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Background: Maximum phonation time (MPT) is used to assess speech and other oral rehabilitation‐related issues. Various factors contribute to MPT decline in older individuals. Although the impact of physical frailty on MPT has been suggested, this has not been conclusively determined. Objective: To examine the relationship between MPT and physical frailty in community‐dwelling individuals aged ≥60 years who were independently mobile. MPT‐associated factors were investigated. Methods: This cross‐sectional study analysed the clinical data of 122 patients (age [interquartile range]: 80.0 [74.0–83.0] years) without dementia who visited a neurology department between 1 February 2021 and 31 January 2023. Investigated factors included age, sex, weight, height, body mass index, smoking history, grip strength, functional independence measure, vital capacity, oral diadochokinesis, MPT and the Japanese Cardiovascular Health Study score. Physical frailty was assessed based on the total score from five items (weight loss, weakness, exhaustion, slowness and low physical activity). The relationship between MPT and physical frailty was examined using Spearman's rank correlation coefficient and hierarchical multiple regression analysis. Results: The MPT was negatively correlated with age (r = −0.347, p <.01) and physical frailty (r = −0.681, p <.01) and positively correlated with vital capacity (r = 0.474, p <.01) and height (r = 0.248, p <.01). The hierarchical multiple regression analysis, conducted with MPT as the dependent variable, demonstrated that physical frailty (β = −.59, 95% confidence interval: −0.74 to 0.43, p <.001) had a strong influence on MPT. Conclusion: In older individuals, MPT is associated with physical frailty. When assessing MPT in clinical settings, it is advisable to perform a concurrent assessment of physical frailty. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal Stromal Tumors (GISTs) are the most common mesenchymal tumors of the GI tract. SEER is an extensive cancer database which proves useful in analyzing population trends. This analysis investigated GIST outcomes between geriatric & non‐geriatric patients. Methods: SEER*STAT 8.4.0.1 was used to extract relevant GIST data from 2000 to 2019. Geriatric age was defined as ≥70 years. Variables included age, sex, surgery, cancer‐specific death, and overall survival. Statistical tests included univariate analysis using KM survival estimate (95% confidence interval) to calculate 5‐year survival (5YS). Log‐Rank tests determined statistical significance. Multivariable Cox's PH regression estimated the geriatric hazard death ratio adjusted for sex, stage, and surgery. Results: The number of patients included was 13,579, yielding overall 5YS of 68.6% (95% CI 67.7–69.5). Cancer‐specific death was 39.11% in 2000 & 3.33% in 2019. Non‐geriatric & geriatric patient data yielded 5YS of 77.4% (76.4%–78.3%) and 53.3% (51.7%–54.8%) respectively (p < 0.0001). For no surgery/surgery, younger patient data yielded 5YS of 48.7% (45.8%–51.4%) and 83.7% (82.7%–84.7%) respectively (p < 0.0001); geriatric data yielded 5YS of 29.3% (26.5%–32.1%) and 62.8% (60.8%–64.6%) respectively (p < 0.0001). Multivariable analysis yielded a geriatric hazard death of 2.56 (2.42–2.70) (p < 0.0001). Conclusions: Cancer‐specific death decreased since 2000, indicating an improvement in survival & treatment methods. Observed lower survival rates overall in the geriatric group. Surgery appeared to enhance survival rates in both groups, suggesting that surgery is an important factor in GIST survival regardless of age. Large prospective studies will help define clinical management for geriatric patients. [ABSTRACT FROM AUTHOR]

Introduction: Stroke poses challenges to the physiological, psychosocial and spiritual well‐being of affected individuals. As the impacts of stroke might not be reversible, a shift in focus to providing care is desirable. Visual art interventions using visual and symbolic art can help participants to express their feelings, give them a sense of choice and the feeling that they are retaining a sense of control, promote insights, restructure their sense of cognition and instil hope. There have been few studies on visual art interventions involving older people with stroke and none in residential care homes (RCHs). Theoretical support and rigorous research designs on the subject are lacking. Thus, this study seeks to address this research gap by examining the feasibility of a visual art intervention for older people in RCHs and exploring the impacts on their holistic well‐being. Methods: This was a single‐blinded, two‐arm, randomised controlled feasibility study grounded on Watson's Caring Theory. The Holistic Well‐Being Scale and Caring Factor Survey were used in the study, with three assessment time‐points: before the intervention (T1), at the mid‐point of the intervention (T2) and immediately after the intervention (T3). Results: Sixty‐one older people with stroke were recruited from 14 RCHs and randomised into the intervention and control groups. The recruitment rate was 44.53%, and the retention rate for the intervention group was 93.55%. Implementing the programme was affordable (at approximately US$126/head), the duration was acceptable (721 min) and the feedback from participants and staff of the RCHs was positive. Conclusions: The visual art intervention programme proved to be clinically feasible. This study adds new insights to the development of visual art interventions and to the caring sciences. The efficacy of the programme on holistic well‐being has yet to be confirmed. [ABSTRACT FROM AUTHOR]

Background: An increasing number of older patients are undergoing emergency laparotomy (EL). Frailty is thought to contribute to adverse outcomes in this group. The best method to assess frailty and impacts on long‐term mortality and other important functional outcomes for older EL patients have not been fully explored. Methods: A prospective multicenter study of older EL patients was conducted across four hospital sites in New Zealand from August 2017 to September 2022. The Clinical Frailty Scale (CFS) was used to measure frailty—defined as a CFS of ≥5. Primary outcomes were 30‐day and one‐year mortality. Secondary outcomes were postoperative morbidity, admission for rehabilitation, and increased care level on discharge. A multivariate logistic regression analysis was conducted, adjusting for age, sex, and ethnicity. Results: A total of 629 participants were included. Frailty prevalence was 14.6%. Frail participants demonstrated higher 30‐day and 1‐year mortality—20.7% and 39.1%. Following adjustment, frailty was directly associated with a significantly increased risk of short‐ and long‐term mortality (30‐day aRR 2.6, 95% CI 1.5, 4.3, p = <0.001, 1‐year aRR 2.0, 95% CI 1.5, 2.8, p < 0.001). Frailty was correlated with a 2‐fold increased risk of admission for rehabilitation and propensity of being discharged to an increased level of care, complications, and readmission within 30 days. Conclusion: Frailty was associated with increased risk of postoperative mortality up to 1‐year and other functional outcomes for older patients undergoing EL. Identification of frailty in older EL patients aids in patient‐centered decision‐making, which may lead to improvement in outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Persistent musculoskeletal (MSK) pain is associated with physical inactivity in older people. While walking is an acceptable form of physical activity, the effectiveness of walking interventions in this population has yet to be established. Objectives: To assess the acceptability and feasibility of conducting a randomised controlled trial (RCT) to test the effectiveness of a healthcare assistant‐led walking intervention for older people with persistent MSK pain (iPOPP) in primary care. Methods: A mixed method, three arm pilot RCT was conducted in four general practices and recruited patients aged ≥65 years with persistent MSK pain. Participants were randomised in a 1:1:1 ratio to: (i) usual care, (ii) usual care plus a pedometer intervention, or (iii) usual care plus the iPOPP walking intervention. Descriptive statistics were used in an exploratory analysis of the quantitative data. Qualitative data were analysed using thematic analysis. A triangulation protocol was used to integrate the analyses from the mixed methods. Results: All pre‐specified success criteria were achieved in terms of feasibility (recruitment, follow‐up and iPOPP intervention adherence) and acceptability. Triangulation of the data identified the need, in the future, to make the iPOPP training (for intervention deliverers) more patient‐centred to better support already active patients and the use of individualised goal setting and improve accelerometry data collection processes to increase the amount of valid data. Conclusions: This pilot trial suggests that the iPOPP intervention and a future full‐scale RCT are both acceptable and feasible. The use of a triangulation protocol enabled more robust conclusions about acceptability and feasibility to be drawn. [ABSTRACT FROM AUTHOR]

Objectives: Using a multi‐ethnic Asian population, this study assessed adherence to prescribed home exercise programs, explored factors predicting adherence, and evaluated whether home exercise adherence was associated with physical activity. Methods: A prospective cohort study was conducted in 68 older adults (aged ≥65 years) from two geriatric outpatient clinics in Singapore, who were receiving tailored home exercises while undergoing 6 weeks of outpatient physical therapy for falls prevention. Adherence was measured as the percentage of prescribed sessions completed. Predictor variables included sociodemographic factors, clinical characteristics, intervention‐specific factors, and physical and psychosocial measures. Multivariable linear regressions were performed to develop a model that best predicted adherence to prescribed exercise. Physical activity levels, measured by accelerometry, were analyzed by cross‐sectional univariate analysis at 6 weeks. Results: The mean adherence rate was 65% (SD 34.3%). In the regression model, the number of medications [B = 0.360, 95% CI (0.098–0.630)], social support for exercising [B = 0.080, 95% CI (0.015–0.145)], and self‐efficacy for exercising [B = −0.034, 95% CI (−0.068–0.000)] significantly explained 31% (R2 = 0.312) of the variance in exercise adherence. Older adults with better adherence took more steps/day at 6 weeks [B = 0.001, 95% CI (0.000–0.001)]. Conclusions: Low adherence to home exercise programs among older adults in Singapore, emphasizing the need for improvement. Counterintuitively, older adults with more medications, lower exercise self‐efficacy, but with greater social support demonstrated higher adherence. Addressing unmet social support needs is crucial for enhancing adherence rates and reducing fall risks. [ABSTRACT FROM AUTHOR]

Aims: Older adults are vulnerable to medication‐related harm mainly due to high use of medications and inappropriate prescribing. This study aimed to investigate the associations between inappropriate prescribing and number of medications identified at discharge from geriatric rehabilitation with subsequent postdischarge health outcomes. Method: RESORT (REStORing health of acutely unwell adulTs) is an observational, longitudinal cohort study of geriatric rehabilitation inpatients. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were measured at acute admission, and at admission and discharge from geriatric rehabilitation, using Version 2 of the STOPP/START criteria. Results: In total, 1890 (mean age 82.6 ± 8.1 years, 56.3% female) were included. The use of at least 1 PIM or PPO at geriatric rehabilitation discharge was not associated with 30‐day and 90‐day readmission and 3‐month and 12‐month mortality. Central nervous system/psychotropics and fall risk PIMs were significantly associated with 30‐day hospital readmission (adjusted odds ratio [AOR] 1.53; 95% confidence interval [CI] 1.09–2.15), and cardiovascular PPOs with 12‐month mortality (AOR 1.34; 95% CI 1.00–1.78). Increased number of discharge medications was significantly associated with 30‐day (AOR 1.03; 95% CI 1.00–1.07) and 90‐day (AOR 1.06; 95% CI 1.03–1.09) hospital readmissions. The use and number of PPOs (including vaccine omissions) were associated with reduced independence in instrumental activities of daily living scores at 90‐days after geriatric rehabilitation discharge. Conclusion: The number of discharge medications, central nervous system/psychotropics and fall risk PIMs were significantly associated with readmission, and cardiovascular PPOs with mortality. Interventions are needed to improve appropriate prescribing in geriatric rehabilitation patients to prevent hospital readmission and mortality. [ABSTRACT FROM AUTHOR]

Aims: (1) To review and synthesize research on the contributions of nurses to rehabilitation in inpatient geriatric rehabilitation units (GRUs), and (2) to compare these reported contributions to the domains of international rehabilitation nursing competency models. The roles and contributions of nurses (e.g. Registered Practical Nurses, Registered Nurses and Licensed Practical Nurses) in GRUs are non‐specific, undervalued, undocumented and unrecognized as part of the formal Canadian rehabilitation process. Design: Arksey and O'Malley's methodological framework for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews guidelines were used. Methods: Six databases were searched for relevant literature: MEDLINE, PsychINFO, CINAHL, EMBASE, SCOPUS and Nursing and Allied Health. English articles were included if they examined nursing roles or contributions to inpatient geriatric rehabilitation. Integrated synthesis was used to combine the qualitative and quantitative data, and thematic analysis was used for coding. Three sets of international competency models were amalgamated to explore how different nurse roles in geriatric rehabilitation were portrayed in the included literature. Results: Eight studies published between 1991 and 2020 were included in the review. Five main geriatric rehabilitation nursing roles were generated from synthesis of the domains of international rehabilitation nursing competency models: conserver, supporter, interpreter, coach and advocate. Conclusions: Nurses working in inpatient geriatric rehabilitation are recognized more for their role in conserving the body than their roles in supporting, interpreting, coaching and advocacy. Interprofessional team members appear to be less sure of the nurses' role in the rehabilitation unit. Nurses themselves do not acknowledge the unique rehabilitation aspects of care for older adults. Enhancing formal education, or adding continuing education courses, to facilitate role clarity for nurses in geriatric rehabilitation could improve nurses' and interprofessional healthcare team members' understandings of the possible contributions of nurses working in rehabilitation settings. [ABSTRACT FROM AUTHOR]

Objective: To understand the barriers and enablers to participation in family‐assisted therapy for older people in Transition Care. Methods: A qualitative study, underpinned by interpretive description, was conducted at two public health services in Melbourne, Australia. Participants included patients in Transition Care, or their family members, who either participated in or chose not to participate in a family‐assisted therapy trial. Semi‐structured interviews were conducted, transcribed verbatim and analysed thematically. Results: Forty‐four participants were interviewed (17 patients and 27 family members). The unifying theme was to let families decide about participation in family‐assisted therapy. The unifying theme was illustrated by three subthemes. The first, what is possible for the family now, described practical considerations including geography, paid and unpaid work structure and commitments and the presence of fit and willing social networks. The second, what is important to the family now, recognised the role of family priorities in deciding. Physical rehabilitation and extra therapy were of high importance to some families. For others, emotional support or searching for a residential aged care bed were more important at the time. Finally, how the family functions described the complexity of relationships and family history that impacted the decision to participate. Conclusions: The decision to participate in family‐assisted therapy is complex and is best made by patients and their families. Clinicians offering family‐assisted therapy are encouraged to avoid assuming what will or will not work for families and instead, to let families decide. [ABSTRACT FROM AUTHOR]

Background: Nurses are consistently present throughout the rehabilitation of older patients but are apprehensive about performing goal‐centred care in the multidisciplinary team. Objectives: The aim of this review was to explore working interventions on setting goals and working with goals designed for nurses in geriatric rehabilitation, and to describe their distinctive features. Methods: We performed a scoping review. We searched MEDLINE and CINAHL through August 4, 2021. Search terms related to the following themes: nurses, rehabilitation, geriatric, goal and method. We used snowballing to find additional. From the selected studies, we systematically extracted data on means, materials and the nursing role and summarized them in a narrative synthesis, using intervention component analysis. Results: The study includes 13 articles, describing 11 interventions which were developed for six different aims: improving multidisciplinary team care; increasing patient centredness; improving disease management by patients; improving the psychological, and emotional rehabilitation; increasing the nursing involvement in rehabilitation; or helping patients to achieve goals. The interventions appeal to four aspects of the nursing profession: assessing self‐care skills incorporating patient's preferences; setting goals with patients, taking into account personal needs and what is medically advisable; linking the needs of the patient with multidisciplinary professional treatment and vice versa; and thus, playing an intermediate role and supporting goal achievement. Conclusions: The interventions show that in goal‐centred care, the nurse might play an important unifying role between patients and the multidisciplinary team. With the support of nurses, the patient may become more aware of the rehabilitation process and transfer of ownership of treatment goals from the multidisciplinary team to the patient might be achieved. Not many interventions were found meant to support the nursing role. This may indicate a blind spot in the rehabilitation community to the additional value of its contribution. [ABSTRACT FROM AUTHOR]

Inhalation therapy represents the standard of care in children, adolescents as well as in young, middle‐aged and geriatric adults with asthma or chronic obstructive pulmonary disease. However, there are only few recommendations for the choice of inhalation devices, which consider both, age‐specific limitations in young and geriatric patients. Transition concepts are lacking. In this narrative review, the available device technologies and the evidence for age‐specific problems are discussed. Pressurized metered‐dose inhalers may be favoured in patients who fulfill all cognitive, coordinative and manual power requirements. Breath‐actuated metered‐dose inhalers, soft‐mist inhalers or the use of add‐on devices such as spacers, face masks and valved holding chambers may be suitable for patients with mild to moderate impairments of these variables. In these cases, available resources of personal assistance by educated family members or caregivers should be used to allow metered‐dose inhaler therapy. Dry powder inhalers may be reserved for patients with a sufficient peak inspiratory flow and good cognitive and manual abilities. Nebulizers may be indicated in persons who are either unwilling or unable to use handheld inhaler devices. After initiation of a specific inhalation therapy, close monitoring is essential to reduce handling mistakes. An algorithm is developed that considers age and relevant comorbidities to support the decision‐making process for the choice of an inhaler device. [ABSTRACT FROM AUTHOR]

Background: Poor oral health is known to be associated with frailty in geriatric populations. Recent exposure to anticholinergic medications is responsible for features of poor oral health. Anticholinergic medications pose a cumulative risk for frailty. Methods: We studied 115 geriatric inpatients (aged >65 years and recruited over a 3‐month period from October to December 2017). Patients who were severely agitated, cognitively impaired, from a non‐English speaking background and with severe sensory impairment were excluded. Frailty and oral health were assessed using the Reported Edmonton Frailty Scale and the Oral Health Assessment Test, respectively. Exposure to anticholinergic medications was assessed using the Anticholinergic Burden Scale. Results: The mean age was 80 (range from 66 to 101). Only 44 patients (38.3%) were not exposed to any anticholinergic medication. Nearly two‐thirds of patients were taking anticholinergic medications, with 25% classified as having a high anticholinergic burden (ACB ≥ 4). Approximately one‐third of severely frail patients were exposed to a high anticholinergic burden. Patients with a high anticholinergic burden were more than twice as likely to have severe frailty (OR 2.21; 95% confidence interval 1.05–4.6). Poor oral health was associated with frailty (OR 1.24; 95% CI 1.02–1.49). Conclusion: High anticholinergic burden was found to be a risk marker for severe frailty independent of its effect on oral health. Poor oral health was associated with all levels of frailty. This study highlights a need for a review of medications with anticholinergic properties in older patients. Further research should be directed at whether deprescribing could prevent poor oral health or slow the progression of frailty. [ABSTRACT FROM AUTHOR]

Background: Skilled nursing rehabilitative care plays a critical role in older adults' functional recovery impacting post‐discharge outcomes. Variations across post‐acute rehabilitative care services and patient outcomes indicate a need to improve rehabilitative care in this setting. We adapted a successful outpatient care program (Live Long Walk Strong‐LLWS) to address this need in post‐acute care settings within the Veterans Health Administration. LLWS differs from standard PT care by treating impairments linked to functional decline that are not traditionally targeted by standard care, providing formalized coaching to optimize behavior change, and providing post‐discharge case management to optimize long‐term outcomes. The purpose was to adapt, refine and implement the LLWS program for the Community Living Center (CLC), determine its acceptability and feasibility, and evaluate its preliminary effectiveness among older adults. Methods: The design of the program was adapted from the original outpatient LLWS program to the CLC setting through quality improvement methods and the Replicating Effective Programs (REP) framework. Primary outcomes included measures of feasibility and acceptability of >80% enrollment and completion of sessions as well as preliminary effectiveness using performance‐based and patient‐reported measures of function including the Short Physical Performance Battery (SPPB), AM‐PAC, a Global Rating of Change questionnaire, and a satisfaction survey. Results: After 18 months, 51 Veterans had enrolled in the LLWS program, with 94.1% maintaining enrollment. We observed >80% completion of the inpatient and home follow‐up sessions. Most patients were highly satisfied with care. Improvements in the SPPB (2.3 (SD 2.2) points), gait speed (0.17 (0.14) m/s) and the AM‐PAC (6.5 (SD 5.7)) surpassed clinically meaningful thresholds. Conclusions: This novel care program is feasible and acceptable to Veterans, demonstrating preliminary effectiveness with improving functional outcomes. Future research is needed to further examine the program's impact on other important outcomes relative to standard modes of care. [ABSTRACT FROM AUTHOR]

Rationale: Hearing loss is a common problem for older adults entering rehabilitation hospitals. Aims and Objectives: To pilot a hearing loss screening device to determine feasibility, usability, and impact on patient outcomes. Methods: We screened all patients newly admitted to a geriatric day hospital for hearing loss using the SHOEBOX® QuickTest (SHOEBOX Ltd.) app as part of a quality improvement programme. We measured the time it took for each patient to complete screening and recorded any issues they had using the app. We recorded the number of patients who screened positive who did not have a previous diagnosis and changes in physician behaviours after they received their patients' results. Results: Seventy‐four patients with a mean age of 83.4 years used the hearing screener. All patients were able to complete the screening with a mean time to completion of 10 min and 48 s. Ninety‐nine percent of patients screened positive for hearing loss. Of these positives 56% were in participants not already known to have hearing loss. Physicians often changed their behaviour after receiving results by using assistive devices during visits and referring to audiology for formal testing. Conclusions: Screening for hearing loss is feasible in a geriatric day hospital. The SHOEBOX QuickTest app is acceptable, usable, resulting in the identification of undiagnosed hearing loss and in changes to physician behaviour. [ABSTRACT FROM AUTHOR]

Objective: To evaluate outcomes associated with an integrated inpatient and outpatient program aimed at optimizing the care of geriatric fracture patients in a mixed community and academic health system setting. Data Sources and Study Setting: This study took place at a tertiary‐care, 886‐bed hospital system. The Geriatric Fracture Program (GFP) was designed in 2018 using the 4Ms Framework (What Matters, Medication, Mentation, and Mobility). Patients ≥65 years old with non‐spine fractures managed by orthopedic faculty surgeons and participating hospitalist groups were included. A fracture liaison team educated patients regarding bone health and ensured ambulatory geriatrics follow‐up. Outpatient geriatric visits focused on mobility, fall risk, bone health imaging, and medications. Study Design: We compared GFP‐enrolled patients (n = 746) to patients seen by non‐GFP‐participating physicians (n = 852) and used a generalized estimating equations approach and Poisson models to analyze associations between participation in the GFP program and four inpatient outcomes (time to surgery, length of stay, Vizient length of stay index, and total direct costs). We examined outcomes across all fractures and also stratified them by fracture type (hip vs. non‐hip). We descriptively examined post‐discharge care outcomes: fall, gait, and balance assessments; bone health imaging; and medications. Data Collection/Extraction Methods: We collected data through chart reviews/electronic health record extracts from July 2018 to June 2021. Principal Findings: GFP‐enrolled patients with all fracture types had a significantly lower length of stay (marginal effect [ME]: −2.12, 95%CI: −2.61, −1.63), length of stay index (ME: −0.33, 95%CI: −0.42, −0.25), and total direct costs (ME: −$5316, 95%CI: −$6806, −$3826); the magnitude of the effects was greater for non‐hip fractures. There was no significant difference in time to surgery. Of 746 GFP patients, 170 (23%) had a post‐discharge visit with a participating geriatrician ≥6 months. Conclusions: A systematic approach to improving care for older adults with fractures improved length of stay and total direct costs. [ABSTRACT FROM AUTHOR]

Aim: This paper analyzes the adaptive changes that take place in mature and elderly women with different track records in social sports in order to develop health and rehabilitation techniques based on personalized and groupwise approaches. Methods: This longitudinal study was conducted between 2009 and 2019 in Zhengzhou, China. The sample consisted of 24 mature and elderly women (45–65 years old) in the experimental group (regular social sports) and 40 women of the same age who did not exercise (control group). The experimental group received physiotherapy twice a week. The sessions were scheduled for 10 a.m. and lasted for 3 h. The functional status of cardiovascular system parameters (blood pressure, heart rate) was measured. In addition, the physical working capacity (PWC 150), as well as the coefficient of body adaptation to stress and the Robinson index (the amount of oxygen required by the human body to function) were estimated. Results: Women from the experimental group maintained stable coefficients of adaptation during all 10 years over which the study was conducted. Women with a long track record (up to 10 years) revealed a slight increase in the body's functional capacity (P ≤ 0.05 with control). More than 50% of the women in the experimental group had cardiovascular measurements within or above the normal range, whereas the opposite was true in the control group. Conclusions: The longitudinal study revealed upward trends of physical working capacity indicators, which can slow down involutional changes in the body. In some cases, the body's functional capacity may be improved. Geriatr Gerontol Int 2023; 23: 98–102. [ABSTRACT FROM AUTHOR]

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

Comprehensive medication management (CMM) is defined as the standard of care that ensures each patient's medications are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given any comorbidities and other medications being taken, and able to be taken by the patient as intended. The practice management component of CMM can be defined as "the structural and system level supports within a practice related to practice management and operations that enable the efficiency, effectiveness, and sustainability of CMM services." To date, there has been no consistent process in the Veterans Health Administration (VHA) to evaluate CMM practice management standardization. This article will describe the VHA effort in development, implementation, and outcomes of a CMM practice optimization tool modified from an existing tool. A modified version of practice management assessment tool was developed to integrate and align with VHA clinical pharmacy practice and policy. The VHA CMM Practice Optimization and Evaluation Tool (POET) was developed to access CMM practice management in multiple practice areas and was deployed for assessment in all VHA facilities. From May 2021 to March 2022, 352 practice area evaluations were completed at 152 VHA facilities using POET. Total submission practice area detail was gathered from 245 Patient Aligned Care Team (primary care), 32 outpatient mental health, 29 acute care, 11 pain, 11 specialty ambulatory care, 8 geriatric community living centers (eg, long‐term care) or hospice, 6 home‐based primary care, 4 critical care, 4 emergency department, and 2 residential rehabilitation and treatment programs. This work evaluating the five essential core practice management domains of CMM using a standardized evaluation process revealed that the VHA could adapt a tool that yields immeasurable information for standardization of CMM provided by a clinical pharmacist. [ABSTRACT FROM AUTHOR]

Background: Communicating about medications across transitions of care is important in older patients who frequently move between health care settings. While there is increasing interest in understanding patient communication across transitions of care, little is known about older patients' involvement in formal and informal modes of communication regarding managing medications. Objective: The aim of this paper was to explore how older patients participated in managing their medications across transitions of care through formal and informal modes of communication. Methods: The study was conducted across two metropolitan hospitals: an acute hospital and a geriatric rehabilitation hospital in metropolitan Melbourne, Australia. A focused ethnographic design was used involving semi‐structured interviews (n = 50), observations (203 h) and individual interviews or focus groups (n = 25). Following thematic analysis, data were analysed using Fairclough's Critical Discourse Analysis. Results: Data analysis revealed two major discursive practices, which comprised of an interplay between formal and informal communication and environmental influences on formal and informal communication. Self‐created patient notes were used by older patients to initiate informal discussion with health professionals about medication decisions, which challenged traditional unequal power relations between health professionals and patients. Formal prompts on electronic medication administration records facilitated the continuous information discourse about patients' medications across transitions of care and encouraged health professionals to seek out older patients' preferences through informal bedside interactions. Environmental influences on communication comprised health professionals' physical movements across private and public spaces in the ward, their distance from older patients at the bedside and utilization of the computer systems during patient encounters. Conclusion: Older patients' self‐created medication notes enabled them to take on a more active role in formal and informal medication communication across transitions of care. Older patients and family members did not have continuous access to information about medication changes during their hospital stay and systems often failed to address older patients' key concerns about their medications, which hindered their active involvement in formal and informal communication. Patient or Public Contribution: Older adults, family members and health professionals volunteered to be interviewed and observed. [ABSTRACT FROM AUTHOR]

Objective: To investigate geriatricians' views about issues facing geriatric medicine, and the preparedness of the health‐care system during the COVID‐19 pandemic. Methods: An online survey of heads of geriatric medicine departments in hospitals in Australia and New Zealand undertaken in May 2020. Results: The majority of hospitals had admitted one or more patients with suspected COVID‐19. Most geriatricians believed their hospital was 'adequately' or 'well prepared' for the pandemic. Inpatient capacity increased to manage acute, post‐acute and rehabilitative care of older patients with COVID‐19. Non‐inpatient services for older people were reduced and telehealth‐instituted widely. Increases in work hours, on‐call and staffing levels were reported. Geriatricians voiced major concerns about the preparedness of residential aged care facilities to manage the pandemic. Conclusions: The COVID‐19 pandemic impacted on geriatricians and the provision of geriatric medicine services. Many issues that subsequently affected older people were predicted in advance. [ABSTRACT FROM AUTHOR]

Aim: Executive dysfunction is pathognomonic for dementia and impedes the activities of daily living (ADL). This study aimed to examine the relationship of dementia severity with executive dysfunction and ADL in mild cognitive impairment and dementia. Methods: This single‐center study enrolled 86 patients (men, 40; women, 46; mean age, 76.1 ± 7.5 years) referred for cognitive and physical rehabilitation between October 2015 and September 2020. The Clinical Dementia Rating (CDR) was 0.5, 1, and ≥2 in 45, 30, and 11 patients, respectively. The presence and severity of executive dysfunction were assessed using the Behavioral Assessment of the Dysexecutive Syndrome–Japanese version (BADS). The ADL and instrumental ADL (IADL) were assessed using the Barthel Index and Frenchay Activities Index (FAI), respectively. We examined the relationship between CDR severity and overall BADS profile score and its sub‐items, and that between the overall BADS profile score and IADL. Results: The cognitive and executive functional assessment scores differed significantly depending on the CDR severity. The CDR severity and overall BADS profile score exhibited significant correlations. The BADS found cognitive impairment in 31%, 70%, and 100% of patients with CDR0.5, CDR1, and CDR≥2, respectively. The FAI score differed according to the CDR severity in women but not in men. The overall profile and age‐adjusted BADS scores were strongly correlated with the IADL in women but not in men. Conclusions: The greater the severity of executive dysfunction, the greater the difficulty in performing ADL. This effect was more pronounced in women and may predict dementia progression. Geriatr Gerontol Int 2021; 21: 1111–1117. [ABSTRACT FROM AUTHOR]

Objectives: Geriatrician impact on patient and system outcomes in formal rehabilitation settings has not been well described to date. We studied the effect of adding a geriatric medicine consultation service to a geriatric focused rehabilitation setting providing care to dialysis and non‐dialysis patients. Design/setting/participants: A pre‐ and post‐retrospective observational cohort study from January 1, 2009 to June 30, 2019 on all consecutively admitted adults aged 65 and older to general rehabilitation program, and adults aged 60 and older to specialized dialysis rehabilitation program, within a 25 bed general rehabilitation unit in a large urban academic rehabilitation center in Toronto, Ontario. Data were analyzed with quality improvement methodology including Statistical Process Control charts (XmR and U charts). Intervention: Addition of a geriatric medicine service providing automatic comprehensive geriatric assessment and co‐management consultative services for all admitted patients from admission onwards who met criteria for the intervention. The intervention commenced on August 1, 2013. Measurements Outcome measures were length of stay (days), service interruption frequency, and average functional independence measure (FIM) change (discharge FIM minus admission FIM) which uses the validated FIM score, a marker of functional ability. A 22 point change in FIM score is clinically relevant. Results: Patient characteristics: general rehabilitation patients (n = 1395, mean age = 79.7, 50.1% female) and dialysis rehabilitation patients (n = 838, mean age = 72.8, 41.8% female). The average FIM change following intervention improved from 20.8 to 29.3 in the general rehabilitation cohort (40.6% improvement, SD = 5.51) and from 22.1 to 30.6 in the dialysis rehabilitation cohort (38.6% improvement, SD = 5.88). Changes in length of stay (24.9%–28.1% reduction) and service interruption frequency (34.3%–49.7% reduction) were also observed. Conclusion: Introduction of a geriatric medicine service for rehabilitation inpatients was associated with significant FIM score improvements. Our results suggest this intervention contributes to important gains in functional independence in reduced time for older adults receiving inpatient rehabilitative care. [ABSTRACT FROM AUTHOR]

Background and purpose: Febrile‐infection‐related epilepsy syndrome (FIRES) is an exceedingly rare and devastating subtype of new‐onset refractory status epilepticus, which causes refractory epilepsy and permanent neurocognitive impairment. Methods: This was a long‐term follow‐up of adult FIRES survivors treated between 2005 and 2018 as part of the EpiCARE initiative, a European Reference Network for rare and complex epilepsies. Clinical, electroencephalography, imaging and functional outcome measures are described using the Scores of Independence for Neurologic and Geriatric Rehabilitation, the modified Rankin Scale and the Global Assessment of Severity of Epilepsy Scale. Results: Six patients with refractory epilepsy following FIRES were evaluated. Despite general improvement after intensive care unit discharge, disease severity was still high at follow‐up in all patients. The functional outcome, as assessed by the modified Rankin Scale, was moderately impaired in 2/6 patients. In contrast, the Scores of Independence for Neurologic and Geriatric Rehabilitation indicated a loss of independence in 5/6, serious problems in memory and planning/problem‐solving in 4/6 and serious attentional problems in 3/6 patients. Conclusions: Febrile‐infection‐related epilepsy syndrome survivors may regain vital functions and mobility but experience a significant loss of independence and participation due to recurring seizures, structural brain damage and neurocognitive decline. Minimization of disastrous outcomes through the systematic evaluation of rescue therapies within a network of specialized centres is crucial. [ABSTRACT FROM AUTHOR]

Objective: To identify functional performance trajectories and the characteristics of people who receive inpatient geriatric rehabilitation after hospital admissions. Design, setting, participants: REStORing 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 measures: Functional 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. Results: A 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). Conclusions: Based 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. [ABSTRACT FROM AUTHOR]

Background and Purpose: Regaining functional independence and independent living is challenging in hospitalized geriatric patients. Different from community dwelling and institutionalized older people, geriatric patients on rehabilitation wards generally receive more frequent and structured physiotherapy with the primary aim to discharge them to their home or place of residence. There is a paucity of evidence concerning the structure and components of physiotherapy programs to improve functional performance in this particular group. In this paper, we describe how we developed the Geriatric Activation Program Pellenberg (GAPP) based on patients' needs and available literature. Methods: We searched the literature on physiotherapy interventions focusing on the core components for improvement of functional performance: strength, balance, function, (gait)speed, coordination, and endurance training. Based on physiotherapist staffing and physiotherapy time allocated to each patient, we organized the practical, daily delivery of the program. Results: GAPP is a 5‐day program, repeated weekly, delivered by physiotherapists and physiotherapy students. Each day, one or a combination of two to three different core components of functional performance is trained intensively in 45‐min sessions. A set of standard exercises is constantly adjusted to each patients' capacity. On day 5, there is a mix of these core elements in a group session (e.g., chair‐dance, table tennis, karate) and the Berg Balance Scale is completed to evaluate progress. Conclusion: GAPP is a multicomponent physiotherapy program for hospitalized patients on a geriatric rehabilitation ward, aimed at improving functional performance. [ABSTRACT FROM AUTHOR]

Background: Discussing patient preferences for cardio‐pulmonary resuscitation (CPR) is routine in hospital admission for older people. The way the conversation is conducted plays an important role for patient comprehension and the ethics of decision making. Objective: The objective was to examine how CPR is explained in geriatric rehabilitation hospital admission interviews, focussing on circumstances in which physicians explain CPR and the content of these explanations. Method: We recorded forty‐three physician‐patient admission interviews taking place in a hospital in French‐speaking Switzerland, during which CPR was discussed. Data were analysed in French with thematic and conversation analysis, and the extracts used for publication were translated into English. Results: Mean patient age was 83.7 years; 53.5% were admitted for rehabilitation after surgery or traumatism. CPR was explained in 53.8% of the conversations. Most explanations were brief and concerned the technical procedures, mentioning only rarely potential outcome. With one exception, medical indication and prognosis of CPR did not feature in these explanations. Explanations occurred either before the patient's answer (as part of the question about CPR preferences) or after the patient's answer, generated by patients' indecision, misunderstanding and by the need to clarify answers. Discussion and conclusions: The scarcity and simplicity of CPR explanations highlight a reluctance to have in‐depth discussions and reflect the assumption that CPR does not need explaining. Providing patients with accurate information about the outcomes and risks of CPR is incremental for reaching informed decisions and patient‐centred care. Patient contribution: Patients were involved in the data collection stage of the study. [ABSTRACT FROM AUTHOR]

Aim: The oral health status of elderly adults has implications for general health problems. Polypharmacy for elderly adults is associated with an increased risk of potentially inappropriate medicines and many adverse drug events; however, no report has shown that polypharmacy itself is associated with complex oral problems. This study aimed to determine the association between polypharmacy and oral health status in patients admitted to the recovery and rehabilitation ward. Methods: This cross‐sectional study included 471 patients (age: 81.9 ± 7.7 years, women: n = 346). Oral health status was measured using the Oral Health Assessment Tool and poor oral health status was defined as a score of ≥3. Cases of patients taking six or more medications were defined as polypharmacy. Logistic regression analysis was performed to examine the relationship between polypharmacy and oral health status. Age, sex, body mass index, number of comorbidities, cognitive and motor functions, and potentially inappropriate medicines were set as confounding factors. Results: Using the Oral Health Assessment Tool, 51.0% (n = 240) of patients scored ≥3. The prevalence of patients with polypharmacy was 56.9% (n = 268). Polypharmacy was significantly associated with poor oral health status (odds ratio = 1.65, 95% confidence interval = 1.14–2.39, P = 0.007; adjusted odds ratio = 1.65, 95% confidence interval = 1.12–2.43, P = 0.011). Conclusions: This study showed that polypharmacy was associated with poor oral health status. Focusing on the number of medications may be helpful in detecting oral problems. Geriatr Gerontol Int 2021; 21: 66–70. [ABSTRACT FROM AUTHOR]

Background: Geriatric collaborative care models improve postoperative outcomes for older adults. However, there are limited data exploring how preoperative geriatric assessment may affect surgical cancellations. Methods: This is a single-center retrospective cohort analysis. Patients enrolled in the Perioperative Optimization of Senior Health (POSH) program from 2011 to 2016 were included. POSH is a collaborative care model between geriatrics, surgery, and anesthesiology. Baseline demographic and medical data were collected during the POSH pre-op appointment. Patients who attended a POSH pre-op visit but did not have surgery were identified, and a chart review was performed to identify reasons for surgical cancellation. Baseline characteristics of patients who did and did not undergo surgery were compared. Results: Of 449 eligible POSH referrals within the study period, 33 (7.3%) did not proceed to surgery; cancellation rates within the POSH program were lower than institutional cancellation rates for adults over age 65 who did not participate in POSH. Patients who did not have surgery were significantly older, more likely to have functional limitations, and had higher rates of several comorbidities compared with those who proceeded to surgery (P < 0.05). Reasons for surgical cancellations included a similar number of patient- and provider-driven causes. Conclusions: Many reasons for surgical cancellation were related to potentially modifiable factors, such as changes in goals of care or concerns about rehabilitation, emphasizing the importance of shared decision-making in elective surgery for older adults. These results highlight the important role geriatric collaborative care can offer to older adults with complex needs. [ABSTRACT FROM AUTHOR]

Objective: Delirium/dementia (collectively called cognitive spectrum disorder [CSD]) is a major issue in hospital wards. However, few reports are available on the incidence of CSD on multi‐faculty wards or on the factors contributing to it. The aim of this study was to address these issues by a neurogeriatric team (neurologists, psychiatrists, specialist nurses, and link nurses from all wards). Patients and Methods: This was a retrospective study with a 12‐month recruiting period, a prospective follow‐up period of 3.0 ± 2.5 weeks, and ≥1×/week visits. We diagnosed acute‐onset delirium by the Confusion Assessment Method and analyzed underlying conditions. We also diagnosed premorbid dementia by neurocognitive examination and neuroimaging following published criteria. Results: Our subjects were 723 CSD from 15 faculties, accounting for 6.5% of admissions, 393 men and 330 women, mean age 81 years. CSD was prevalent in cardiology/cardiac surgery (CAR), orthopedic surgery (OP), and neurology/neurosurgery (N), with dementia alone in ophthalmology and a combination of delirium/dementia in the other faculties. Premorbid dementia were diagnosed with Alzheimer's disease (AD), white matter disease, dementia with Lewy bodies (DLB), or some combination of these. Delirium was accompanied by worsening of gait difficulty. The ratio of brain (N) versus extra‐brain was 105 (14.5%):618 (85.5%). Severe CSD was common in DLB than AD but without statistical significance. Conclusion: Total 6.5% of hospital admissions showed CSD, with CAR, OP, and N being prevalent. The ratio of brain versus extra‐brain was 14.5%:85.5%. Severe CSD was more prevalent in DLB patients than in AD patients, but without statistical significance. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the feasibility of an additional therapeutic upper limb exercise (ULE) intervention in early phase post‐stroke rehabilitation and to assess outcomes of therapy using the Armeo Spring (ARMEO) versus Therapist‐assisted Table Top (TAT) interventions. Design Randomized, single‐blind trial. Setting: Stroke acute inpatient rehabilitation unit. Participants: Forty‐five participants early after first stroke, Fugl‐Meyer Assessment (FMA) score >8, Modified Ashworth score (MAS) of <3. Interventions: Participants were randomized to TAT or ARMEO ULE in addition to the required 3 hours of 1:1 standard of care provided in an inpatient rehabilitation facility (IRF). Main Outcome Measures: Completed number of treatments; withdrawals; serious/adverse events; Functional Independence Measure (FIM) motor; FIM efficiency; FMA; MAS; elbow active (A) and passive (P) range of motion (ROM); and therapist effort measured by the Modified Borg Rating of Perceived Exertion Scale (RPE). Results: Post‐intervention FIM and FMA scores increased but did not demonstrate any statistically significant differences between the intervention groups (P =.585,.962, partial n2 =.001,.001, respectively). There were no statistically significant differences in post‐intervention MAS elbow flexion and extension (P =.332,.252, partial n2 =.009,.007, respectively) and A/P ROM elbow extension between training groups (P =.841,.731, partial n2 =.001,.003, respectively). There was a statistically significant difference in post‐intervention A/P ROM elbow flexion between groups (P =.031,.018, partial n2 =.123,.146). Post‐intervention RPE did not show any statistically significant differences between the training groups (P =.128, partial n2 =.063). Total elbow range showed larger adjusted mean gains for the ARMEO. No serious adverse events were reported. Conclusions: This study demonstrates that additional therapeutic ULE in the early phase of post‐stroke inpatient rehabilitation is feasible and that both interventions showed positive changes in selected outcomes. [ABSTRACT FROM AUTHOR]

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

Background: Prior studies of inpatient rehabilitation of patients with brain tumor demonstrate similar functional gains as compared to other rehabilitation populations. There are few studies specifically examining the rehabilitation of patients with glioblastoma.Objective: To compare functional outcomes between matched patients admitted to acute inpatient rehabilitation after initial diagnosis of glioblastoma (iGBM) and after diagnosis of recurrent glioblastoma (rGBM).Design: A retrospective, case-matched study using descriptive statistics compared demographic information and functional outcomes as designated by the Functional Independence Measure (FIM) score.Setting: A single, freestanding inpatient rehabilitation hospital.Patients: Over a 20-month period, 25 patients with iGBM were matched with 25 patients admitted to an inpatient rehabilitation facility with rGBM by the following criteria: (1) side of lesion (left/right hemisphere), (2) admission total FIM score within 10 points, (3) age within 10 years, and (4) gender. Nineteen of the 25 patients in each group were matched meeting all criteria, and 6 of the 25 patients were matched meeting three out of four criteria.Interventions: Not applicable.Main Outcome Measure: The primary outcome measures were differences in functional outcomes as measured by FIM scores.Results: There were no statistically significant differences (P < .05) between the groups in mean admission FIM scores, discharge FIM scores, FIM gains, and FIM efficiencies. There were no statistically significant differences in the development of complications during acute rehabilitation and transfer rate to acute care hospital. Sixty-four percent of patients in both groups were able to be discharged home.Conclusions: This study demonstrated no statistically significant differences in functional outcomes between matched patients admitted with iGBM compared to rGBM. Further studies are indicated to examine the rehabilitation outcomes of patients with rGBM in inpatient rehabilitation. [ABSTRACT FROM AUTHOR]

See related article by Jeffrey Levine. [ABSTRACT FROM AUTHOR]

Objective: To assess relationships between resilience, frailty and outcomes in geriatric rehabilitation inpatients. Methods: Eighty‐nine inpatients had Brief Resilience Scale (BRS) and frailty index (FI‐CGA) completed. Pearson's or Spearman's correlation was used to determine correlation between BRS, FI‐CGA and covariates. Multivariate logistic regression was used to determine associations between resilience, frailty and covariates with functional independence measure gain, length of stay (LOS) > 21 days, mortality and discharge care requirements. Results: There was a negative correlation between BRS and premorbid FI‐CGA (r = −0.31, P = 0.03) and admission FI‐CGA (r = −0.26, P = 0.01) and between BRS and Mini‐Mental State Examination score (rho = −0.26, P = 0.02). BRS was not associated with observed outcomes. Premorbid FI‐CGA was associated with inpatient mortality, and greater increase in FI‐CGA during acute stay was associated with greater LOS. All patients who died were frail (FI‐CGA > 0.25). Conclusion: Resilience and frailty were inversely related. Frailty was an independent predictor of rehabilitation LOS and mortality. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore the prevalence of ageist attitudes among older adults hospitalised in a geriatric rehabilitation facility, as well as the association between satisfaction with care and ageist attitudes. In addition, this study also explores the prevalence of ageist attitudes among healthcare professionals. Background: An ageist environment may potentially increase internalisation of stereotypes by older adults, which in turn may have a negative impact on care outcomes. Methods: In this quantitative correlational study, a questionnaire was completed by 100 older patients hospitalised in a rehabilitation department of a geriatric medical centre located in North‐Central Israel, and 87 healthcare professionals working in the same department. Results: The attitudes of older patients towards their peers were neither definitely positive nor definitely negative, as were the attitudes held among healthcare professionals working in the facility. Patients with lower knowledge about old age, women and patients born in former Soviet Republics had more ageist attitudes. Older patients' satisfaction with care was relatively high and was not associated with ageist attitudes towards their peers. Conclusions: Both healthcare professionals and older patients held ageist attitudes to some extent. Certain older patients' sociodemographic characteristics, as well as lower knowledge about old age, have been found associated with more ageist attitudes towards their peers. In contrast, satisfaction with care does not seem to affect older patients' attitudes towards their peers. Healthcare professionals working in a geriatric facility should be aware of the prevalence of ageism among older patients. Implications for practice: The findings highlight the importance of educational interventions among healthcare professionals to increase awareness of the prevalence of ageism among older patients in a geriatric setting. [ABSTRACT FROM AUTHOR]

Aim: To examine the effects of a simplified reablement program on physical function and quality of life in hospitalized older patients. Methods: The randomized controlled trial enrolled 114 older patients aged ≥65 years who, 2 weeks before admission, had been able to walk independently. Patients randomized to the reablement group received supervision and assistance to carry out the simplified reablement program 30 min daily during their hospital stay. Patients in the reminding group received only oral encouragement to continue the reablement program for 30 min daily. The control group received only usual care that included medical intervention consistent with the patient's diagnosis. The main outcome was improvement in physical function, including the modified version of the Katz Activities of Daily Living (ADL) score, Timed Up and Go test (TUG) and Hand Grip Strength (HGS). Secondary outcomes included the EuroQoL 5 Dimension (EQ‐5D) Questionnaire and Visual Analog Scale (VAS). Results: The intervention had no significant effect on the Katz ADL score. However, a significant within‐group improvement in TUG occurred in the reminding group and reablement group. In addition, a significant time‐dependent improvement in HGS occurred only in the reablement group. With respect to secondary outcomes, the EQ5D score improved significantly only in the reablement group at 3 months after discharge. Conclusions: The simplified reablement program may be beneficial to optimize physical function and improve quality of life in hospitalized older patients. It is recommended that health professionals should assist or encourage older patients to do simplified reablement during their hospital stay. Geriatr Gerontol Int 2020; 20: 436–442. [ABSTRACT FROM AUTHOR]

We report a case of a geriatric patient who underwent CABG and developed sigmoid volvulus (SV) with recurrence. SV is a rarely reported complication of CABG. Timely diagnosis, management, and follow‐up are strictly advised, particularly in geriatric patients. Immediate surgical measures are required to prevent volvulus‐associated ischemia. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate the impact of delirium on short‐term outcomes in hip fracture patients. Special attention was given to patients with delirium and dementia. Methods: A prospective observational cohort study was carried out in hip fracture patients aged ≥70 years who were admitted to a hospital unit where a multicomponents approach to delirium is established for all patients. Our population was split into delirium (n = 212) and non‐delirium cohort (n = 171) according to the Confusion Assessment Method. Patients with a previous diagnosis of dementia in an outpatient appointment were also assessed within the delirium cohort. The utility of the rehabilitation was measured with the Absolute Functional Gain index. Results: A total of 383 patients were entered into the study. The median age was 86 years, and most patients were women (78.8%). Delirium patients were older, presented a lower previous Barthel Index (BI), had higher rates of dementia and came more frequently from nursing homes. Comparative analysis did not show differences in mortality, complications, length of stay or walking ability between the cohorts. However, lower BI on discharge, lower Absolute Functional Gain and the presence of nosocomial infections were found more frequently in the delirium cohort. In multivariate analysis, only the BI on discharge (P = 0.010) was lower in delirium patients. Within the delirium cohort, those suffering from dementia had worse BI on discharge (P = 0.017) and lower Absolute Functional Gain (P = 0.019). Conclusions: Delirium was not associated with mortality, walking ability, length of stay and clinical complications in hip fracture patients. BI on discharge was the only short‐term outcome affected. In the delirium cohort, those suffering from dementia showed worse rehabilitation results. Geriatr Gerontol Int 2020; 20: 130–137. [ABSTRACT FROM AUTHOR]

This clinical report describes the expeditious treatment of a geriatric patient with squamous cell carcinoma of the nose treated with total rhinectomy, craniofacial implant placement, and a nasal prosthesis. [ABSTRACT FROM AUTHOR]

Background: Female genital fistula is associated with significant physical, psychological, and economic consequences; however, a knowledge and practice gap exists around services adjunct to fistula surgery.Objectives: To examine rehabilitation and reintegration services provided adjunct to genital fistula surgery, map existing programming and outcomes, and identify areas for additional research.Search Strategy: We searched the published and grey literature from January 2000 to June 2019. Two reviewers screened articles and extracted data using standardized methods.Selection Criteria: Research and programmatic articles describing service provision in addition to female genital fistula surgery were included.Data Collection and Analysis: Of 3047 published articles and 2623 unpublished documents identified, 26 and 55, respectively, were analyzed.Main Results: Programming identified included combinations of health education, physical therapy, social support, psychosocial counseling, and economic empowerment, largely in sub-Saharan Africa. Improvements were noted in physical and psychosocial health.Conclusions: Existing literature supports holistic fistula care through adjunct reintegration programming. Improving the evidence base requires implementing robust study designs, increasing reporting detail, and standardizing outcomes across studies. Increased financing for holistic fistula care is critical for developing and supporting programming to ensure positive outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The dosage of occupational therapy and physiotherapy positively correlates with rehabilitation patient and health service outcomes. Nevertheless, increasing the dosage during inpatient rehabilitation without additional resources can be challenging. This study aimed to determine feasibility of increasing the dosage of inpatient occupational therapy and physiotherapy rehabilitation with independent tasks and exercises outside of supervised sessions, the 'My Therapy' programme. Methods: A two‐group, quasi‐experimental, pre–post‐design examined feasibility of delivering My Therapy in addition to usual care, compared to usual care alone, for hospitalised musculoskeletal and frail older rehabilitation patients. My Therapy was prescribed by the occupational therapist and physiotherapist. A booklet was provided with an individually tailored set of tasks and exercises that were a sub‐set of routine therapy, to be practised safely, effectively and independently outside of supervised sessions. The primary outcome was feasibility of My Therapy implementation to achieve at least 70% adherence. Secondary outcomes were self‐reported daily My Therapy participation (minutes), total daily rehabilitation participation (minutes), adverse events, length of stay, 10‐metre walk speed, FIM scores and discharge destination. Results: Participation in My Therapy was achieved by 72% (83/116) of the My Therapy group, who averaged 14 min (SD 14) of daily practice outside of supervised sessions. Total daily rehabilitation participation was 177 min (SD 47) for My Therapy participants (n = 116) and 148 min (SD 88) for usual care participants (n = 89); mean difference 30 min (p =.00). A minimal clinically important difference in FIM was achieved for a significantly higher portion of the My Therapy group (22%, n = 26) compared to usual care (10%, n = 9; p =.02). There were no adverse events, safety concerns or group differences for other secondary outcomes. Conclusion: My Therapy was a feasible and safe way to increase the dosage of inpatient occupational therapy and physiotherapy rehabilitation via independent practice. Clinical Trial Registry: ACTRN12616000691448. [ABSTRACT FROM AUTHOR]

Readmission to acute care (RTAC) from inpatient rehabilitation can have negative consequences for individuals and associated financial costs are increasing. Consequently, preventing avoidable RTAC represents a target for improvement in quality of care. The aim of this integrative review was to identify predictors of RTAC from inpatient rehabilitation. A systematic search of MEDLINE, EMBASE, ProQuest, and CINAHL databases was used. Thematic analysis was used to examine extracted data. Strong evidence indicating that the principal predictors of RTAC are lower functional status on admission to rehabilitation, a more severe injury and a higher number of comorbidities was identified in this review. This is despite the heterogeneous nature of impairment groups and factors/measures examined. However, the relevance of some predictors of RTAC (such as patient demographics, invasive devices and primary diagnoses) may be dependent on rehabilitation setting, impairment group or time between rehabilitation admission and RTAC (eg, below 3 vs 30 days). Consequently, findings of this integrative review highlight that RTAC is a complex, multifactorial patient issue with a complex interplay between the predictors and reasons for RTAC. LEVEL OF EVIDENCE: IV. [ABSTRACT FROM AUTHOR]

Background: Patient participation is a key concern in health care. Nevertheless, older patients often do not feel involved in their rehabilitation process. Research states that when organizational conditions exert pressure on the work situation, care as a mere technical activity seems to be prioritized by the health‐care staff, at the expense of patient involvement. Objective: The aim of this article is to explore how health‐care professionals experience patient participation in IC services, and explain how they perform their clinical work balancing between the patient's needs, available resources and regulatory constraints. Design: Using a framework of professional work and institutional logics, underpinned by critical realism, we conducted semi‐structured interviews with 18 health‐care professionals from three IC institutions. Results: IC appears as an important service in the patient pathway for older people with a great potential for patient participation. However, health care staff may experience constraints that prohibit them from using professional discretion, which is perceived as a threat to patient participation. Further, they may adopt routines that simplify their interactions with patients. Our results call for more emphasis on an individualized rehabilitation process and a recognition that psychological and social aspects are critical for patient participation in IC. Conclusion: Patients interact in the face of conflicting institutional priorities or protocols. The study adds important knowledge about the practice of patient participation in IC from a front‐line provider perspective. Underlying mechanisms are identified to understand and recommend how to facilitate patient participation at different levels in narrowing the gap between policy and clinical work in IC. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To review the evidence evaluating the effectiveness of informal caregiver interventions to facilitate the recovery of older people discharged from the hospital. DESIGN: Systematic review and meta‐analysis. SETTING: Hospital and community. METHODS: Published and unpublished randomized and nonrandomized controlled trials assessing the effectiveness of informal caregiver interventions to support the recovery of older people discharged from the hospital were identified (to March 2019). The primary outcome was patient health‐related quality of life (HRQOL). Secondary outcomes included patient function, caregiver burden, caregiver HRQOL, psychological distress, adverse events, and health resource use. Studies were critically appraised and meta‐analyzed. PARTICIPANTS: Adults who had been admitted to the hospital. RESULTS: A total of 23 studies were eligible (4695 participants). The indication for hospital admission was stroke in 21 trials (91%). Interventions consisted of training and/or skills‐based programs, with or without home visits/telephone follow‐up. Caregiver interventions for patients following stroke may provide no benefit for patient HRQOL at 12 months (standardized mean difference =.29; 95% confidence interval = ‐.12 to.69; low‐quality evidence). Caregiver interventions demonstrated benefit for caregiver burden and both patient and caregiver anxiety at 12 months. No consistent effect was found on functional outcomes, depression, HRQOL, adverse events, or health resource use measures. CONCLUSIONS: Informal caregivers who receive training to facilitate the recovery of older people discharged from the hospital following stroke may have a lower burden and reduced anxiety at 12 months compared with those who do not. However, the evidence was moderate to low quality. Further study is warranted to explore whether caregiver interventions can be modified for nonstroke populations such as those with hip fracture. J Am Geriatr Soc 67:1960–1969, 2019 [ABSTRACT FROM AUTHOR]

Background/aim: Limited research has been available to support the use of the Kettle Test in a subacute rehabilitation setting with patients diagnosed with a variety of medical conditions. The Kettle Test is an occupation based performance measure designed to detect cognitive processes and function. The aim of this research was to measure the correlation between three cognitive tests, the Mini‐Mental State Examination (MMSE), Cognitive Functional Independence Measure (Cognitive FIM) and the Kettle Test. Secondly, to assess the efficacy of these tests in predicting functional outcomes via the motor subscale of the Functional Independence Measure (mFIM). Methods: A prospective single‐centre cohort study in a subacute rehabilitation setting of 97 patients. Results: Correlation coefficients between the tests were statistically significant and moderately strong, with values ranging from 0.593 to −0.589. Significant positive correlations were seen between admission MMSE, Cognitive FIM and the mFIM and significant negative correlations between Kettle Test scores and the mFIM. The Kettle Test score had a stronger relationship with mFIM (r = −0.40; P < 0.01) compared to the Cognitive FIM (r = 0.33; P < 0.01) and MMSE (r = 0.26; P < 0.05). The Kettle Test variance is significantly associated with the MMSE and Cognitive FIM at admission and discharge measures. Modelling identified that age and gender significantly contribute to this relationship. When adjusted for age and gender the MMSE and Cognitive FIM both explained the 47% of the variance at discharge. Conclusion: There were statistically significant inter‐test correlations between the MMSE, Cognitive FIM and Kettle Test. The Kettle Test had the strongest relationship to patient functional outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To characterize rehabilitation services use of older adults according to fall‐risk classification based on screening guidelines. Design: Cross‐sectional analysis of 2015 National Health and Aging Trends Study. Setting: Study participants' homes. Participants: National sample of 7,440 community‐dwelling Medicare beneficiaries. Measurements: In‐person interviews and functional assessments. Based on Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths and Injuries criteria, participants were classified as low, moderate, or high fall risk. Results: Twenty‐three percent of older adults classified as moderate fall‐risk (n = 2602) and 40.6% of those at high fall‐risk (n = 940) reported rehabilitation services use in the past year. Among older adults who reported rehabilitation services in the past year (n = 1,505), treatment to address falls was reported by 2.8%, 12.6%, and 34.7% of those classified with low, moderate, and high fall‐risk, respectively (p < 0.001). Older adults with high fall‐risk who did not receive rehabilitation services had significantly better self‐reported physical capacity (p = 0.02) but comparable physical performance (all p's > 0.05) relative to those who received rehabilitation. Conclusion: Older adults at high risk for falls were significantly more likely to report rehabilitation services use compared to those with low and moderate risk of falling. The findings also indicate that there is low adherence to national clinical recommendations for rehabilitation services use in older adults vulnerable to falls‐related injury. Among the high fall‐risk group, those who did not receive rehabilitation services had similarly low physical function as compared with those who received rehabilitation, indicating potential unmet need to address physical impairments related to fall‐risk. J Am Geriatr Soc 67:100–107, 2019. [ABSTRACT FROM AUTHOR]

Aim: To test the hypothesis that the functional outcome of hip fracture patients who receive weekend rehabilitation is better than that of similar patients who undergo non-weekend rehabilitation. Methods: The present retrospective observational study used data from the Japan Rehabilitation Database spanning 2005-2015. We identified in-hospital hip fracture patients admitted to acute hospitals. After applying exclusion criteria, 469 patients were eligible. The primary outcome was motor Functional Independence Measure (FIM) efficiency. Results: Of the patients with hip fracture, 68.0% received weekend rehabilitation. The patients who received weekend rehabilitation had significantly higher scores in motor FIM efficiency (mean 1.08 vs 0.73, P < 0.001), FIM efficiency (mean 1.12 vs 0.79, P = 0.001) and shorter length of stay (mean 32 vs 54, P < 0.001) than the patients without weekend rehabilitation. Multivariate linear regression analysis identified the weekend rehabilitation as a signifi- cant factor in motor FIM efficiency (coefficient 0.237, 95% confidence interval 0.074-0.400, P = 0.004), FIM efficiency (coefficient 0.235, 95% confidence interval 0.079-0.391, P = 0.003) and length of stay (coefficient -9.649, 95% confidence interval -18.194 to -1.104, P = 0.027). Conclusions: The present cohort analysis showed that weekend rehabilitation for hip fracture patients can lead to functional recovery and reduce the length of stay. [ABSTRACT FROM AUTHOR]

Normal and pathological ageing are associated with several motor impairments that reduce quality of life and represent a general challenge for public healthcare systems. Consequently, over the past decades, many scientists and physiotherapists dedicated their research to the development and improvement of safe and costless methods to counteract the progressive decline of motor functions with age. The urgency of finding new and easy to implement methods is even more paramount in case of acute pathologies (e.g. stroke or hip surgery). The frailty of older population makes it difficult or even impossible to use traditional physical therapy at an early stage after the occurrence of a pathology. To that purpose, non-physical approaches such as cognitive training (e.g. memory, attention training) and mental techniques (e.g. motor imagery) have grown in popularity for the elderly. Such methods, involving individual and/or group exercises, have shown particular effects on increasing or maintaining cognitive functions, as well as physical performances. Improving the motor function (especially in older age) requires an improvement of motor execution, i.e. the pathway from the brain motor areas to the muscle but also higher cognitive control. The present work reviews different non-physical interventions that can be used as a complementary approach by asymptomatic or frail older adults, and the effects thereof on functional performance. The use of cognitive training or motor imagery protocols is recommended when physical practice is limited or not possible. Finally, insights into the underlying neurophysiological mechanisms are proposed. [ABSTRACT FROM AUTHOR]

Objectives To examine racial differences in the use of rehabilitation services and functional improvement during receipt of services. Design Secondary analysis of the 2016 National Health and Aging Trends Study ( NHATS). Setting Standardized in-person home interviews. Participants Community-dwelling Medicare enrollees (N = 6,309), 1,276 of whom reported receiving rehabilitation services in the previous 12 months. Measurements Self-reported use of rehabilitation services, setting (inpatient, outpatient, home based), reason for use, and perceptions of change in functioning after receiving services. Results Controlling for sex, dual eligibility for Medicaid, age, number of chronic conditions, functional mobility at the prior round, income, and geographic region, the odds of receiving rehabilitation services in any setting was 1.38 times as great in whites as in blacks (95% confidence interval = 1.09-1.75). Of those receiving therapy, whites were more likely to receive home-based and inpatient rehabilitation services, but there were no racial differences in improvement in function. Conclusion Strategies are needed to identify possible barriers to use of rehabilitation services for vulnerable groups of aging individuals who need rehabilitation services, particularly older blacks. [ABSTRACT FROM AUTHOR]