Restorative Care Research Articles

Estimation of Caries Treatment Needs in First Permanent Molars of Lithuanian 5-6-Year-Old Children, Based on Caries Lesion Activity Assessment.

Background and Objectives: Early detection of dental caries lesions at active stages of development can facilitate their monitoring and reduce needs for restorative dental care. This study aimed to describe the prevalence and caries treatment needs in first permanent molars of pre-school children, based on a caries lesion activity assessment, and in relation to participants’ ages, dental plaque levels and toothbrushing habits. Materials and Methods: Large cross-sectional dental caries survey using multistage cluster sampling was conducted among Lithuanian 4–6-year-old children attending kindergartens. For the present study purpose, all individuals presenting erupted permanent molars were selected. Thus, only 5–6-year-olds (n = 453) took part in this study. They were examined for caries by one calibrated examiner using Nyvad clinical diagnostic criteria that differentiate between active and inactive caries lesions. Dental plaque was assessed by the Silness-Löe index, and parents’ reports about toothbrushing frequency were collected. Results: Overall, 41% of permanent molars were affected by caries; 6-year-olds had more caries lesions than 5-year-olds (p < 0.05). Mean number of decayed and filled surfaces (DF-S) of all participants was 1.79 (SD 2.93), half of lesions were noncavitated, more than one-third were cavitated and fillings comprised less than one surface per child. Majority of lesions were active; prevalence of inactive lesions (all noncavitated) was 1% and 6% in 5- and 6-year-olds, respectively. Prevalence of active lesions increased with age; it correlated with plaque levels and with toothbrushing frequency (<0.001). Likelihood to detect active lesions was up to nine times higher in teeth with abundant plaque (odds ratio (OR) 8.73; confidence interval (CI) 5.35–14.25), and up to seven times higher in individuals brushing teeth irregularly (OR 6.88; CI 2.21–21.41). Conclusions: The obtained data indicate high treatment needs in the erupted permanent molars of the Lithuanian pre-school population and imply that caries management should primarily focus on improved biofilm removal, accompanied with regular use of fluoridated toothpaste.

Aspiring a Paradigm Shift in the Current Understanding of Oral Health Promotion by Testing the Possibility of Deriving Requisite Manpower Using Basic Clinical Data: An Epidemiological Investigation

Introduction: Majority of rural dental outreach programs focus on screening the subjects attending the programs and providing oral health education for them. There has only been limited emphasis on the provision of care as a part of the outreach activities for the geographically disadvantaged rural population. The objective of this study is to check whether the basic clinical data as collected in the form of number of decayed teeth can be a valid and reliable predictor in calculation of requisite time for provision of restorative services by developing a predicting equation from the data obtained on 400 subjects in outreach activities and subsequently testing the predicting general linear equation for predictive accuracy. Materials and Methods: The number of decayed teeth in each of the participants was recorded along with collection of demographic data from the study participants. Data obtained from the 400 participants was used to generate a predicting equation after running a backward stepwise multiple linear regression. The equation was subsequently tested among a subsample of 200 participants from the exploratory sample and an independent validatory sample of 200. SPSS version 20 software, multiple linear regression, Wilcoxon signed rank test, Mann Whitney U test were used in data analysis. Results: Number of decayed teeth was observed to be a single, significant predictor of the man hours required in provision of restorative care. The predicting equation generated had good predictive accuracy and predictive stability as observed from the non-significant differences between the requisite time calculated using the predicting equation and that clinically determined by the calibrated examiner among both the subsample of exploratory sample and the validatory sample. Conclusion: The predicting equation generated in this study accurately and consistently estimated the requisite man hours necessary for provision of restorative oral health care in outreach programs.

Oral health status and treatment needs of children with special health care needs in rural and urban areas of Hyderabad - A cross sectional study.

Aim:The aim of the cross-sectional study was to ascertain the oral health status and treatment needs of special health care need children of age group 3–16 years in rural and urban areas of Hyderabad, Telangana, India.Materials and Method:To assess and compare the caries status, oral health status, oral hygiene measures, diet and treatment needs in rural and urban population. The data collected was processed and analyzed using the SPSS statistical software program.Results:Among 1000 subjects in rural and urban population highly significant difference was observed for Oral hygiene aids (P < 0.003) and for DMFT (P < 0.008) and no significant difference for dmft (P > 0.26). OHIs status showed no difference in primary and permanent in both rural and urban population (P > 1). Filled and missed were in DMFT, dmft was very low even though there were carious tooth in study population. Most of the children in rural and urban population required varied treatment needs like oral prophylaxis, restoration, pulp therapy, crowns and extractions.Conclusion:High prevalence of dental caries and the need for restorative care was noted in these children emphasizing the necessity of change of attitude towards oral health and improved oral care by repeated counselling of parents by primary health care physicians.

Effectiveness of comprehensive oral care on Bradburn scale of psychological well-being among young adult smokers and tobacco chewers: A prospective clinical study

Aim: To assess the benefits of comprehensive oral care in improving the psychological well-being of young adult smokers and tobacco chewers. Materials and Methods: A prospective, clinical study of 60 young adult smokers/tobacco chewers or both were carried out. This study was conducted to assess the psychological well-being at the first dental visit, and then after the completion of comprehensive oral care using Bradburn scale of psychological well-being (Affect Balance Scale). Comprehensive oral care included oral prophylaxis, simple restorative care, preventive procedures, and health education. Health education was given before the appointment, during the stage of diagnosis and treatment planning, in the operatory during the various stages of treatment. Results: A total of 60 males were participated in this clinical study, with a minimum age of 18 years to the maximum age of 25 years. A total of 20 (33.3%) were using both smokeless and smoking tobacco. The majority of them were school educated (74%) and semi-skilled (86%). The overall oral hygiene status was fair. The mean decayed, missing, and filled teeth (DMFT) ranged from 0 to 9. The Bradburn scale of psychological well-being score was 1.55 ± 2.54 at the first visit to the dentist and after completing the comprehensive oral care there was an improvement in the score (3.20 ± 1.29). This was statistically significant. Conclusion: This study findings showed improvement in the psychological well-being of young adult smokers and tobacco chewers after the completion of comprehensive oral care.

Causal links associated with missed residential aged care.

To estimate and model the types and frequencies of care that nurses and carers self-identify as being missed in the Australian residential aged care sector. The study advances missed care research to explore how the care of elderly Australians is compromised. A multi-variate approach was used to apply the consensus scores of 2,467 staff to missed opportunities for resident health promotion and restorative care. Eight latent care variables have direct predictor effects on missed Australian residential aged care, all of which are largely under the control of residential care management, with the exception of the physical locality of the aged care settings. Missed care, associated with maximizing the residents' life potential, relieving their distress and maintaining their current health can be quantified and predicted. Aged care policies that maximize adequate staffing numbers with appropriate levels of skill are paramount to minimizing missed Australian residential care.

Prognostication accuracy of final destination in poststroke patients requiring transitional care.

Transitional care program in Australia targets older patients in hospitals requiring ongoing slow-stream restorative care prior to discharge. Poststroke patients often require extended care and are transferred to these facilities. Transitional care providers require a predicted discharge destination. The aim of this study was to assess the accuracy of this prediction. This study included all patients transferred to transitional care from a stroke rehabilitation unit over eight years. Information regarding the predicted final discharge destination was collected from medical records, and the actual discharge destination was obtained from the transitional care registry. Final destination prediction was equivalent between medical and multidisciplinary teams (κ=0.87). However, only 60% of the predictions were accurate. Subgroup analysis, as measured by the Modified Barthel Index, suggested that functional gain was a better predictor of final destination. Other characteristics, such as age, sex and type of stroke, did not demonstrate good correlation with the final destination. Functional improvement, that is the Modified Barthel Index, is the best predictor of final destination after transitional care.

Minimally interventive restorative care of teeth with molar incisor hypomineralization and open apex-A 24-month longitudinal study.

To assess the efficacy of treatment using a minimally invasive approach (selective removal of carious tissue, restoration and preventive strategies) in immature permanent molars with MIH. A total of 281 patients, aged 6-8years, with carious lesions (ICDAS 5-6), severe MIH, and incomplete root formation (one tooth/patient) were included. After clinical and radiographic examinations, selective carious tissue removal was performed, and the teeth received interim restoration for 6months and were then restored with composite resin. Clinical and radiographic follow-up was undertaken, 6, 12, 18, and 24months. A protocol of preventive oral care measures was established and repeated at each follow-up, including diet counselling, oral hygiene instruction, dental plaque control, and topical application of fluoride varnish containing CPP-ACP. All clinical procedures and evaluations were done by a single operator. Clinical and radiographic success was observed 24months after treatment in 96.8% of the cases. Failures were due to enamel fracture at restoration margins, resulting in pulpitis and absence of apex closure. Selective removal of carious tissue, interim, and subsequently definitive restoration, combined with home and professional preventive measures, maintained marginal integrity of restorations in immature permanent molars with severe MIH, confirmed by pulp vitality and occurrence of apexogenesis.

The Implementation of Restorative Care and Factors Associated with Resident Outcomes in Long-Term Care Facilities in Taiwan.

This study aimed to analyze how restorative care is implemented in long-term care facilities and factors associated with resident outcomes in Taiwan. A one-group pre-test and post-test design was adopted in 24 long-term care facilities by collecting a sample of 310 participants at the baseline and 210 at six months. Participants were residents aged 65 or over, and were being constrained, used diapers, or were bedridden, or a combination of these. Their physical and mental functions were measured using Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), Mini-Mental State Examination (MMSE), Geriatric Depression Scale-15 (GDS-15), and EuroQol-5D (EQ-5D). Mean differences in the outcomes were analyzed, and mixed effect models were used to examine influencing factors. The results showed that most of the participants had good family support. However, participants with better family support were more likely to drop out. Improvements were found in the residents’ outcomes on physical function, depression and quality of life. Social support was a significant influencing factor on most of the outcomes. In conclusion, restorative care was found to have positive effects on residents’ physical function and helped maintain mental function. Sufficient support and communication between participants, families, and staff in facilities are key factors leading to positive outcomes.

Restorative intervention thresholds and treatment decisions of general dental practitioners in London.

Introduction Minimally invasive dentistry has been promoted as the contemporary approach to the operative management of dental caries. Operative intervention should be undertaken on cavitated lesions which are actively progressing. However, there may be large variability in the restorative intervention thresholds and care plans of general dental practitioners (GDPs).Aims To investigate restorative threshold and treatment decisions for occlusal and proximal carious lesions in a cohort of GDPs in London. To investigate potential differences based on number of years since graduation and attendance on a caries management course.Materials and methods A previously used, validated caries questionnaire was distributed to foundation dentists, general practice dentists and practising educational supervisors in NHS London dental practices. Results Two hundred and seventeen GDPs participated in the study. For occlusal lesions, nine (9.1%) newly-qualified dentists selected to intervene surgically on lesions confined to enamel, compared to 24 (29.8%) dentists who have been qualified for more than five years (p <0.05). In addition, a greater number of dentists who had attended a training course were more likely to do a minimally invasive preparation for a proximal lesion (38.2%), compared to 19.8% of those who had not (p <0.05). The majority of all participants (74.2%) chose to restore a proximal lesion using resin composite. Despite this material choice, 58.5% of those graduating within five years opted to prepare a traditional Black's class II cavity. Conclusion A practitioner's restorative intervention threshold and their choice of treatment appears to be negatively affected by the number of years post-qualification, and positively influenced by attending a caries management course.

Provider and community perspectives of dental therapists in Alaska's Yukon-Kuskokwim Delta: A qualitative programme evaluation.

Dental therapists deliver preventive and basic restorative care and have been practicing since 2006 in Alaska's Yukon-Kuskokwim (YK) Delta. In this qualitative programme evaluation, we documented health providers' and community members' experiences with dental therapy. The goal of the evaluation was to develop a conceptual model of dental care delivery in Alaska Native Communities centred on dental therapists. We developed semi-structured interview scripts and used snowball sampling to recruit 16 health providers with experience providing care in the YK Delta and 125 community members from six YK Delta Communities in 2017 and 2018. The six communities were a stratified convenience sample based on community-level exposure to dental therapists (high, medium and no exposure). Interview data were digitally recorded, transcribed, verified for accuracy and coded inductively into conceptual domains using content analytic methods. Providers believed individuals living in the YK Delta have benefited from clinic-based restorative care and community-based education provided by dental therapists. The restricted scope of dental therapy practice limits the complexity of care that may be offered to patients. However, community members expressed high satisfaction with the quality of care provided by dental therapists. Community members noted more widespread knowledge and evolving norms about oral health and believed dental therapists are helping to prevent disease and improve quality of life. Participants believed access to dental care for children has improved over the years, but felt that many adults in the YK Delta continue to have unmet needs. A potential barrier to sustained programme effectiveness is low retention of dental therapists in the region, driven primarily by reports that dental therapists feel overworked, stressed and geographically isolated. Dental therapists have contributed to the dental care delivery system in Alaska's YK Delta. Future opportunities remain within the system to address the needs of adults, develop strategies to retain dental therapists in the region and incorporate evidence-based, prevention-oriented strategies to improve oral health behaviours and reduce oral diseases.

Conservative and endodontic treatment performed under general anesthesia: A discussion of protocols and outcomes.

This work discusses the procedures and outcomes of restorative and endodontic treatments performed under general anesthesia, with examples from the Unit of Special Care Dentistry at the University Hospital of Clermont-Ferrand. The restorative and endodontic treatment techniques used in the Special Care Unit are described. These techniques are compared to existing reports in the literature of treatment procedures under general anesthesia. Little evidence was found in the literature regarding sealants or restorative protocols. A few studies described root canal treatment and pulpotomy protocols carried out under general anesthesia, and the results of these met academic outcome standards. Patients with equal needs should have equal access, equal quality of treatment and equal treatment outcomes, regardless of whether a facilitatory procedure is used to achieve treatment. The provision of restorative treatment under general anesthesia is essential to avoid an excessive number of extractions in patients unable to receive treatment in the chair. Restorative care provided under general anesthesia should be standardized and evaluated in the same way as treatment performed under local anesthesia. In this way, the provision of conservative dental care under general anesthesia could be promoted and the maintenance of a functional dentition encouraged.

Defining Serious Illness Among Adult Surgical Patients

ContextPalliative care (PC) for seriously ill surgical patients, including aligning treatments with patients' goals and managing symptoms, is associated with improved patient-oriented outcomes and decreased health care utilization. However, efforts to integrate PC alongside restorative surgical care are limited by the lack of a consensus definition for serious illness in the perioperative context. ObjectivesThe objectives of this study were to develop a serious illness definition for surgical patients and identify a denominator for quality measurement efforts. MethodsWe developed a preliminary definition including a set of criteria for 11 conditions and health states. Using the RAND-UCLA Appropriateness Method, a 12-member expert advisory panel rated the criteria for each condition and health state twice, once after an in-person moderated discussion, for validity (primary outcome) and feasibility of measurement. ResultsAll panelists completed both rounds of rating. All 11 conditions and health states defining serious illness for surgical patients were rated as valid. During the in-person discussion, panelists refined and narrowed criteria for two conditions (vulnerable elder, heart failure). The final definition included the following 11 conditions and health states: vulnerable elder, heart failure, advanced cancer, oxygen-dependent pulmonary disease, cirrhosis, end-stage renal disease, dementia, critical trauma, frailty, nursing home residency, and American Society of Anesthesiology Risk Score IV-V. ConclusionWe identified a consensus definition for serious illness in surgery. Opportunities remain in measuring the prevalence, identifying health trajectories, and developing screening criteria to integrate PC with restorative surgical care.

Outcomes of reablement and their measurement: Findings from an evaluation of English reablement services

Reablement – or restorative care – is a central feature of many western governments’ approaches to supporting and enabling older people to stay in their own homes and minimise demand for social care. Existing evidence supports this approach although further research is required to strengthen the certainty of conclusions being drawn. In countries where reablement has been rolled out nationally, an additional research priority – to develop an evidence base on models of delivery – is emerging. This paper reports a prospective cohort study of individuals referred to three English social care reablement services, each representing a different model of service delivery. Outcomes included healthcare‐ and social care–related quality of life, functioning, mental health and resource use (service costs, informal carer time, out‐of‐pocket costs). In contrast with the majority of other studies, self‐report measures were the predominant source of outcomes and resource use data. Furthermore, no previous evaluation has used a global measure of mental health. Outcomes data were collected on entry to the service, discharge and 6 months post discharge. A number of challenges were encountered during the study and insufficient individuals were recruited in two research sites to allow a comparison of service models. Findings from descriptive analyses of outcomes align with previous studies and positive changes were observed across all outcome domains. Improvements observed at discharge were, for most, retained at 6 months follow‐up. Patterns of change in functional ability point to the importance of assessing functioning in terms of basic and extended activities of daily living. Findings from the economic evaluation highlight the importance of collecting data on informal carer time and also demonstrate the viability of collecting resource use data direct from service users. The study demonstrates challenges, and value, of including self‐report outcome and resource use measures in evaluations of reablement.

The Minnesota Oral Health Project’s Primary Caries Prevention Program for Primary Care Medical Providers

Program Goals High risk children in Minnesota have limited access to dental care; consequently, the prevention of cavities is essential. Since many children on Minnesota Health Care Programs do not have a dental home and do not see a dentist for preventive care or restorative care, caries prevention must be offered by other health care professionals. Evaluation The Minnesota Oral Health Project (www.crushcavities.com) was founded following the Surgeon General’s 2000 conference on Oral Health in America as a means to address the limited access to pediatric dental …

Balance training using virtual reality improves balance and physical performance in older adults at high risk of falls.

PurposeExercise programs designed for falls prevention have been proven effective in reducing falls by approximately 21%. Virtual reality may provide a viable alternative intervention for falls prevention. This study compared the effects of virtual reality training using the Balance Rehabilitation Unit (BRU) versus exercise using a modified Otago Exercise Programme (EX) on improving balance and physical performance in the short-term restorative care setting of the Gait and Balance Gym (Gabagym).Patients and methodsThis was a pre- and post-intervention study of 195 participants (median age 78 years, IQR 73–84; 67% female) who presented with a risk and/or history of falls. Participants were assigned to either EX (n=82) or BRU (n=63). Supervised sessions occurred twice a week for 6 weeks. Participants receiving interventions were compared to a separate group (n=50) with similar characteristics who did not receive any intervention. Balance and physical performance were assessed at initial and final attendance and included the 5 Times Sit to Stand (5STS) test, Timed Up and Go (TUG), gait speed and posturography assessment using the BRU. Fear of falling was assessed using the Falls Efficacy Scale. Handgrip strength and adherence were also monitored.ResultsPost-intervention, EX and BRU groups achieved similar improvements and reported similar adherence rates (71% vs 72%, respectively). Both intervention groups improved in balance and physical performance measures. Both interventions showed significantly better improvement than the non-intervention group in TUG (p<0.001), gait speed (p=0.021), limits of stability in posturography assessment (p=0.008), FES-I score (p=0.013) and handgrip strength (p=0.021). Only the BRU group improved control of static posture in the eyes closed (p=0.002) and foam eyes closed (p=0.006) tasks.ConclusionThis study highlights the potential use of virtual reality as a practical alternative to improve outcomes of balance training for reduction of falls risk in older adults.

A function-focused approach in primary care for older people with functional decline: Making the most of reablement and restorative care

There is growing international interest in maximising the functional ability of older people. The aim of this article is to discuss 'reablement' and 'restorative care' in the context of providing a function-focused approach in primary care to address the needs of older people with functional decline. Loss of functional ability can profoundly affect an older person and is often what prompts them to seek healthcare. The emergence of reablement and restorative care isawelcome development in policy. Reablement andrestorative care are discussed in relation to current Australian Government-funded programs. These programs increase the availability of multidisciplinary services in community settings and support general practitioners (GPs) totake a comprehensive, 'function-focused' approach to the management of functional decline. GPs are important to identify and refer older people likely to benefit, and they play an essential part in effective program delivery.

Emergency department visits and dental procedures: Mission of Mercy, 2013-2016.

Objective: This study compared attendees at Wisconsin Mission of Mercy (MoM) events with and without prior emergency department (ED) visits for dental care in terms of demographic characteristics and dental procedures received.Methods: De-identified archival data available from the America’s Dentists Care Foundation (2013–2016) were analyzed. Summary statistics were calculated based on prior ED visit status for county-level characteristics and type of dental procedures received. Generalized estimating equation models with logistic links were fitted to examine associations between the predictor and independent variables.Results: Most attendees were White, adult females (mean age 37 years). Current dental pain was reported by 61% vs 33% of attendees with and without prior ED visit. Cleaning (57%) was the most common procedure received by attendees with no prior ED visits, while extractions (47%) were the most common for those with prior ED visits. Among MoM attendees, males had higher odds of prior ED visits compared to females. Compared to White, Black had higher odds and Hispanic had lower odds of having prior ED visits. In the multivariable analysis, dental pain (OR: 3.32; 95% CI: 2.75, 4.02) had the strongest association with prior ED visits. Attendees with prior ED visit history had higher odds of receiving extractions and restorative care, compared to cleaning after adjustment for person and county-level characteristics.Conclusion: Among MoM attendees, prior ED visits were associated with not being Hispanic, being male, and having dental pain. Compared to attendees with no prior ED visit, those with prior ED visits had higher odds of receiving restorative care and extractions.

Tooth wear and aging.

In an ageing population, tooth wear is likely to increase. It is increasing in prevalence in the younger population and a greater number of patients are retaining their teeth into old age. This paper is a narrative review of the clinical presentation, the epidemiology and the restorative intervention for erosive tooth wear. The dilemmas in managing this common condition with the aging dentition in mind are described. The paper discusses evidence-based prevention methods and highlights how preventive intervention may be preferable over extensive restorative care and high maintenance needs. Patient wishes, expectations and commitment to treatment and maintenance require consideration during clinical decision making. Successful management of erosive tooth wear in an ageing population depends on effective diagnosis, preventive intervention and holistic advice regarding restorative intervention.

Expansion of Dental Care for Low-Income Children Through a Mobile Services Program.

Although access to dental care has improved over time, many children still face difficulty in obtaining services. One strategy to increase access is through mobile dental services, often in collaboration with schools, Head Start programs, and school-based health centers. This study evaluates a large mobile dental care program based in Minnesota. Thematic analysis of interview data collected during a 2-day site visit and multivariate regression analysis of electronic records of patients (adults and children) that received care from 2000 through 2015, representing 84,279 unique patients. The number of patients increased from 5558 in 2000 to 13,863 in 2015. There was a decline in the share of preventive procedures over this period, from 45.7% to 29.4%, and an increase in the share of patients seen at fixed sites. The interview data revealed that program growth relied on relationships with school leaders, expanded scope of practice for dental assistants and dental therapists, and high Medicaid reimbursement. Mobile dental care programs can increase both preventive and restorative dental care for individuals who otherwise would not easily access oral health care services; mobile dental programs could be an option in many other communities and schools.

Autonomy and Participation As Common Goals of Nursing, Therapy and Social Medicine: Proposal for an Organizational Configuration Model on the Basis of Service Blueprinting

Every person who is in the need of long-term care (according to German Social Code SGB XI §14) fulfills the requirements of disability according to German Social Code SGB IX, § 2. The right of participation and autonomy must be specially protected and realized for persons with long-term care needs because these persons have a limited capacity to advance their interests. The rights of people in the need of long-term care or assistance are protected not only by the national constitution but also by the UN Disability Rights Convention. Participation is an important principle of these extra-statutory regulations and has an extraordinary significance and individual meaning for quality of life. For concretizing the aim of participation and for realizing participation in daily practice, the following question arises: How must organizations be configured to achieve individual aims of participation for persons with long-term care need, complex health care needs and with potential for rehabilitation across sectoral, disciplinary and professional borders? This analysis focuses on people older than 70 years with geriatric-relevant multimorbidity and with potential for rehabilitation. The aim of this study was to create a configuration model for the organization of interdisciplinary cooperation in rehabilitation out of a case study and on the basis of the service blueprinting method [1]. In a next step this configuration model can be evaluated concerning its effectiveness for achieving individual participation goals and quality of life of persons with long-term care need and with potential for rehabilitation. For creating the configuration model, the service blueprinting method [1] on the basis of Dervin's sense making theory [11] was applied to a case vignette of geriatric rehabilitation against a background of organization theories and nursing science concepts. With the case study the configuration model can be applied exemplarily at the setting of restorative care, therapy and rehabilitation. With the service blueprinting method, the rehabilitation process is aligned onto the geriatric patient's individual health care needs, perceptions of participation and quality of life. As a result of the sequencing and service blueprinting process we offer a dynamic model for the coordination of responsibility of interdisciplinary rehabilitation teams with a user-centered alignment. Its effectiveness (and side-effects) for interdisciplinary cooperation and for patient's individual goals of participation and quality of life must be evaluated in further studies. A mixed-method design should be used to evaluate objective outcome parameters such as dependency on nursing care, hospital admission rates and subjective outcome parameters such as patient's perception of participation, autonomy and quality of life. The configuration model can be used for evaluating already implemented geriatric rehabilitation processes and organizations. The configuration model can be used in health care research or organizational research. After more evidence for desirable effects, it can be implemented into the health care system. Side effects should be monitored.This paper was written in cooperation with the working group "Nursing", department "Practical Social Medicine and Rehabilitation" of the German Society of Social Medicine and Prevention (Deutsche Gesellschaft für Sozialmedizin und Prävention DGSMP e.V.).