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Introduction: Adherence to best practices for care of hip fracture patients is fundamental to decreasing morbidity and mortality in older adults. This includes timely transfer from the hospital to rehabilitation soon after their surgical care. Hospitals experience challenges in implementing several best practices. We examined the potential barriers associated with timely discharge for patients who underwent a hip fracture surgery in an academic hospital in Ontario, Canada. Methods: We conducted a retrospective cross-sectional review of a local database. We used descriptive statistics to characterize individuals according to the time of discharge after surgery. Multivariable binary logistic regression was used to evaluate factors associated with delayed discharge (>6 days post-surgery). Results: A total of 492 patients who underwent hip fracture surgery between September 2019 and August 2020 were included in the study. The odds of having a delayed discharge occurred when patients had a higher frailty score (odds ratios [OR] 1.19, 95% confidence interval [CI] 1.02;1.38), experienced an episode of delirium (OR 2.54, 95% CI 1.35;4.79), or were non-weightbearing (OR 3.00, 95% CI 1.07;8.43). Patients were less likely to have a delayed discharge when the surgery was on a weekend (OR.50, 95% CI.32;.79) compared to a weekday, patients had a total hip replacement (OR.28, 95% CI.10;.80) or dynamic hip screw fixation (OR.49, 95% CI.25;.98) compared to intramedullary nails, or patients who were discharged to long-term care (OR.05, 95% CI.02;.13), home (OR.26, 95% CI.15;.46), or transferred to another specialty in the hospital (OR.49, 95% CI.29;.84) compared to inpatient rehabilitation. Conclusions: Clinical and organizational factors can operate as potential barriers to timely discharge after hip fracture surgery. Further research is needed to understand how to overcome these barriers and implement strategies to improve best practice for post-surgery hip fracture care. [ABSTRACT FROM AUTHOR]

To describe admission and discharge characteristics of participants admitted to prosthetic rehabilitation following a lower limb amputation and determine changes in participant characteristics including if the population has gotten older over time at admission. A retrospective chart audit of consecutive admissions to an amputee rehabilitation program. Study criteria were transtibial level LLA and above and ≥ 18 years old. Admission characteristics included: age, Montreal Cognitive Assessment (MoCA), Functional Comorbidity Index (FCI) and days between amputation surgery and admission. Discharge characteristics included the L -Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence (ABC) scale. Multivariable linear regression modelling quantified the association between participant characteristics and admission time. A total of 601 participants (62.3 ± 14.1 years) were included, 63 were (84.9 ± 3.7 years) aged 80 and over. FCI scores [β = 70.34, (95% CI: 20.93, 119.74), p = 0.005] and days between amputation surgery [β = −0.08, (95% CI: −0.13, −0.02), p = 0.011] were independently associated with admission time. People with an LLA are presenting with a higher number of comorbidities at admission over time while being admitted faster from amputation surgery. Future research should investigate the impact of these changing characteristics on rehabilitation outcomes to better assist this population. It is expected that the rate of inpatient prosthetic rehabilitation admissions due to lower limb amputations will increase amongst those over eighty. An analysis of participant characteristics of people admitted to inpatient prosthetic rehabilitation over time will inform modification and developments to future programs. Future prosthetic rehabilitation programs should consider an increased number of comorbidities when developing prognostic expectations for participants. A shortened interval between amputation surgery and admission should be considered when developing prosthetic rehabilitation programs. [ABSTRACT FROM AUTHOR]

Background and Purpose: The international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool is a new instrument developed to evaluate the therapeutic quality of exercise interventions. Home-based exercise has been shown to improve physical fitness in older adults, but its effects may be influenced by therapeutic quality. The purpose of this systematic review was to describe the therapeutic quality of home-based exercise interventions for community-dwelling older adults and examine the relationship between therapeutic quality and changes in physical fitness. Methods: Six electronic databases and 2 clinical trial registries were searched for randomized controlled trials investigating the effects of home-based exercise on physical fitness in community- dwelling older adults (≥60 years). Therapeutic quality was evaluated using the i-CONTENT tool for items of patient selection, type of exercise, safety, type/timing of outcomes, exercise dose, and adherence. International Consensus on Therapeutic Exercise aNd Training items were used to explain heterogeneity in meta-regression analyses. Risk of bias, certainty of evidence and credibility of analyses were assessed. Results: Thirty-six trials (n = 6157 participants) were identified. Most studies (≥66.7%) had high or probably high therapeutic quality for i-CONTENT items, except exercise dose (47.2%) and adherence (16.7%). Interventions improved upper- (N = 20 trials; standardized mean difference [SMD] = 0.39; 95% CI, 0.13-0.64; low certainty of evidence) and lower-body strength (N = 28; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty), and aerobic fitness (N = 8; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty). For exercise dose, low- or probably low-quality studies negatively influenced effects on upper- (estimated β = -.48; P = .049; moderate credibility) and lower-body strength (estimated β = -.77; P = .048; moderate credibility). For adherence, low- or probably low-quality studies negatively influenced effects on aerobic fitness (estimated β = -.97; P = .02; low credibility). Conclusions: Home-based exercise may improve upper- and lower-body strength, as well as aerobic fitness in older adults. However, the effectiveness of interventions is affected by inadequate dosing of exercise programs and adherence issues. Physical therapists should have the best available evidence to support their clinical decision making, especially when designing and monitoring home programs. [ABSTRACT FROM AUTHOR]

This study compared handheld dynamometry (HHD) at the weakest point of the strength curve for hip extensors, hip abductors, and knee extensors in older adults and onerepetition maximum (1RM) of that same muscle groups with cuff weights. Fifty participants (62-94 years) were tested. Paired t tests indicated no significant differences between the 2 measures. Reliability testing for absolute agreement between 1RM and HHD yielded intraclass correlations of good to excellent. This demonstrates HHD at or near the weakest point of a muscle group provides an accurate measure of older individual's 1RM for knee extension, hip extension, and hip abduction. [ABSTRACT FROM AUTHOR]

This study compared the effect of traditional exercise training and game-based exercise by TRAZER© on dynamic balance activities, vestibular ocular motor sensory (VOMS), falls efficacy scale-international (FES-I), and muscular performance in healthy older adults. Twenty-two older adults (mean age: 77.59 ± 6.20 years) randomly divided into two groups (1) exercise training (ET) and (2) ET + TRAZER©. Both groups participated in one-hour exercise sessions, three days a week for 10 wk. The ET + TRAZER© group completed the three dynamic/agility balance assessments each day. The results showed the three TRAZER© assessments significantly increased in the ET + TRAZER© group. However, there was not a statistically significant difference between the groups for timed up and go (TUG), sit-to-stand (STS), and FES-I. Our findings provided evidence that game-based exercise intervention improved muscular function and VOMS, especially dynamic balance and reaction time in older adults. [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 and Purpose: Despite being associated with serious adverse outcomes, such as mortality, sarcopenia remains largely undiagnosed in older individuals. This study aimed to assess the awareness, practices, and barriers and enablers to clinical implementation of sarcopenia diagnosis and treatment among geriatric rehabilitation health care professionals in the Netherlands. Methods: As part of EMPOWER-GR, a cross-sectional survey among geriatric rehabilitation health care professionals working in the Netherlands was undertaken between September 23, 2020, and January 28, 2021. Professionals were recruited via a geriatric rehabilitation care provider, health care professional associations, professional networks of the research team, and social media. Descriptive statistics were used to assess the study outcomes. Results and Discussion: Of the 501 geriatric rehabilitation health care professionals, 12.2% were physicians, 23.0% physical therapist/occupational therapists, 30.3% dietitians, 19.6% nurses, and 11.0% health care assistants. The concept of sarcopenia was known by 83.8% of the participants, 92.5% correctly identified sarcopenia as low muscle mass and strength (and low physical performance), and 73.8% identified sarcopenia as very important in the management of older adults admitted for rehabilitation. Although 26.2% and 18.9% of the participants reported screening and diagnosing sarcopenia, respectively, in their current practice, only 3.0% adequately used the (revised) definition of the European Working Group on Sarcopenia in Older People. When sarcopenia has been diagnosed, 65.0% reported initiating treatment consisting of resistance exercise training (78.7%), food fortification/high-energy or protein diet (85.4%), and oral nutritional supplements (70.4%). Most important barriers to screening and diagnosis were lack of knowledge, access to tools, and equipment and time, while enablers were protocol implementation, access to training, and clear responsibilities. Conclusions: Sarcopenia awareness is high among geriatric rehabilitation health care professionals in the Netherlands, but adequate screening and diagnosis is almost nonexistent in current clinical practice, which hampers interventions. Better knowledge, clear responsibilities, and access to tools and protocols, as well as prioritization, are needed for sarcopenia to be diagnosed and treated in geriatric rehabilitation in the Netherlands. [ABSTRACT FROM AUTHOR]

To explore the feasibility of an exergame prototype in residential individuals with major neurocognitive disorder (MNCD). Participants were randomly assigned to a 12-week stepping exergame training or traditional exercise (active control group). Semi-structured interviews were conducted after six and 12 weeks of exergaming. Qualitative data were thematically analysed using NVivo 12. The Short Physical Performance Battery, one minute sit-to-stand test, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory, Cornell Scale for Depression in Dementia, and Dementia Quality of Life were assessed at baseline and post intervention using a Quade's ANCOVA. Seven older adults with MNCD in the exergame and 11 in the active control group completed the study [mean age = 83.2 ± 6.5 years; 94.4% female; SPPB score = 7.3 ± 2.4]. Results indicated that the VITAAL exergame prototype was experienced as enjoyable and beneficial. The post-MMSE score was higher (η2=.02, p = 0.01, F = 8.1) following exergaming versus traditional exercise. The findings suggest that the exergame prototype is accepted by individuals with MNCD residing in a long-term care facility when they are able to participate and under the condition that they are extensively guided. The preliminary efficacy results revealed higher post-MMSE scores after exergaming versus traditional exercise. Future trials should confirm or refute these findings. The trial was registered in ClinicalTrials.gov (Identifier: NCT04436315) The VITAAL exergame prototype is accepted by individuals with MNCD residing in a long-term care facility who are able to participate. Supervision of exergaming by health professionals is essential for successful implementation. The VITAAL exergame prototype might maintain cognitive levels in major neurocognitive disorder longer than walking combined with standardised squatting and stepping exercises. [ABSTRACT FROM AUTHOR]

Objective: The Utrecht Scale for Evaluation of Rehabilitation is a multi-domain measurement with good content validity, structural validity and reliability for measuring physical functioning (mobility, selfcare) and cognitive functioning in geriatric rehabilitation. We aimed to determine the construct validity of both Utrecht Scale for Evaluation of Rehabilitation scales and the responsiveness and interpretability of the scale for physical functioning in geriatric rehabilitation. Design: Prospective follow-up study embedded in routine care. Setting: Four care organisations in The Netherlands. Subjects: Patients admitted for inpatient geriatric rehabilitation (2021–2022). Main measures: Data collection included the Utrecht Scale for Evaluation of Rehabilitation, Mini-Mental State Examination, Barthel index, and a global rating scale anchor on recovery. Hypothesis testing was used to determine construct validity and responsiveness. For interpretability, minimal important change and floor and ceiling effects were determined. Results: The mean age of participants (n = 211) was 77 (SD 10.4). Their mean length of stay was 38.6 days (SD 26.3), and 81% returned home. The Utrecht Scale for Evaluation of Rehabilitation showed adequate construct validity, as all three hypotheses were confirmed for both scales. The Utrecht Scale for Evaluation of Rehabilitation-physical function scale showed adequate responsiveness, with all five hypotheses confirmed. The mean change for physical function (scale range 0–70) was 15.5 points (SD 17.1). The minimal important change for Utrecht Scale for Evaluation of Rehabilitation-physical function was 14.5 points difference for improvement. This scale showed no floor (2%) and ceiling effects (14%) at admission and discharge. Conclusions: The Utrecht Scale for Evaluation of Rehabilitation showed to be effective for evaluating physical functioning during geriatric rehabilitation as well as screening cognitive functioning. In total, 14.5 points difference has been established as a minimal important change for physical functioning. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the physical and functional outcomes of the 'Ending Pyjama Paralysis' intervention in an inpatient geriatric rehabilitation unit. Design: Quasi-experimental mixed-methods design nested within the 'REStORing health of acutely unwell adulTs' (RESORT) prospective, observational, longitudinal cohort of geriatric rehabilitation inpatients study. Setting: Geriatric rehabilitation wards in a major metropolitan public hospital between June 2019 and March 2020. Intervention: The 'Ending Pyjama Paralysis' movement originated in the UK. Its aim was to encourage patients to 'Get up, Get dressed and Get moving' to reduce hospital-associated functional decline. However, the physical and functional benefits of this campaign have not yet been evaluated. The 'Ending Pyjama Paralysis' was adopted as an integrated intervention on two out of four geriatric rehabilitation wards. The two control wards received usual care. Main Measures: Physical measures included the Short Physical Performance Battery, and functional measures included the Katz Index of Independence in Activities of Daily Living and Lawton and Brody's Instrumental Activities of Daily Living, which were completed on admission and discharge. A linear mixed-effects model was used to analyse the results. Results: A total of 833 admissions were included in this study. Of these, 512 patients were in the control group, and 321 were in the intervention group. There were no significant differences in both physical and functional measures between the intervention and control groups. Conclusion: The 'Ending Pyjama Paralysis' campaign did not result in enhanced functional or physical benefits in geriatric rehabilitation inpatients in this setting when applied in addition to usual care. [ABSTRACT FROM AUTHOR]

Background and Purpose: Sarcopenia is known to be associated with poor outcomes after arthroplasty; however, no study has reported the relationship between sarcopenia and postoperative walking independence. This study aimed to determine the impact of sarcopenia risk screening using the SARC-CalF questionnaire and calf circumference on the time to walk independently after total hip or knee arthroplasty in older patients. Methods: We included 599 nonobese patients aged 65 years and older who underwent unilateral and primary total hip or knee arthroplasty. Preoperative sarcopenia risk was assessed using the SARC-CalF or calf circumference. The outcome of this study was the time to independent walking after surgery; it was calculated as the number of days from the date of surgery to the date when the patient was able to walk independently. The association between preoperative sarcopenia risk and time to independent walking after surgery was analyzed using Kaplan-Meier curves and Cox proportional hazards models. Results: Among the 599 patients undergoing total joint arthroplasty, 175 (29.2%) were determined to be at risk of sarcopenia using SARC-CalF and 193 (32.2%) using calf circumference. The Kaplan-Meier curve showed that sarcopenia risk assessed by SARC-CalF or calf circumference was associated with a prolonged time to independent walking in patients undergoing hip arthroplasty (log-rank test, P < .001 and P < .001, respectively). In patients undergoing hip arthroplasty, the Cox proportional hazards model showed that SARC-CalF score of 11 points and greater or a calf circumference less than the cutoff was a risk factor for delayed time to independent walking (hazard ratios: 0.55 and 0.57, P < .001 and P = .001, respectively). There was no association between preoperative sarcopenia risk and postoperative time to independent walking in patients who underwent knee arthroplasty. Conclusions: Sarcopenia screening tools, such as SARC-CalF or calf circumference, should be useful for planning postoperative rehabilitation in older adults scheduled for hip arthroplasty. However, the accuracy of SARC-CalF or calf circumference measurement in patients scheduled for knee arthroplasty may be low. [ABSTRACT FROM AUTHOR]

Background: In order to perform an activity that requires an upright posture, balance is a complex process that involves receiving and integrating the sensory inputs as well as planning and carrying out movements. Falls are frequent among elderly people. An example of home based aerobic activity is multidirectional stepping training. Purpose: To find out the effectiveness of multidirectional stepping training on balance among geriatric population. Materials and Methods: From November 2022 to April 2023, 200 participants were recruited from the Sai Chai Physio Centre, with only 82 participants selected based on inclusion and exclusion criteria. The subjects were separated into two groups: Group A (n=41) and Group B (n=41). Group A received multidirectional stepping training, whereas Group B received conventional exercise. Both the interventions were given for four weeks, three times a week for 40 minutes. Results: The findings indicated that both the groups showed statistically significant improvement after the interventions in scores of fall efficacy scale and Balance outcome measure for elderly rehabilitation(p<0.005). Multidirectional stepping training showed statistically significant improvement in both the measures. Conclusion: When compared to conventional exercise, multidirectional stepping training is more effective at improving balance. [ABSTRACT FROM AUTHOR]

Returning home is considered an indicator of successful rehabilitation for community-dwelling older adults. However, the factors associated with unplanned discharge remain uncertain. This retrospective chart review included patients 65 yrs and older admitted to a geriatric rehabilitation unit from medical and surgical wards in an academic hospital. Patient characteristics and outcomes were abstracted from the electronic medical record. The primary outcome was unplanned discharge destination defined as anything other than return to patients' preexisting residence. The associations between patient variables and unplanned discharge destination were analyzed using Pearson χ² and univariate logistic regression. Of the 251 charts screened, 25 patients (10.0%) had an unplanned discharge destination, and 74 of the remaining 226 (32.7%) experienced a delayed discharge (beyond 20 days). Requiring assistance for activities of daily living (odds ratio [OR], 2.80; 95% confidence interval [CI], 1.17-7.47), a diagnosis of chronic obstructive pulmonary disease (OR, 4.04; 95% CI, 1.63-9.71), and lower serum albumin level (OR, 1.67; 95% CI, 1.06-2.72) were associated with unplanned discharge. Variables commonly associated with worse outcomes such as age, cognitive scores, delirium, and number of comorbidities were not barriers to returning home and should therefore not be used on their own to limit access to geriatric rehabilitation. [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]

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Background: Based on electroencephalogram (EEG) analysis, index of consciousness (IoC) monitoring is a new technique for monitoring anesthesia depth. IoC is divided into IoC1 (depth of sedation) and IoC2 (depth of analgesia). The potential for concurrent monitoring of IoC1 and IoC2 to expedite postoperative convalescence remains to be elucidated. We investigated whether combined monitoring of IoC1 and IoC2 can effectively enhances postoperative recovery compared with bispectral index (BIS) in elderly patients undergoing laparoscopic urological surgery under general anesthesia. Methods: In this prospective, controlled, double-blinded trail, 120 patients aged 65 years or older were arbitrarily assigned to either the IoC group or the control group (BIS monitoring). All patients underwent blood gas analysis at T1 (before anesthesia induction) and T2 (the end of operation). The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered to all patients at T0 (1 day before surgery) and T4 (7 days after surgery). Serum concentrations of C-reactive protein (CRP) and glial fibrillary acid protein (GFAP) were assessed at T1, T2, and T3 (24 h after surgery). Postoperative complications and the duration of hospitalization were subjected to comparative evaluation. Results: The incidence of postoperative cognitive dysfunction (POCD) was notably lower in the IoC group (10%) than in the control group (31.7%) (P = 0.003). Postoperative serum CRP and GFAP concentrations exhibited significant differences at time points T2 (CRP: P = 0.000; GFAP: P = 0.000) and T3 (CRP: P = 0.003; GFAP: P = 0.008). Postoperative blood glucose levels (P = 0.000) and the overall rate of complications (P = 0.037) were significantly lower in Group IoC than in Group control. Conclusion: The employment of IoC monitoring for the management of elderly surgical patients can accelerate postoperative convalescence by mitigating intraoperative stress and reducing peripheral and central inflammatory injury. Trial registration: Chinese Clinical Trial Registry Identifier: ChiCTR1900025241 (17/08/2019). [ABSTRACT FROM AUTHOR]

Technological advancements facilitate feedback adaptation in rehabilitation through virtual reality (VR) exergaming, serious gaming, wearables, and telerehabilitation for older adults fall prevention. Although studies have evaluated these technologies, no comparisons of their effectiveness have been conducted to date. Thus, this study aims to assess the differences in effectiveness of these interventions on balance and functional mobility in the older adults. A systematic review and network meta-analysis (NMA) were conducted to identify the most effective interventions for improving balance and functional mobility in adults aged 60 and over. The search was conducted in five databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science) up to June 10, 2023. The eligibility criteria were: (1) older adults, (2) functional mobility, balance, or gait as the primary outcome, (3) new technology intervention, and (4) randomized study design. New technology interventions were classified into five categories: exergaming with balance platforms or motion capture technologies, other serious gaming, interventions with wearables, and telerehabilitation. Additionally, two categories of control interventions (conventional exercises and no treatment) were extracted. The NMA was performed for the aggregated results of all outcomes, and separately for clinical functional scales, functional mobility, and gait speed results. Fifty-two RCTs with 3081 participants were included. Exergaming with motion capture was found to be statistically significant in producing a better effect than no treatment in the analysis of the functional mobility with an SMD of −0.70 (P < 0.01). The network meta-analysis revealed that exergaming with motion capture offers greater therapeutic benefits for functional mobility and balance compared to no treatment control. The effectiveness of this approach is similar to that of conventional exercises. Further RCTs are needed to provide a more definitive conclusion, particularly with respect to the effectiveness of serious games, telerehabilitation, and interventions with wearables. [ABSTRACT FROM AUTHOR]

Inpatient falls have a significant impact on the outcomes of older patients during inpatient rehabilitation. A retrospective case-control study was conducted using data of 7066 adults aged 55 yrs or older to evaluate significant predictors of inpatient falls during inpatient rehabilitation and the association of inpatient falls with discharge destination and length of stay. A stepwise logistic regression was used to model odds of inpatient falls and home discharge with demographic and clinical characteristic variables and a multivariate linear regression to evaluate the association between inpatient falls and length of stay. Nine hundred thirty-one of 7066 patients (13.18%) had inpatient falls during inpatient rehabilitation. The group with inpatient falls had longer length of stay (14.22 ± 7.82 vs. 11.85 ± 5.33 days, P < 0.0001) and a decreased proportion of home discharges when compared with the group without inpatient falls. There were increased odds of inpatient falls among patients with diagnoses of head injury, other injuries, a history of falls, dementia, a divorced marital status, and a use of laxatives or anticonvulsants. Inpatient falls were associated with an increased length of stay (coefficient = 1.62, confidence interval = 1.19–2.06) and decreased odds of home discharge (odds ratio = 0.79, confidence interval = 0.65–0.96) after inpatient rehabilitation. This knowledge may be incorporated into strategies for reducing inpatient falls during inpatient rehabilitation. [ABSTRACT FROM AUTHOR]

Senior adults (>age 65) represent almost 20% of the population but account for 48% of hospital bed occupancy. In older adults, hospitalization often results in functional decline (i.e., iatrogenic disability) and, consequently, the loss of autonomy. Physical activity (PA) has been shown to counteract these declines effectively. Nevertheless, PA is not implemented in standard clinical practice. We previously showed that MATCH, a pragmatic, specific, adapted, and unsupervised PA program, was feasible and acceptable in a geriatric assessment unit (GAU) and a COVID-19 geriatric unit. This feasibility study aims to confirm that this tool could be implemented in other geriatric care programs, notably a geriatric rehabilitation unit (GRU) and a post-acute care unit (PACU), in order to reach the maximum number of older patients. Eligibility and consent were assessed by the physician for all the patients admitted to the three units (GAU, GRU, and PACU). The rehabilitation therapist taught each participant one of the five PA programs based on their mobility score on the decisional tree. Implementation (eligibility (%): patients eligible/number admitted and delay of implementation: number of days until prescription); feasibility (adherence (%): number sessions completed/number sessions prescribed and walking time (%): total walking time/time prescribed time); and acceptability (healthcare team (%): tool adequacy (yes/no) and patient: System Usability Scale questionnaire (SUS: x/100)) were evaluated and analyzed using a Kruskal–Wallis ANOVA or Fisher's exact test. Eligibility was different between the units (GRU = 32.5% vs. PACU = 26.6% vs. GAU = 56.0%; p < 0.001), but the time before implementation was similar (days: GRU = 5.91 vs. PACU = 5.88 vs. GAU = 4.78; p > 0.05). PA adherence (GRU = 83.5% vs. PACU = 71.9% vs. GAU = 74.3%) and walking time (100% in all units) were similar (p > 0.05). Patients (SUS: GRU = 74.6 vs. PACU = 77.2 vs. GAU = 77.2; p > 0.05) and clinicians (adequacy (yes; %): GRU = 78.3%; PACU = 76.0%; GAU = 72.2%; p > 0.05) found MATCH acceptable. Overall, MATCH was implementable, feasible, and acceptable in a GAU, GRU, and PACU. Randomized controlled trials are needed to confirm our results and evaluate the health benefits of MATCH compared with usual care. [ABSTRACT FROM AUTHOR]

Background: Occupational therapists develop maintenance programs (MPs) for long-term care (LTC) residents to optimize participation in everyday activities. The purpose of this study was to examine nursing professional attitudes and knowledge of MPs and to evaluate the effectiveness of an occupational therapist-led in-service. Method: Nursing staff (n = 20) attended the in-service, completed a pre and posttest, and completed interviews (n = 5). We used an exploratory sequential mixed methods design with a one-group quasiexperimental design for the quantitative portion and a descriptive qualitative approach for the interviews. Results: The results indicated significantly increased knowledge regarding MPs, use of the MPs, and overall perception of nursing management support (p < 0.05). Qualitative analysis of the interviews revealed four themes: MPs promote resident independence, perceived multiple barriers prevent implementation, the need for increased staff training and communication, and positive interdisciplinary MP communication. Conclusion: Preliminary data indicated that therapists-led educational sessions may have a positive impact on nursing staff knowledge and perceptions of MPs. However, future programming to develop training to overcome barriers of MP implementation is needed. [ABSTRACT FROM AUTHOR]

There is a trend toward formalization of the rehabilitation process for older rehabilitants in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support, and environment in rehabilitation wards. So far, literature about the principles of CRE is scarce. This study aims to explore the opinions of rehabilitants and informal caregivers regarding CRE, through a qualitative study between 2019 and 2020. Three telephone interviews were conducted with informal caregivers, and also 3 focus groups with 15 rehabilitants and 3 informal caregivers, all with recent experience in rehabilitation. Nine themes emerged regarding the rehabilitation process: (1) rehabilitant (attention for resilience, motivation, cognitive and emotional aspects), (2) rehabilitant centered (goal setting, physical and cognitive functioning and coping), (3) informal caregivers (involving and attention for resilience and relation), (4) communication (aligning the rehabilitation process), (5) exercise (increasing intensity by using task-oriented exercise, patient-regulated exercise, and group training), (6) peer support (learning experiences and recognition), (7) daily schedule (influence on the planning and activities outside therapy), (8) nutrition (energy for rehabilitation), and (9) eHealth (makes rehabilitation more challenging and fun). Regarding organizational processes, 4 themes were identified: (1) environmental aspects (single bedrooms, shared room for activities and therapy options on the ward), (2) staff aspects (small team with an emphatic supportive and motivating attitude), (3) organizational aspects (organized in an efficient way), and (4) return home (the discharge process should be well prepared for instance with home visits). Organizing excellent rehabilitation care requires a thorough understanding of the concept of CRE, as it is a complex and comprehensive concept that concerns the whole rehabilitation process. Its effectiveness and efficiency should be researched in prospective studies. [ABSTRACT FROM AUTHOR]

Background: Hip fracture is a major burden on health care systems worldwide and requires hospitalisation for a long period. Objective: The aim was to evaluate the effectiveness of multicomponent home‐based rehabilitation compared with different control interventions (in‐hospital rehabilitation, active control or usual care) in older patients after hip fracture surgery. Design: Systematic review and meta‐analysis of randomised controlled studies. Data sources: We searched three electronic databases, including Ovid‐MEDLINE, Ovid‐Embase, CINAHL and the Cochrane Library for relevant articles up to March 2020. Review methods: Two investigators independently extracted data and assessed study quality using the risk of bias. Data were analysed using Review Manager 5.3. The current review employs the PRISMA procedure. Results: Out of 2996 studies, 22 articles were relevant for this review and meta‐analysis. Among them, five compared the multicomponent home‐based rehabilitation with in‐hospital rehabilitation, one compared it with active control, six with usual care and ten compared the home exercise only with usual care. There was no significant difference in activities of daily living (ADL) between multicomponent home‐based rehabilitation and in‐hospital rehabilitation, while multicomponent home‐based rehabilitation significantly increased in ADL when compared to usual care. Home exercises also had significant effects on ADL, quality of life(QoL), balance, gait and muscle strength of the knee extensor compared with usual care (p <.05). Conclusions: Multicomponent home‐based rehabilitation is comparable to in‐hospital rehabilitation regarding improvements in muscle strength, gait speed, balance, ADL and QoL. Relevant to clinical practice: Multicomponent home‐based rehabilitation is comparable to in‐hospital rehabilitation regarding improvements in muscle strength, gait speed, balance, ADL and QoL. Also, high adherence to home exercise may be associated with better clinical outcomes. Therefore, more compliance‐oriented multicomponent home‐based rehabilitation programmes for older patients after hip fracture must be developed by health care professionals, including physical therapist, to ensure optimum home‐based rehabilitation. [ABSTRACT FROM AUTHOR]

Importance: Adaptive equipment, such as shower grab bars and modified toilet seating, is effective but underused in the United States. To change this, a better understanding of how equipment ends up being installed is needed. We hypothesized that rehabilitation services were a major mechanism. Objective: To examine the association between receipt of rehabilitation services and installation of adaptive equipment. Design: Observational cohort of the National Health and Aging Trends Study in 2015 and 2016. Setting: Community. Participants: A total of 416 community-dwelling adults age 65 yr or older who needed bathing equipment and 454 who needed toileting equipment. Outcomes and Measures: Study outcomes were the installation of bathing or toileting equipment. The primary independent variable was the receipt of rehabilitation services between 2015 and 2016. Results: Among older adults who needed equipment in 2015, 34.3% had bathing equipment and 19.2% had toileting equipment installed by 2016. In multivariate logistic regression analyses, rehabilitation services were associated with installation of bathing (odds ratio [OR] = 5.07, 95% confidence interval [CI] [2.60, 9.89]) and toileting equipment (OR = 2.67, 95% CI [1.48, 4.84]). Conclusions and Relevance: A minority of those in need have adaptive equipment installed within a year. In the current health care system, rehabilitation providers play a major role in equipment installation. What This Article Adds: Rehabilitation providers are involved in the installation of adaptive bathroom equipment among older persons who need it. Still, most in need of equipment do not have it after a year, suggesting that further work is needed to increase access to rehabilitation providers and develop other avenues for obtaining equipment. In the current health care system, a minority of older adults in need have adaptive equipment installed within a year. Rehabilitation providers play a major role in helping older adults modify their home environment to maximize function and reduce disability. [ABSTRACT FROM AUTHOR]

The current quasi-experimental study aimed to compare the effects of virtual reality (VR) and home chair-based (HCB) exercises on balance, daily living activities, and loneliness among older adults (N = 90) with balance disorders living in nursing homes. Participants were assigned to three groups: (a) VR exercises, (b) HCB exercises, and (c) routine nursing home programs. Findings indicated that VR and HCB exercises significantly increased participants' balance and daily living activities compared to routine programs (p < 0.001). However, there was no clinical difference among groups regarding Berg Balance Scale and Barthel Index scores. Main effect of time regarding loneliness mean score (p = 0.991) was not significant among groups. The minimal detectable change pre-set standard for loneliness also showed no significant clinical difference. Exercise had no significant impact on loneliness; however, it had a positive role in improving balance and daily living activities, with no significant difference between VR and HCB exercises. Further studies are recommended to evaluate adherence to such exercises. [Research in Gerontological Nursing, 16(1), 33–42.] [ABSTRACT FROM AUTHOR]

Background: Communication about managing medications during transitions of care can be a challenging process for older patients since they often have complex medication regimens. Previous studies highlighted that links between communication breakdowns and medication incidents in older patients occur mainly at discharge or in the post‐discharge period. Little attention has been paid to exploring communication strategies facilitating patient‐centred medication communication at transitions of care from a discourse‐analytic perspective. Objectives: To explore, through a discursive lens, strategies that enable patient‐centred medication communication at transitions of care. Design: A focused ethnographic study was employed for this study. The study was reported according to the COREQ checklist. Methods: Interviews, observations and focus groups were analysed utilising Critical Discourse Analysis and the Medication Communication Model following thematic analysis. Data collection was undertaken in eight wards across two metropolitan hospitals in Australia. Results: Patient preferences and beliefs about medications were identified as important characteristics of patient‐centred communication. Strategies included empathetic talk prioritising patients' medication needs and preferences for medications; informative talk clarifying patients' concerns; and encouraging talk for enhancing shared decision‐making with older patients. Challenges relating to the use of these strategies included patients' hearing, speech or cognitive impairments, language barriers and absence of interpreters or family members during care transitions. Relevance to clinical practice: To enhance medication communication, nurses, doctors and pharmacists should incorporate older patients' preferences, previous experiences and beliefs, and consider the challenges faced by patients across transitions. Strategies encouraging patients' contribution to decision‐making processes are crucial to patient‐centeredness in medication communication. Nurses need to engage in informative talk more frequently when administering the medications to ensure older patients' understanding of medications prescribed or altered in hospital settings. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted with elderly individuals who had recovered from COVID-19 to investigate the effects of COVID-19 on balance, perception, attention, memory, and quality of life and produce rehabilitative solutions for these problems. Material and Method: A total of 45 volunteers older than 65 years who had not had COVID-19 were included in group 1. A total of 45 volunteers older than 65 years who had recovered from COVID-19 were included in group 2 (elderly people who have had COVID-19 at least 6 months ago). After obtaining the individuals' demographic data, we conducted vestibular assessment for balance and administered the Stroop test for attention, the Mini-Mental State Examination (MMSE), the digit span test for short-term memory, and a quality-of-life test. Results: Mean age of the individuals who had had COVID-19 was 68.24 ± 3.32 years, and the mean age of the individuals who had not had COVID-19 was 68.55 ± 3.34 years. There were statistically significant correlations between the two groups for the Stroop test (P <.05), MMSE (P <.05), the digit span test for perception and attention (P <.05), and the vestibular assessment quality-of-life test (P <.01). Sensory (P <.001), past, present, and future activities (P <.05), social participation (P <.001), and death (P <.05) were found to be significant in the total score (P <.001). The covariance analysis of elderly individuals who had had COVID-19 revealed that they performed significantly worse on the balance, perception, attention, memory, and quality-of-life tests than elderly individuals who had not had COVID-19. Conclusion: The negative effects of COVID-19 were found among elderly individuals older than 65 years. We suggest that telerehabilitation should be developed for elderly people who have recovered from COVID-19 and that its effects investigated. [ABSTRACT FROM AUTHOR]

Objective: To test the feasibility of a pilot study for a future definitive trial investigating the effect of different meal service programs for old people living at home. Design: An 8-week randomized controlled trial was performed. Setting: Three municipalities in the Nordic country, Denmark. Subjects: Danish participants (≥65y) with reduced functionality. Intervention: Three different meal service programs 1) 24-h meals service, 2) Protein-rich meal service, and 3) Rehabilitation meal service, were developed and compared to standard care. Main Measures: The main outcome was study feasibility. Dietary intake, anthropometry, physical function, quality of life, readmissions and adverse events were also evaluated. Comparisons between participants receiving a meal service program and standard care were done by one-way ANOVA, chi-square test and Fishers exact test Results: A total of 592 subjects were assessed for eligibility and 13% (76/592) were recruited. Final analysis included 75% (57/76) of participants. The outcome measures seemed acceptable and feasible though eligibility, inclusion, and completion of the intervention were lower than expected. The 24-h meal service program managed to significantly increase the intake of protein (p = 0.049) and energy (p = 0.038) compared to the control group where reductions were seen. No other significant differences were found. Conclusions: The pilot study was feasible and several benefits for completers were seen. However, in a future definitive trial, inclusion criteria should be wider, more effort should be put on the time, training and focus of the personal in close contact to the older subjects and the intervention should be less comprehensive and more flexible. [ABSTRACT FROM AUTHOR]

Importance: Positive psychological factors have been related to better outcomes among adults with various health conditions. Objective: To predict functional ability and participation in older adults who had experienced a hip fracture on the basis of data at admission to acute (inpatient) rehabilitation. We measured physical factors, as well as positive and negative psychological factors, at three time points. Design: Prospective and cross-sectional cohort study. Data collection occurred during admission, at discharge, and 6 mo after rehabilitation. Setting: Inpatient geriatric rehabilitation center and follow-up at home. Participants: Seventy-one older adults (M age 5 78.58 yr, SD 5 6.09) who had sustained a hip fracture because of a fall and who attended acute rehabilitation; 55 completed follow-up assessments 6 mo after discharge from rehabilitation. Measures: Participants completed the Adult Hope Scale, Life Orientation Test, Positive Affect Questionnaire, Geriatric Depression Scale (at admission only), hand-grip strength measures, Numeric Pain Rating Scale, and FIM® Motor domain (mFIM) before and after acute rehabilitation and after 6 mo. The Activity Card Sort (ACS) was administered only at follow-up. Outcome measures were the mFIM and ACS. Results: At 6-mo follow-up, functional ability was correlated more with optimism than with age, gender, or handgrip strength measured at admission. Participation was predicted by age, the hope–agency component, and pain in walking at admission; however, the hope–agency component was only marginally significant. At discharge, functional ability was strongly predicted by age, hand-grip strength, and mFIM scores at admission. Conclusions and Relevance: Optimism and hope played a role in explaining rehabilitation outcomes at 6-mo follow-up. Occupational therapy evaluation should address positive psychological factors, and intervention should aim to strengthen these factors as powerful aids in older adults’ recovery from hip fractures. What This Article Adds: This study reflects the philosophy of occupational therapy, which places great emphasis on the connection between clients’ mind–body–spirit and their participation in daily life occupations. [ABSTRACT FROM AUTHOR]

The characteristics of elderly hip fracture patients in acute care hospitals were analyzed based on hospitalization and discharge route and the presence or absence of a dementia diagnosis. The study was conducted as a cross-sectional exploratory study using data from the Diagnosis Procedure Combination database in Japan from April 2014 to March 2016. Patients aged 65 years or older who had surgery for a hip fracture were identified. We subsequently extracted patients whose home, medical institution (including convalescent rehabilitation wards), or elderly care facility was both the admission and discharge route. A total of 105 122 patients were included. 19% of patients were diagnosed with dementia. Patients with dementia had a shorter length of acute care hospital stay than those without dementia. The hospitalization route for dementia patients was 51% at home and 40% at a care facility. Dementia patients were discharged to hospital and care facilities at 41% each. Nearly all patients received hospital-based postoperative rehabilitation regardless of dementia but patients with dementia had lower gains in activities of daily living. Hip fracture patients with dementia have less opportunity for continuous hospital-based rehabilitation and need an environment that allows for continuous elderly care facility-based and community-based rehabilitation. In Japan, an aging society, one in five elderly patients undergoing hip fracture surgery was diagnosed with dementia. Many hip fracture patients with dementia have a shorter length of hospital stay and may have fewer opportunities to change hospitals to receive rehabilitation. It is necessary to establish an ongoing and proactive community- and elderly care facility-based rehabilitation system for patients with hip fracture with dementia after acute care hospital discharge. [ABSTRACT FROM AUTHOR]

The de Morton Mobility Index (DEMMI) is a unidimensional clinical instrument proven reliable and valid for measuring mobility in the elderly, but its responsiveness has not been evaluated when applying the methodology recommended by COSMIN. To evaluate the responsiveness and the predictive validity of the DEMMI. Elderly people, referred for municipality-based rehabilitation, were consecutively included. Eight hypotheses regarding the relationship between the change scores in the DEMMI and other functional measures of mobility were tested by assessing the participants before and after rehabilitation. Three months after completing the rehabilitation, the participants' functional status was evaluated. 250 elderly people (mean age 85 years, 63% women) were included. The change scores in the DEMMI and the other measures correlated (r = 0.422 to 0.547), but only three out of the eight hypotheses were confirmed. A DEMMI score of less than 48 and less than 67 can predict inability of ambulating close to the participant's residence and using public transport, respectively. We found a moderate responsiveness and a high predictive validity of the DEMMI score. The DEMMI appears to be an appropriate instrument for monitoring change in mobility and predicting functional status among elderly patients undergoing rehabilitation. The de Morton Mobility Index (DEMMI) is a clinical instrument for measuring mobility. This study shows that the DEMMI was responsive to change in mobility and predicted disability among a diverse group of elderly individuals referred to rehabilitation after hospital discharge. The DEMMI is applicable as an outcome measure in trials investigating the effect of rehabilitation and for clinical decision-making concerning geriatric rehabilitation. [ABSTRACT FROM AUTHOR]

Aims: To acquire an in‐depth understanding of how older individuals diagnosed with acquired brain injury (ABI) experience their well‐being and care when undergoing physical rehabilitation. Design: Systematic literature review. Data sources: The electronic databases of PubMed, CINAHL, APA PsycInfo, ASSIA and SCOPUS were searched from 2005 to 2020. Extensive reference checking was also conducted. Review methods: A systematic review was conducted following PRISMA guidelines, including predominantly qualitative studies. Studies' quality was appraised using the critical apraisal skills programme (CASP) tool. Results: Seventeen studies met the inclusion criteria. Following methods of thematic synthesis, four overarching interpretive themes were identified: (a) Rehabilitation processes and their impact on older individuals' well‐being; (b) Identity and embodiment concerns of older individuals during rehabilitation; (c) Institutional factors affecting older individuals' care and well‐being experiences; and (d) Older individuals' participation in creative activities as part of rehabilitation. Conclusion: Organizational and structural care deficiencies as well as health disparities can adversely impact older individuals' autonomous decision‐making and goal‐setting potentials. The discrepancy between older individuals' expectations and the reality of returning home along with the illusionary wish to return to a perceived normality, can further negatively affect older individuals' sense of well‐being. Constructive communication, emotional support, family involvement in rehabilitation and creating a stimulating, enriching social environment can humanize and facilitate older individuals' adjustment to their new reality following ABI. Impact: There is a lack of qualitative research on older individuals' ABI rehabilitation experiences, especially traumatic brain injury incidents. Further study should consider patients' concerns over their involvement in decision‐making and goal setting about their care. Overall, this review reveals the need to examine further the significance of humanizing care and the factors that affect older individuals' sense of well‐being. [ABSTRACT FROM AUTHOR]

Background and Purpose: The transversus abdominis (TrA) is a key muscle for lumbar stabilization and is often retrained in physical therapy. Feedback tools, such as the pressure biofeedback unit (PBU) and rehabilitative ultrasound imaging (RUSI), are frequently used by physical therapists to train their patients and improve their patients' ability to contract this muscle. However, the effect of these tools in rehabilitating the TrA in older adults remains to be demonstrated, as is their efficiency in transferring the skill of recruiting the TrA from a supine position to a standing position. The objective of the study was to compare the immediate effectiveness of the PBU and RUSI to reeducate the TrA muscle in a population of asymptomatic older adults (without pain). Methods: Forty participants were randomized into 2 groups (RUSI or PBU). The intervention included a training session involving 15 TrA contractions held for 10 seconds with the corresponding feedback device. The dependent variable, TrA thickness (a muscle activation indicator), was measured using ultrasound images before and after the intervention in a supine and standing position. Nonparametric analyses were used for inter- and intragroup comparisons. Results and Discussion: The results showed no between-group differences in TrA activation ratio (AR) in the supine or standing position (supine AR: TrA RUSI thickness change P =.53 vs PBU thickness change P =.73, comparison between groups P =.51; standing AR: TrA RUSI thickness change P =.003 vs PBU thickness change P =.10; comparison between groups P =.61). However, the change in TrA thickness compared to the other abdominal wall muscles in a standing position was significantly less post-intervention for the RUSI group only (RUSI P =.006 vs PBU P =.72). Both groups remained similar post-intervention for this outcome (P =.20). Conclusions: Neither the RUSI nor the PBU seems to have the desired effect on the activation of TrA in asymptomatic older adults. [ABSTRACT FROM AUTHOR]

Background: Geriatric hip fracture patients often experience gaps in care including variability in the timing and the choice of an appropriate setting for rehabilitation following hip fracture surgery. Many guidelines recommend standardized processes, including timely access of no later than day 6 to rehabilitation services. A pathway for early identification, referral and access to geriatric rehabilitation post-hip fracture was created to facilitate the implementation. The study aimed to describe the barriers and enablers prior to the implementation of this pathway. Methods: We conducted a qualitative descriptive study consisting of semi-structured interviews with geriatric hip fracture patients (n = 8), caregivers (n = 1), administrators (n = 12) and clinicians (n = 17) in 2 orthopaedics units and a geriatric rehabilitation service. Responses were analysed using a systematic approach, and overarching themes describing the barriers and enablers were identified. Results: The clinicians' and administrators' top barriers to implementation of the pathway were competing demands (n = 24); lack of bed availability, community resources and funding (n = 19); and the need for extended hours and increased staff (n = 16). The top 3 enablers were clear communication with patients (n = 27), awareness of the benefits of geriatric rehabilitation (n = 24) and the need for education and resources to properly use the pathway (n = 15). Common barriers among patients and caregivers included lack of care coordination, overcoming some of their own specific challenges during their transition, gaps in the information they received before discharge, not knowing what questions to ask and lack of resources. Despite these barriers, patients were generally pleased with their transition from the hospital to geriatric rehabilitation. Conclusion: We identified and described key barriers and enablers to early identification, referral and access to geriatric rehabilitation post-hip fracture. These influencing factors provide a basis for the development of a standardized pathway aimed at improving access to rehabilitative care for geriatric hip fracture patients. [ABSTRACT FROM AUTHOR]

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

To investigate early predictors for discharge to a geriatric rehabilitation department at a skilled nursing home in older patients after hospitalization for hip fracture surgery. Retrospective cohort study. Data from 21,176 patients with hip fracture aged ≥70 years, who were registered in the Dutch Hip Fracture Audit database between January 1, 2017, and December 31, 2019, were included. Patients were categorized into 3 discharge groups: home (n=7326), rehabilitation (n=11,738), and nursing home (n=2112). Age, gender, Pre-Fracture Mobility Score (PFMS), premorbid Katz index of independence in Activities of Daily Living (Katz-ADL), history of dementia, American Society of Anesthesiologists physical status classification (ASA score), type of anesthesia, fracture type, surgical treatment, and cotreatment by a geriatrician were gathered. Multinomial regression analysis was used to assess for early predictors. Higher age, poor premorbid mobility, lower premorbid Katz-ADL, no history of dementia, ASA score 3-5, general anesthesia, intramedullary implant, and cotreatment by a geriatrician were independent predictors for discharge to geriatric rehabilitation vs discharge home. Identical predictors were found for discharge to a nursing home vs discharge home. History of dementia and premorbid Katz-ADL were distinguishing factors; a higher premorbid Katz-ADL and a history of dementia were associated with a higher risk of discharge to a nursing home vs discharge home. The multinomial regression model correctly predicted 86%, 38.6%, and 2.4% of the patients in the rehabilitation group, home group, and nursing home group, respectively. This study showed that age, PFMS, premorbid Katz-ADL, surgical treatment, ASA score, type of anesthesia, history of dementia, and cotreatment by a geriatrician were independent early predictors for discharge to geriatric rehabilitation vs discharge home in older patients after hip fracture surgery. Identical predictors were found as predictors for discharge to a nursing home vs discharge home, except for history of dementia and premorbid Katz-ADL. [ABSTRACT FROM AUTHOR]

To explore how occupational therapists and physiotherapists constructed and interpreted the meaning of rehabilitation in relation to older people in acute care. A focussed ethnographic study was undertaken, primarily using observation, interviewing and review of clinical records within one acute medical ward in a general hospital in the UK. Five patient participants gave consent for their episode of care to be studied, with observations and interviews primarily involving the identified patients and five occupational therapy and physiotherapy professionals. Four themes were identified: rehabilitation as a process to facilitate physical improvement; rehabilitation as physiotherapy-led; rehabilitation as a place...but not here; and rehabilitation as a process which prioritises safety over function. Such conceptualisations of rehabilitation were recognised as rooted in social and historical perceptions and challenged the ideals of rehabilitation professionals. The meaning of rehabilitation in acute care is shaped by a range of cultural, contextual and systemic influences. Recognising these influences, and subsequent challenges to rehabilitation ideals, can encourage professionals to work towards meaningful change. A reductionist version of rehabilitation was evident within this context which placed value on physical improvement, achieving optimum safety and led by physiotherapy. This version of rehabilitation was unsatisfactory to occupational therapists and physiotherapists in this setting and different to their ideals. Where rehabilitation may be associated with another place, practitioners should reflect on whether this is influencing patients becoming a lower priority for interventions whilst waiting and address this, if required, within their own reasoning, prioritisation and delegation. Those who recognise similarities with their own practice context could individually, and within teams, revisit definitions of rehabilitation to notice, document and have conversations about the ideals of their professions versus the reality of practice. Occupational therapists and physiotherapists can be champions for organisational and cultural change to promote rehabilitation as a multi-disciplinary phase of care working towards optimising improvements in wellbeing, function and safety, irrespective of location. [ABSTRACT FROM AUTHOR]

Objective Foot tactile sensitivity loss, commonly assessed by monofilaments, is a fall risk factor among older adults. The broadly used threshold of the monofilament for fall risk assessment in older adults is 5.07. However, this threshold originates from assessing foot ulceration risk in people with peripheral neuropathy. The primary purpose of this study was to identify the optimal filament size and its cutoff number of sensitive sites that can be used to best identify a high risk of falls in terms of the foot tactile sensitivity for community-dwelling older adults. Methods In this cross-sectional study, the foot tactile sensitivity was assessed by a 6-piece Semmes-Weinstein monofilament kit at 9 sites per foot among 94 older adults, including 38 fallers and 56 nonfallers. The number of sensitive sites was determined for each monofilament size as the cutoff. Logistical regression analyses were used to determine the monofilament size and number of sensitive sites best able to differentiate fallers from nonfallers. Results Fallers showed overall worse foot tactile sensory measurements than nonfallers. Logistical regression analyses identified 4.31 as the best monofilament size and 7 as the number of sensitive sites to differentiate fallers from nonfallers with an accuracy of 71.3%. Conclusion The 4.31 monofilament could be the best filament to detect the risk of falls among older adults in terms of tactile sensory loss. Inability to feel the pressure from the 4.31 filament at more than 7 sites could indicate a high risk of falls. Impact These findings could help physical therapists and other rehabilitation professionals improve decision making in detecting older adults with a high risk of falls, thus facilitating the effort of fall prevention in older adults. [ABSTRACT FROM AUTHOR]

Objective: This study examined cognitive, affective, and medical impairments and their impact on rehabilitation approaches for improving functional outcome after hospitalization in older adults. Design: A secondary analysis of a randomized clinical trial in 229 adults 65 yrs or older admitted to two skilled nursing facilities undergoing rehabilitation services was conducted. Patients were randomized to receive physical and occupational therapy by therapists trained in systematic approaches to engage patients, called Enhanced Medical Rehabilitation, or standard of care. The outcome of interest was functional improvement, defined as Barthel index at discharge (controlling for Barthel index upon admission). This study analyzed the relationship of measures of cognition, depression, and medical comorbidities as predictors of functional outcome and as moderators interacting with treatment group. Results: Clock drawing score moderated treatment effect size; the functional improvement of Enhanced Medical Rehabilitation over standard of care therapy reduced with increasing executive impairment. in contrast, general cognitive abilities, depression, medical co- morbidities, and readiness for rehabilitation were neither predictors nor moderators of functional improvement. Conclusions: For older adults undergoing rehabilitation, greater functional improvement with the motivational techniques of Enhanced Medical Rehabilitation was contingent on patients having intact executive function. Given that executive function impairments are com-mon in rehabilitation populations, new strategies are needed to improve treatment outcomes in physical/occupational therapy. [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]

Objectives: There is insufficient knowledge about the functional and medical recovery of older people infected with SARS-CoV-2. This study aims to gain insight into the course of functional and medical recovery of persons who receive geriatric rehabilitation (GR) following SARS-CoV-2 infection across Europe. Special attention will be paid to the recovery of activities of daily living (ADL) and to the GR services offered to these patients. Design: A multi-center observational cohort study. Setting and participants: This study will include several European countries (EuGMS member states) each providing at least 52 comparable routine datasets (core dataset) of persons recovering from a SARS-CoV-2 infection and receiving geriatric rehabilitation. The routine data will be anonymously collected in an online CASTOR database. The ethical regulations of each participating country will be followed. Primary outcome: ADL functioning. Secondary outcomes: Length of stay, discharge destination, hospital readmission and mortality. Other variables that will be collected are quality of life, treatment modalities, complications, cognition, frailty, mood/anxiety, BMI, nutrition and pain. All variables will be reported at admission and compared with follow-up scores (discharge, 6 weeks and 6 months follow-up). Conclusion: This study will explore the effect of geriatric rehabilitation on post-COVID-19 patients, especially on ADL recovery, and the variety of geriatric rehabilitation services across Europe. Information from this study may help improve recovery of older persons infected with SARS-CoV-2 and improve geriatric rehabilitation services in the ongoing COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: To explore common complications in people with neurological conditions during rehabilitation admission. Methods: All neurological subjects, including those with stroke, spinal cord injury (SCI), and traumatic brain injury, who were admitted for intensive and less-intensive rehabilitation programs during January to December 2012 were recruited. Both avoidable and unavoidable complications and related factors were assessed. Results: Among 1146 subjects, 65% was male with a mean age of 54.5 years. Almost 90% were admitted for intensive rehabilitation. The common avoidable complications that occurred were urinary tract infection (UTI) (12.8%), musculoskeletal pain (7.0%), neuropathic pain (2.3%), pneumonia (1.5%), and pressure injury (1.2%). Spasticity, which is an unavoidable complication, occurred in 2.1% of subjects. Older age, male gender, diagnosis of SCI, and longer stay were important factors related to complications. Conclusions: Most of the common complications during rehabilitation were avoidable complications, especially UTI and pain. A heightened level of awareness and vigilance should be exercised in older male subjects, those with prolonged hospital stay, and those with a diagnosis of SCI. [ABSTRACT FROM AUTHOR]

There is evidence to suggest that assisted cycling can effectively improve the motor function of patients with Parkinson's disease (PD) and an assisted cycling intervention is more beneficial for those with more advanced PD. Therefore, the aim of this study was to investigate the influence of an intervention with a coordination program at MOTOmed Viva 2 Parkinson on dynamic balance, muscle parameters, and symptoms in elderly people diagnosed with advanced stages of PD. We studied 4 elderly people with PD in advanced stages. We evaluated PD symptomatology using the adapted Spanish version of the MDS-UPDRS (Movement Disorder Society Unified Parkinson's Disease Rating Scale); dynamic balance was evaluated by means of the Timed Up and Go (TUG) and the MOTOmed Viva 2 Parkinson system stores data about muscle tone, symmetry, coordination, and spasms, in each of the sessions undertaken. We found that a 21-minute coordination training in 13 sessions with the MOTOmed device demonstrates positive effects on muscle tone, spasms, coordination, symmetry, and balance in older adults diagnosed with advanced stages of PD. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to know the impact of executive functions on the performance of instrumental activities of daily living in Parkinson disease (PD). Methods: A cross-sectional descriptive study was conducted with 94 participants (64 PD and 30 controls). Results: The poor inhibitory control and verbal fluency in PD could be related to their performance on instrumental activities of daily living as poorer executive performance directly influences the motor and process skills needed to perform instrumental activities of daily living. Conclusion: Our results suggest that rehabilitation activities for these executive tasks could be of interest for the performance of PD patients. [ABSTRACT FROM AUTHOR]

Background and Purpose: Sit-to-stand tests measure a clinically relevant function and are widely used in older adult populations. The modified 30-second sit-to-stand test (m30STS) overcomes the floor effect of other sit-to-stand tests observed in physically challenged older adults. The purpose of this study was to examine interrater and test-retest intrarater reliability for the m30STS for older adults. In addition, convergent validity of the m30STS, as well as responsiveness to change, was examined in older adults undergoing rehabilitation. Methods: In phase I, 7 older adult participants were filmed performing the m30STS. The m30STS was standardized to allow hand support during the rise to and descent from standing but required participants to let go of the armrests with each stand. Ten physical therapists and physical therapist assistants independently scored the filmed m30STS twice, with 21 days separating the scoring sessions. In phase II, 33 older adults with comorbidities admitted to physical therapy services at a skilled nursing facility were administered the m30STS, Berg Balance Scale, handheld dynamometry of knee extensors, and the modified Barthel Index at initial examination and discharge. Results: In phase I, the m30STS was found to be reliable. Interrater reliability using absolute agreement was calculated as intraclass correlation coefficient (ICC)2,1 = 0.737 (P ≤ .001). Test-retest intrarater reliability using absolute agreement was calculated as ICC2,k = 0.987 (P ≤ .001). In phase II, concurrent validity was established for the m30STS for the initial (Spearman ρ = 0.737, P = .01) and discharge (Spearman ρ = 0.727, P = .01) Berg Balance Scale as well as total scores of the modified Barthel Index (initial total score Spearman ρ = 0.711, P = .01; discharge total score Spearman ρ = 0.824, P = .01). The initial m30STS predicted 31.5% of the variability in the discharge Berg Balance Scale. The m30STS did not demonstrate significant correlation with body weight-adjusted strength measures of knee extensors measured by handheld dynamometry. The minimal detectable change (MDC90) was calculated to be 0.70, meaning that an increase of 1 additional repetition in the m30STS is a change beyond error. Conclusion: The m30STS is a reliable, feasible tool for use in a general geriatric population with a lower level of function. The m30STS demonstrated concurrent validity with the Berg Balance Scale and modified Barthel Index but not with knee extensor strength to body weight ratio. One repetition of the m30STS was established as the MDC90 as change beyond error. [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]

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

Supplemental digital content is available in the text. Objective: Knee osteoarthritis and age are associated with high sarcopenia risk, especially in patients who have received total knee replacement. The aim of this study was to identify the effects of elastic resistance exercise training after total knee replacement on muscle mass and physical outcomes in older women with knee osteoarthritis. Design: Sixty older women who received unilateral primary total knee replacement surgery were randomized to an experimental group, which received 12 wks of postoperative elastic resistance exercise training, or a control group, which received standard care. The outcome measures included physical function performance (ie, Timed Up & Go, gait speed, forward reach, single-leg stance, timed chair rise), appendicular lean mass, and the Western Ontario and McMaster Universities Osteoarthritis Index. The assessment time points were 2 wks before surgery (T0), 1 mo after surgery (T1, before resistance exercise training), and 4 mos after surgery (T2, upon completion of resistance exercise training). Results: After 12 wks of postoperative elastic resistance exercise training, the experimental group exhibited a significantly greater change in appendicular lean mass (mean difference = 0.81 kg, P = 0.004) than the control group. Elastic resistance exercise training also exerted significant effects on Timed Up & Go and gait speed with mean differences of 0.28 m/sec (P < 0.001) and −2.66 secs (P < 0.001), respectively. Conclusions: A 12-wk elastic resistance exercise training program after total knee replacement exerted benefits on muscle mass, mobility, and Western Ontario and McMaster Universities Osteoarthritis Index functional outcomes in older women with knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Objective: The aim of this study was to assess the impact of the burden and patterns of multimorbidity on disability domains. Design: In a cross-sectional study of 425 older adults from the Boston Rehabilitative Impairment Study of the Elderly, participants self-reported 13 chronic conditions and underwent assessment of body function (leg strength, velocity, and power, trunk extensor endurance, leg range of motion, foot sensation), activities (400-m walk test, Short Physical Performance Battery, Late Life Function and Disability Instrument function scores) and participation (Late Life Function and Disability Instrument participation scores). The association between multimorbidity patterns (identified by latent class analysis) and disablement measures, as well as multimorbidity burden (captured by a multimorbidity score) and disablement measures, was tested. Results: Latent class analysis identified three classes—low multimorbidity, high multimorbidity, and predominantly musculoskeletal conditions. Class membership (multimorbidity pattern) was not associated with disablement measures, but multimorbidity score was associated with poor performance in all domains. A 1-point higher multimorbidity score was associated with lower scores in body functions (by 0.06 SD unit), activities (0.07–0.10 SD units), as well as participation (0.07–0.09 units). Conclusion: Multimorbidity counts may be an excellent tool for risk stratification and identification of persons in need of rehabilitation. To Claim CME Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives: Upon completion of this article, the reader should be able to (1) describe and distinguish the effect of multimorbidity burden and multimorbidity patterns on three disability domains in older adults; (2) identify and discuss possible reasons why high multimorbidity burden may result in a restriction among social participation in older adults; and (3) detect disability risk among older patients during clinical assessment by using a simple count of common chronic conditions. Level: Advanced Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity. [ABSTRACT FROM AUTHOR]

The primary objectives of this research were to pilot the use of a new pain and mobility outcome measure, the Pain and Mobility Index (PMI), and to assess its convergent validity with the Short Physical Performance Battery (SPPB). Twenty-eight subjects were divided into nonhospitalized and hospitalized groups. The number of subjects needed for future research using the PMI to assess for rehospitalization risk is at least 124. Discharge SPPB and PMI scores showed a good correlation, and there was a significant difference in bed mobility scores and SPPB scores between the nonhospitalized and hospitalized groups. [ABSTRACT FROM AUTHOR]

Background and Purpose: Age-related muscle strength deterioration and decreased ability to react appropriately and regain balance after unexpected sudden disturbances and deficit they have in the use of responsible mechanisms to control the dynamic stability in response to a disturbance are important intrinsic risk factors for the fall. The main objective of this study is to verify the impact on the dynamic balance, through the Limits of Stability test, of a physical exercise program in older adults using the Nintendo Wii console. Methods: The sample consisted of a total of 12 patients. Pre and posttreatment measurements and assessments were carried out at the Laboratory of Motion Analysis, Biomechanics, Ergonomics and Motor Control (LAMBECOM) in the Faculty of Health Sciences of the Rey Juan Carlos University. Results and Conclusions: The results of this study show improvements in the scores of all the variables analyzed by Limits of Stability: RT, MVL, EPE, MXE and DCL. The results obtained seem to determine that the protocol used through training with the Nintendo Wii and its Wii Fit video game produced clinical improvements in postural control and dynamic balance and a positive impact on quality of life. [ABSTRACT FROM AUTHOR]