTs) comparing exergame-assisted rehabilitation with control groups, published in French or English, from Web of Science, CINHAL, Embase, Medline, and CENTRAL (last search in June 2021). Two reviewers independently assessed the studies. Risk of bias was assessed using RoB2, PEDRO scale, and the GRADE system. The outcomes of interest were (a) fall rate, (b) risk of falling, measured by the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), One-Leg Stance, or Berg Balance Scale (BBS), (c) fear of falling, measured with the Fall Efficacy Scale (FES-I) or the Activities-specific Balance Confidence (ABC) score. Data were pooled and mean differences (MDs) between exergame and control groups were calculated using a random-effects model. Results: Twenty-seven RCTs were included (1,415 participants, including 63.9% of women, with mean age ranging from 65 to 85.2 years old). Exergame-assisted interventions were associated with a reduction in the incidence of falls (4 studies, 316 participants, MD = −0.91 falls per person per year; 95% CI: −1.65 to −0.17, p = 0.02, moderate quality). Regarding fall risk (20 studies included, low-quality evidence), SPPB did not change (MD = 0.74; 95% CI: −0.12 to 1.60, p = 0.09), but all other scores were improved: BBS (MD = 2.85; 95% CI: 1.27 to −4.43, p = 0.0004), TUG (MD = −1.46; 95% CI: −2.21 to −0.71, p = 0.0001) and One-Leg Stance (MD = 7.09; 95% CI: 4.21 to 9.98, p < 0.00001). Fear of falling scores (FES-I and ABC) showed no difference. Conclusion: There is moderate-quality evidence of a reduction in the fall rate with exergame-assisted rehabilitation and low-quality evidence suggesting a mild reduction in the risk of falling. Statistically significant benefits from exergame-assisted rehabilitation did not achieve clinically meaningful changes in risk of falling assessments.

Effects of a diabetes mellitus-specific care intervention and home environment among older adults following hip fracture surgery

ObjectivesTo explore the impact of home environment on effects of a diabetes mellitus (DM)–specific care model among older adults following hip-fracture surgery. MethodsA secondary analysis using the Home Environmental Barriers Scale assessed home environment (intervention group=81, control group=79) at 1- and 3-months post-discharge. Outcomes of physical functioning were assessed at 1-, 3-, 6-, and 12-months post-discharge. ResultsThe intervention group had better home environmental improvements compared with the control group. Participants were characterized as having good or poor environmental improvements. Those with good improvements and received the intervention had better activities of daily living compared with matched controls. Participants with poor improvements and received the intervention had better scores for hip range of motion and quadriceps muscle strength compared with matched controls. DiscussionA DM-specific home rehabilitation for older adults following hip-fracture surgery that includes assessment of the home environment can facilitate complex postoperative functional recovery.

Abstract 13877: Robotic Exercise Rehabilitation of Older Adults With Cardiovascular Disease Appears Safe and Effective

Introduction: Recent research has focused on the effects of physical exercise in improving the functional capacity of frail older adults. Training with a balance exercise assist robot (BEAR) system is effective for improving posture. We compared the clinical safety and efficacy of postural strategy training using a BEAR system with those of conventional resistance training or no training in older patients with cardiovascular disease (CVD). Methods: Elderly patients (n = 130; mean age, 77.5 years) admitted to our hospital for worsening CVD were randomly allocated to two cardiac rehabilitation (CR) groups: conventional resistance training (group R, n=65) and use of the BEAR (group B, n=65). After appropriate medical therapy, patients underwent cardiopulmonary exercise testing, including assessment of comfortable walking speed, timed up-and-go (TUG), and a short physical performance battery (SPPB), just before discharge and after a weekly for 4 months of CR. We followed up the patients for fall-related fractures and cardiac events, which were defined as hospitalization for worsening CVD or cardiac death, and then compared with non-CR group (group N, n=165). Patients were followed for a mean of 2.1 years. Results: BEAR use had no adverse effects in any patient. Comfortable walking speed, TUG, and SPPB had improved significantly in both groups at 4 months compared with baseline but did not differ significantly between groups. No fall related fractures occurred in group B and 2 in group R, there was no significant difference between the two exercise groups. On the other hand, although there was no significant difference in event-free survival rates between the two exercise groups, event-free survival was significantly greater in these groups than in group N ( P ˂ 0.001). Conclusions: Exercise training by using a BEAR system is safe and effective for older adults with CVD. We demonstrated here that BEAR use is comparable to conventional resistance training for improving exercise capacity and balance in elderly patients with CVD. Both exercise groups were better prognosis compared with non-exercise.

Prevalence of frailty and frailty outcomes within the inpatient rehabilitation setting: use of routinely collected electronic health information.

Frailty within the older adult rehabilitation population is relatively under-explored. We aimed to derive a frailty index (FI) from electronic routinely collected data to determine frailty prevalence, and to assess its ability to predict adverse outcomes in the rehabilitation setting. A FI was derived and retrospectively applied to electronically recorded health information of older adults admitted for inpatient rehabilitation. For analysis, subjects were allocated into frailty score (FS) groups (0-5). Primary outcome was a six-month hospitalistion rate, and other outcomes were: mortality, entrance into long-term care (LTC) at one year, length of stay (LOS), 30- and 90-day hospitalistions. Univariate and multivariable logistic regressions analysed associations between frailty and outcomes. One hundred and sixty-two patient electronic notes were reviewed. Mean (SD) age was 86 (8.2) years, 147 (90.7%) were considered frail (FS>0.25). The most frail group (FS 5) had higher risk of six-month hospitalisations (OR=6.19; 95%CI=1.82, 21.13; p=0.004). A higher frailty score was associated with shorter LOS compared to lowest frailty scores (15.7 days vs 25.4 days; p=0.04). No relationship was found with shorter-term outcomes. Prevalence of frailty is high in the rehabilitation setting. Association of frailty with shorter LOS and lack of association found with shorter-term outcomes warrant further study.

Real-Time Telerehabilitation in Older Adults With Musculoskeletal Conditions: Systematic Review and Meta-analysis.

BackgroundReal-time telerehabilitation (TR) is a new strategy for delivering rehabilitation interventions to older adults with musculoskeletal conditions, to provide continuity to conventional services and mitigate travel-related barriers.ObjectiveWe aimed to examine the effectiveness of treatment delivered via real-time TR services compared to conventional services among older adults with musculoskeletal conditions, in terms of physical performance, treatment adherence, and cost-effectiveness.MethodsA literature search of randomized controlled trials (RCTs) published from January 2000 to April 2022 was conducted in six online databases: Cochrane Library, PubMed (ie, MEDLINE), PEDro, ClinicalKey, EBSCO, and ProQuest. The main eligibility criterion for articles was the use of real-time TR among older adults with musculoskeletal conditions to improve physical performance. Two reviewers screened 2108 abstracts and found 10 studies (n=851) that met the eligibility criteria. Quality assessment was based on version 2 of Cochrane’s risk-of-bias tool for RCTs, in order to assess the methodological quality of the selected articles. Results were pooled for meta-analyses, based on the primary outcome measures, and were reported as standardized mean differences (SMDs) with 95% CIs. A fixed model was used, and subgroup analysis was performed to check for possible factors influencing TR’s effectiveness based on different treatments, controls, and outcome measures.ResultsThe search and screening process identified 10 papers that collectively reported on three musculoskeletal conditions in older adults and three types of TR programs. Aggregate results suggested that real-time TR, compared to conventional treatment, was more effective at improving physical performance regarding balance (SMD 0.63, 95% CI 0.36-0.9; I2=58.5%). TR was slightly better than usual care at improving range of motion (SMD 0.28, 95% CI 0.1-0.46; I2=0%) and muscle strength (SMD 0.76, 95% CI 0.32-1.2; I2=59.60%), with moderate to large effects. Subgroup analyses suggested that real-time TR had medium to large effects favoring the use of smartphones or tablets (SMD 0.92, 95% CI 0.56-1.29; I2=45.8%), whereas the use of personal computers (SMD 0.25, 95% CI –0.16 to 0.66; I2=0%) had no effect on improving balance and was comparable to conventional treatment.ConclusionsWe found that real-time TR improved physical performance in older adults with musculoskeletal conditions, with an effectiveness level equal to that of conventional face-to-face treatment. Therefore, real-time TR services may constitute an alternative strategy for the delivery of rehabilitation services to older adults with musculoskeletal conditions to improve their physical performance. We also observed that the ideal device for delivering TR is the smartphone. Results suggested that the use of smartphones for TR is driven by ease of use among older adults. We encourage future studies in areas related to rehabilitation in older adults, in addition to examination of physical performance outcomes, to gain additional knowledge about comprehensive care.Trial RegistrationPROSPERO CRD42021287289; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=287289

Detecting Changes in Human Agency of Older Adults in Rehabilitation

ABSTRACT Tools assessing person-centered rehabilitation should promote client self-awareness as well as measure the target outcomes. The aim of this study was to evaluate the ability of the Assessment of Perceived Agency (ATPA19) to track changes in rehabilitation for older adults. Older adults (mean age 79) participated in a ten-month intervention (baseline n = 97, and follow-up n = 63). The ATPA19 and WHOQOL-BREF physical domain showed the strongest correlation and were the only tools that detected significant changes in older adults. The ATPA-19 is an agency-based tool that can reveal new effects complementing those of the assessment tools commonly used in rehabilitation in older adults.

Application of Telerehabilitation for Older Adults During the COVID-19 Pandemic: A Systematic Review.

The employment of telerehabilitation in different disciplines, particularly in the rehabilitation of older adults, has grown significantly across the world. In the wake of the COVID-19 outbreak, a chance has arisen to improve the user experience and to draw attention to the advantages of utilizing this service. The current research aimed to evaluate the investigations that utilized telerehabilitation to assist elderly people during the COVID-19 pandemic. Systematic searches of papers published between September 1, 2019 and 1 December, 2021 were conducted in PubMed, Cochran Library, Web of Science, Scopus, Science Direct, and ProQuest databases. The author narrowed down the list of articles by using search terms. Ultimately, publications from the COVID-19 period were studied for their perspectives on the employment of telerehabilitation among the elderly population. The whole process was supervised by two investigators at the same time. In total, 2529 articles were included in the first search. Five articles were chosen for further assessment based on the careful consideration of their titles, abstracts, and full texts. Cross-sectional, feasibility, case, and interventional studies comprised 20%, 20%, 20%, and 40% of the papers, respectively. The studies were carried out in Brazil, the United States, Germany, Japan, and South Korea and involved using telerehabilitation for elderly individuals, identification of crucial manifestations and impairments, improving physical function in this population, and ensuring their happiness. Using a digital strategy for rehabilitation should be regarded as a means of overcoming the field's obstacles. As a result, legislators and rehabilitation groups should consider the employment of telerehabilitation for the elderly population during the COVID-19 pandemic.

Does anatomical type of proximal hip fracture affect rehabilitation outcomes among older adults?

Background and purposeNumerous studies have detailed the potential benefits of inpatient geriatric rehabilitation for older adults with hip fractures. However, data regarding effect of fracture type (femoral neck, intertrochanteric, or subtrochanteric) on rehabilitation outcomes are limited. This study assessed whether the anatomical type of proximal hip fracture affects rehabilitation outcomes among disabled older adults. MethodsA population-based study was conducted comparing all patients with a recent hip fracture who were admitted to a geriatric rehabilitation facility in Israel. Data were collected retrospectively from an electronic database during a 5-year period (2014–2019). The Functional Independence Measure (FIM) was used to assess physical and cognitive function at admission and discharge. ResultsThe analyses included 624 older adults with hip fractures. We found significant differences in motor FIM score at admission, as patients with femoral neck fracture performed better than patients with intertrochanteric and subtrochanteric fracture did. The disparity in motor FIM score remained consistent through discharge, with all groups achieving a median gain of 14 points. Within one month of rehabilitation, about a third of all patients achieved a higher functional level. ConclusionsPatients with femoral neck fracture have better motor ability than do those with intertrochanteric and subtrochanteric fractures, which were retained throughout the course of rehabilitation; yet, the level of improvement remained similar. Clinicians should be aware of such differences in functional ability when discussing goals of care with older adults with hip fractures and consider them when implementing individual rehabilitation programs .

Low-Vision Evaluations and Interventions Used in Practice

Low vision creates challenges in completing vision-dependent tasks and activities. The purpose of this 3-round e-Delphi study was to determine a consensus for the evaluations and interventions commonly used in low-vision rehabilitation for older adults with low vision. Ten occupational therapists with at least 3 years of practice in low-vision rehabilitation participated in the study. The results of the study identified the most frequently used evaluations and interventions for older adults with low vision. Findings of this study coincided with the literature and can be integrated into current practice with this population.

Benefits of a Balance Exercise Assist Robot in the Cardiac Rehabilitation of Older Adults with Cardiovascular Disease: A Preliminary Study.

We examined whether adding robot-supported balance exercises to cardiac rehabilitation improves the ability to balance in older adults with cardiovascular disease (CVD). We conducted a prospective study in 52 older adults who had been hospitalized for worsening CVD. Once weekly for four months, for a total of sixteen sessions as outpatients, the subjects used a Balance Exercise Assist Robot (BEAR) to perform balance exercises and an ergometer for aerobic exercises. Participants’ mean age was 76.9 ± 6.8 years (range, 65–95 years), and their mean brain natriuretic protein level was 164.0 ± 190.0 pg/mL. After the intervention, participants showed significant improvements in gait speed (before, 1.06 ± 0.33 m/s; after, 1.23 ± 0.30 m/s; p < 0.001), Short Physical Performance Battery score (before, 10.02 ± 2.25; after, 10.88 ± 1.79; p ˂ 0.001), timed up-and-go (before, 11.11 ± 5.07 s; after, 9.45 ± 3.45 s; p ˂ 0.001), and knee extension (before, 26.97 ± 11.78 kgf; after, 30.13 ± 13.04 kgf; p = 0.001). Cardiac rehabilitation including exercises using BEAR improved physical functioning and the ability to balance in older adults with CVD. Frail and prefrail patients improved, whereas robust ones did not change.

The effectiveness of rehabilitation interventions including outdoor mobility on older adults' physical activity, endurance, outdoor mobility and falls-related self-efficacy: systematic review and meta-analysis.

ObjectiveTo determine the effectiveness of community-based rehabilitation interventions which incorporate outdoor mobility on physical activity, endurance, outdoor mobility and falls-related self-efficacy in older adults.DesignMEDLINE, Embase, CINAHL, PEDro and OpenGrey were searched systematically from inception to June 2021 for randomised controlled trials (RCTs) of community-based rehabilitation incorporating outdoor mobility on physical activity, endurance, outdoor mobility and/or falls-related self-efficacy in older adults. Duplicate screening, selection, extraction and appraisal were completed. Results were reported descriptively and with random-effects meta-analyses stratified by population (proactive [community-dwelling], reactive [illness/injury]).ResultsA total of 29 RCTs with 7,076 participants were identified (66% high bias for at least one domain). The outdoor mobility component was predominantly a walking programme with behaviour change. Rehabilitation for reactive populations increased physical activity (seven RCTs, 587 participants. Hedge’s g 1.32, 95% CI: 0.31, 2.32), endurance (four RCTs, 392 participants. Hedges g 0.24; 95% CI: 0.04, 0.44) and outdoor mobility (two RCTs with 663 participants. Go out as much as wanted, likelihood of a journey) at intervention end versus usual care. Where reported, effects were preserved at follow-up. One RCT indicated a benefit of rehabilitation for proactive populations on moderate-to-vigorous activity and outdoor mobility. No effect was noted for falls-related self-efficacy, or other outcomes following rehabilitation for proactive populations.ConclusionReactive rehabilitation for older adults may include walking programmes with behaviour change techniques. Future research should address the potential benefit of a walking programme for proactive populations and address mobility-related anxiety as a barrier to outdoor mobility for both proactive and reactive populations.

Predictors of cognitive gains during inpatient rehabilitation for older adults with traumatic brain injury.

Traumatic brain injury (TBI) among older adults is increasing and can affect cognition. To effectively meet the rehabilitation needs of older adults, a clearer picture is needed of patient-, clinical-, and facility-level characteristics that affect cognitive recovery during inpatient rehabilitation facility (IRF) stays. To identify patient, clinical, and facility factors associated with cognitive recovery among older adults with TBI who received IRF care. Secondary data analysis. Uniform Data System for Medical Rehabilitation-participating IRFs in the United States. Patients were 65 to 99 years of age at IRF admission for TBI. Participants received IRF care between 2002 and 2018 (N=137,583); 56.3% were male; 84.2% were white; mean age was 78.7 years. Change in Functional Independence Measure Cognitive Score (FIM-Cognitive) from IRF admission to discharge, categorized as favorable (FIM-cognitive score gains ≥3 points) or poor (FIM-cognitive score gains <3 points) cognitive outcomes. Not applicable. Patients had greater odds of favorable cognitive recovery if they were female (adjusted odds ratio [aOR] 1.05, 95% confidence interval [CI] 1.05-1.08), had higher motor functioning at IRF admission (aOR 1.03, 95% CI 1.03-1.04), longer length of stay (aOR 1.07, 95% CI 1.06-1.07), or received care at a freestanding IRF (vs. hospital rehab unit) (aOR 1.57, 95% CI 1.52-1.61). Patients who were older (aOR 0.99, 95% CI 0.98-0.99), Black (aOR 0.79, 95% CI 0.75-0.83), Hispanic or Latino (aOR 0.97, 95% CI 0.91-1.02), or were part of another racial or ethnic group (aOR 0.85, 95% CI 0.81-0.90) (vs. White), had high-cost comorbid conditions (aOR 0.71, 95% CI 0.65-0.76), or who had higher cognitive functioning at IRF admission (aOR 0.90, 95% CI 0.90-0.91) had lower odds of favorable cognitive recovery. Patient (age, sex, race, ethnicity), clinical (level of functioning at IRF admission, length of stay) and facility (e.g., freestanding IRF) factors contributed to the cognitive recoveries of older adults during IRF stays.

‘Is my journey destination home?’ Exploring the experiences of older adults who undertake a transition care programme: a qualitative study

AbstractTransition care programmes (TCP) provide older adults with goal-oriented rehabilitation after hospitalisation. However, limited research has focused on understanding older adults' experiences when undertaking TCP. Using a phenomenological approach, we explored the lived experience of older adults undertaking a TCP at a transition care facility in Australia. A purposive sample (N = 33 participants: 16 older adults, four family members and 13 staff) was recruited. Semi-structured interviews were undertaken at three time-points during admission and inductive thematic analysis was utilised. Older adults reflected on their TCP experiences through an emotional lens through which they deliberated, ‘is my destination home?’ Fear of losing independence and uncertainty about their discharge destination strongly influenced older adults' perspectives regarding their TCP experience. Emotional responses, both positive and negative, were influenced by expectations prior to admission, level of family support and staff behaviour. Staff and family concurred that many older adults were confused about their admission to the facility and initially were unprepared to engage in the rehabilitation provided. Older adults experienced TCP as a time of great uncertainty and feared the unknown when discharged from hospital to transition care. They expressed grief at the loss of existing life roles and anxiety about the possibility of being unable to return home. Health professionals need to inform and tailor rehabilitation for older adults to better support this transient time of life.

Impact of Sarcopenia and Obesity on Gait Speed After Total Knee Replacement.

Older adults with sarcopenic obesity have a higher risk of experiencing mobility difficulty. Additionally, sarcopenia and obesity are closely associated with knee osteoarthritis. This study investigated the associations of sarcopenia, obesity, and in combination of both with walking disability during postoperative rehabilitation in older adults with knee osteoarthritis who underwent total knee replacement. A retrospective cohort study. From a rehabilitation center database, we retrospectively selected and investigated 482 older patients with knee osteoarthritis who had undergone total knee replacement and received postoperative rehabilitation. Sarcopenia was identified in accordance with the diagnostic criteria established by the Asian Working Group for Sarcopenia and obesity was defined as body mass index ≥ 30kg/m2. Accordingly, patients were classified into four body composition groups, namely sarcopenic obese, sarcopenic, obese, and normal (reference group). After total knee replacement, all patients attended monthly follow-up admission during the postoperative rehabilitation. Gait speed was measured before surgery and monthly after total knee replacement. A gait speed cutoff of 1.0m/s was used to identify postoperative walking disability. Kaplan-Meier curve analysis was performed to measure the probability of experiencing postoperative walking disability among the groups. Cox multivariate regression models were established to calculate the hazard ratios of postoperative walking disability. Compared with the reference group, the sarcopenic, obese, and sarcopenic obese groups appeared to have a higher probability of experiencing postoperative walking disability (all P < .001). The sarcopenic obese group were likely to have the highest risk of experiencing postoperative walking disability (adjusted hazard ratio= 3.89). Sarcopenia or obesity alone may independently exert negative effects on postoperative gait speed. The participants with sarcopenic obesity were likely to have the highest risk of experiencing walking disability following total knee replacement. The findings may serve as a reference for clinicians developing rehabilitation strategies to optimize walking ability after total knee replacement, especially those preoperatively diagnosed as having sarcopenic obesity.

A framework for rehabilitation for older adults living with dementia

Introduction & BackgroundThe aging of the population assures increased prevalence of Individuals Living with Dementia (ILwD) and there will be an increased representation of this cohort requiring physical rehabilitation. If physical therapists (PTs) manage these patients as they do their age-matched, cognitively-intact peers, they will likely be unsuccessful. ILwD have unique needs related to interpersonal and pragmatic components of rehabilitation. Therapeutic nihilism (doubting the benefit of therapy) is well-documented in PTs, either because of existing biases about dementia or previous challenges in working with ILwD. Physical rehabilitation eligibility and placement decisions are often made by PTs without special training in dementia, based upon brief exposure to patients in environments not well-designed for their best functioning. This can lead to underestimation of rehabilitation potential and denial of future PT services. PTs who work with ILwD desire more practical knowledge and targeted skills. Those with more education and training have a more positive attitude and outlook related to ILwD.PurposeThe purpose of this paper is to introduce a framework for rehabilitation with ILwD equipped with pragmatic ideas to facilitate therapeutic success. The four primary components of the model are: (1) Establish a personal RELATIONSHIP, (2) Use intentional verbal and nonverbal COMMUNICATION, (3) Understand and optimize MOTOR LEARNING capabilities, and (4) Create a safe, purposeful ENVIRONMENT. Specific strategies to help PTs optimize each component are provided with supporting evidence. The model is intended to be dynamic, encouraging PTs to capitalize on the most accessible strategies within their control for a given patient and setting.ImplicationsThis framework provides a practical resource for working with ILwD with immediate implications for facilitating therapeutic success. The model is displayed in a schematic that reminds the reader of ideas at a glance within the context of each of the components. If an appreciation for this content was among core competencies required among PTs working with ILwD, perhaps there would be significantly fewer patients written off as “uncooperative” or “unable to participate” in PT.

Enhancing Locomotor Learning With Transcutaneous Spinal Electrical Stimulation and Somatosensory Augmentation: A Pilot Randomized Controlled Trial in Older Adults.

This study investigated locomotor learning of a complex terrain walking task in older adults, when combined with two adjuvant interventions: transcutaneous spinal direct current stimulation (tsDCS) to increase lumbar spinal cord excitability, and textured shoe insoles to increase somatosensory feedback to the spinal cord. The spinal cord has a crucial contribution to control of walking, and is a novel therapeutic target for rehabilitation of older adults. The complex terrain task involved walking a 10-meter course consisting of nine obstacles and three sections of compliant (soft) walking surface. Twenty-three participants were randomly assigned to one of the following groups: sham tsDCS and smooth insoles (sham/smooth; control group), sham tsDCS and textured insoles (sham/textured), active tsDCS and smooth insoles (active/smooth), and active tsDCS and textured insoles (active/textured). The first objective was to assess the feasibility, tolerability, and safety of the interventions. The second objective was to assess preliminary efficacy for increasing locomotor learning, as defined by retention of gains in walking speed between a baseline visit of task practice, and a subsequent follow-up visit. Variability of the center of mass while walking over the course was also evaluated. The change in executive control of walking (prefrontal cortical activity) between the baseline and follow-up visits was measured with functional near infrared spectroscopy. The study results demonstrated feasibility based on enrollment and retention of participants, tolerability based on self-report, and safety based on absence of adverse events. Preliminary efficacy was supported based on trends showing larger gains in walking speed and more pronounced reductions in mediolateral center of mass variability at the follow-up visit in the groups randomized to active tsDCS or textured insoles. These data justify future larger studies to further assess dosing and efficacy of these intervention approaches. In conclusion, rehabilitation interventions that target spinal control of walking present a potential opportunity for enhancing walking function in older adults.

Lessons Learned From the COVID-19 Pandemic as Experienced by Older Adults Treated for COVID-19.

BackgroundIn order to provide the best care, the perspective of older COVID-19 patients must be involved in the development of treatment protocols. This study describes the experiences of older adults affected by COVID-19 who recovered in the hospital or at home.MethodsQualitative semi-structured interviews were conducted with 23 older adults affected by COVID-19. A content-based thematic analysis was conducted.ResultsNine categories were identified as recurring topics, which were grouped into three major themes. The first theme describes experiences in the first phase of the disease when older adults fell ill. The second theme includes experiences during the illness, ranging from illness severity to participation in decision-making, communication barriers and isolation effects. The final theme covers the recovery course, residual symptoms and social aspects.ConclusionOlder adults treated for COVID-19 experienced a feeling of being in a fast-paced whirlwind and lost total control over the situation. Extra attention should be paid to shared decision making, coordinated information provision and the instalment of a primary contract to the patient. The uncertainty of their situation, isolation measures and fears could result in psychological consequences and hinder rehabilitation in older adults.

Psychosocial Rehabilitation in Older Adults: Old Wine in a New Silver Bottle?

Psychosocial Rehabilitation in Older Adults: Old Wine in a New Silver Bottle?