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van Haastregt JCM, Everink IHJ, Schols JMGA, Grund S, Gordon AL, Poot EP, Martin FC, O'Neill D, Petrovic M, Bachmann S, van Balen R, van Dam van Isselt L, Dockery F, Holstege MS, Landi F, Pérez LM, Roquer E, Smalbrugge M, Achterberg WP. Management of post-acute COVID-19 patients in geriatric rehabilitation: EuGMS guidance. Eur Geriatr Med 2022; 13:291-304. [PMID: 34800286 PMCID: PMC8605452 DOI: 10.1007/s41999-021-00575-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/06/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe a guidance on the management of post-acute COVID 19 patients in geriatric rehabilitation. METHODS The guidance is based on guidelines for post-acute COVID-19 geriatric rehabilitation developed in the Netherlands, updated with recent insights from literature, related guidance from other countries and disciplines, and combined with experiences from experts in countries participating in the Geriatric Rehabilitation Special Interest Group of the European Geriatric Medicine Society. RESULTS This guidance for post-acute COVID-19 rehabilitation is divided into a section addressing general recommendations for geriatric rehabilitation and a section addressing specific processes and procedures. The Sect. "General recommendations for geriatric rehabilitation" addresses: (1) general requirements for post-acute COVID-19 rehabilitation and (2) critical aspects for quality assurance during COVID-19 pandemic. The Sect. "Specific processes and procedures", addresses the following topics: (1) patient selection; (2) admission; (3) treatment; (4) discharge; and (5) follow-up and monitoring. CONCLUSION Providing tailored geriatric rehabilitation treatment to post-acute COVID-19 patients is a challenge for which the guidance is designed to provide support. There is a strong need for additional evidence on COVID-19 geriatric rehabilitation including developing an understanding of risk profiles of older patients living with frailty to develop individualised treatment regimes. The present guidance will be regularly updated based on additional evidence from practice and research.
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Affiliation(s)
- Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Irma H J Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Stefan Grund
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Derby, UK
| | - Else P Poot
- Verenso Dutch Association of Elderly Care Physicians, Utrecht, The Netherlands
| | - Finbarr C Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Desmond O'Neill
- Trinity College Dublin Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Stefan Bachmann
- Department of Rheumatology and Internal Medicine, Kliniken Valens, Valens, Switzerland
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Frances Dockery
- Department of Geriatrics and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Marije S Holstege
- Department of Research GRZPLUS, Omring and Zorgcirkel, Hoorn, The Netherlands
| | - Francesco Landi
- Geriatric Internal Medicine Department, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Laura M Pérez
- Clinical Head of Outpatient Clinic and Geriatric Home Care, Intermediate Care Hospital Parc Sanitari Pere Virgili, Barcelona, Spain
- Research Group on Aging, Frailty and Transitions in Barcelona (RE-FiT BCN), Vall d'Hebrón Institut de Recerca, Barcelona, Spain
| | - Esther Roquer
- Geriatric Service, University Hospital Sant Joan de Reus, Reus, Spain
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Chair of the Guidance Committee Post COVID-19 Geriatric Rehabilitation, Verenso Dutch Association of Elderly Care Physicians, Utrecht, The Netherlands
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Grund S, Bauer J, Schuler M. [Post-acute geriatric rehabilitation outcomes in fracture patients treated in an orthogeriatric trauma center-A prospective investigation with historical control]. Z Gerontol Geriatr 2020; 53:564-571. [PMID: 32367172 DOI: 10.1007/s00391-020-01727-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the increasing amount of positive evidence with respect to mortality for the orthogeriatric co-management in a center for geriatric traumatology (CGT), effects on the course after the acute inpatient hospital treatment have been insufficiently investigated. METHODS Patients over 75 years old who needed rehabilitation following acute inpatient treatment before (retrospective, n = 90) and after (prospective, n = 99) the introduction of a certified CGT were investigated. The two groups were compared with respect to the frequency of discharge into an indication-specific (AHB) and geriatric rehabilitation, mobility performance including the five times sit-to-stand test, short physical performance battery (SPPB) and competence in activities of daily living with the Barthel index (BI). RESULTS After introduction of a CGT 17.2% (95 % confidence interval [95 % CI]: 10-25%; p < 0.027) of the patients were discharged to a specialized orthopedic inpatient rehabilitation (AHB) vs. 6.7% (95 % CI: 1-12%) before the introduction. Correspondingly less patients needed geriatric rehabilitation (before CGT 93.3 %, 95 % CI: 88.1-98.6 vs. CGT 82.8 %, 95 % CI: 75-90; p < 0.001). The overall outcome of post-acute geriatric inpatient rehabilitation improved in both groups but did not differ. Patients who needed two therapy sessions in the CGT were clearly poorer than those with one therapy session with respect to activities of daily living (BI: 34.1, 95 % CI: 30-37.2 vs. 41.2, 95 % CI: 30.9-51.4) and mobility performance (SPPB: 1.2, 95 % CI: 0.7-1.8 vs. 2.2, 95 % CI: 0.9-3.4; p = 0.048). The differences remained despite improvement of both groups during geriatric rehabilitation. CONCLUSION The establishment of a CGT enables more patients to be discharged into a less cost-intensive AHB. The more intensive treatment in the CGT offers more severely affected patients the chance for further functional improvement through post-acute inpatient geriatric rehabilitation. A predominantly closing treatment of patients in a CGT is not conceivable in the CGT model presented.
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Affiliation(s)
- Stefan Grund
- Geriatrisches Zentrum Heidelberg, Universität Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland. .,Abteilung für Geriatrie und Geriatrische Rehabilitation, Agaplesion Bethanien Krankenhaus Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland.
| | - Jürgen Bauer
- Geriatrisches Zentrum Heidelberg, Universität Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland.,Abteilung für Geriatrie und Geriatrische Rehabilitation, Agaplesion Bethanien Krankenhaus Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland
| | - Matthias Schuler
- Diakonissen Krankenhaus Mannheim Abteilung für Geriatrie, Speyerer Straße 91-93, 68163, Mannheim, Deutschland
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EuGMS survey on structures of geriatric rehabilitation across Europe. Eur Geriatr Med 2019; 11:217-232. [DOI: 10.1007/s41999-019-00273-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose
Geriatric rehabilitation provides effective multidisciplinary treatment for older people who show symptoms of relevant and potentially reversible functional decline. The aim of this study is to provide an overview on structures of geriatric rehabilitation across Europe.
Methods
All European Geriatric Medicine Society (EuGMS) Full board members, each representing one member state of the society, were asked to complete an online questionnaire about the current structure of geriatric rehabilitation in their country.
Results
Thirty-one out of 33 EuGMS Full Board members participated in this questionnaire. Geriatric rehabilitation was officially recognized in 65% (20/31) of participating countries while 29% (9/31) had no geriatric rehabilitation services in their country. In countries with geriatric rehabilitation, the number of available beds varied widely (0–70/100,000 inhabitants). Average length of stay varied from 7 to 65 days. The estimated mean age of the patients in geriatric rehabilitation was 80 years, with most patients being older than 70 years. Six countries had no specified lower age limit and no country had an upper age limit. 42% (13/31) of countries reported having national or local guidelines and 35% (11/31) had a benchmarking or audit system established. Most participants responded positively about the prospects for improvement in the field.
Conclusion
We observed major differences among EuGMS member countries with regard to the availability of geriatric rehabilitation and how it was organized. Despite various barriers in most countries, future improvement in geriatric rehabilitation services is anticipated.
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Subjective well-being of geriatric patients during and after inpatient geriatric rehabilitation: a biopsychosocial prediction model. Eur Geriatr Med 2019; 10:965-975. [PMID: 34652771 DOI: 10.1007/s41999-019-00240-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The study focused on indicators of subjective well-being (SWB) and how they developed during and after geriatric rehabilitation. Furthermore, a biopsychosocial prediction model for longer-term SWB was tested. METHODS Patients of an inpatient geriatric rehabilitation unit were assessed at admission, discharge and a three-month follow-up. Indicators of SWB comprised affect, life satisfaction, valuation of life and autonomy. Further, biomedical and psychosocial variables assessed upon admission were used to predict SWB at follow-up. Statistical analysis included repeated-measures (M)ANOVA depicting SWB development over time with Cohen's d for effect size, along with canonical correlation analyses used to test the biopsychosocial prediction model. RESULTS 78 out of 122 patients were assessed three times. Across all measurement points, different change patterns among SWB indicators were detected: Positive affect was significantly higher at follow-up than at admission (mean difference (MD) = .28, p < .01, Cohen's d = .37). Negative affect declined during rehabilitation (MD = - .29, p < .01, Cohen's d = .40) but increased again until follow-up (MD = .31, p < .01, Cohen's d = .42). Life satisfaction and valuation of life showed no change over time, while experience of autonomy gradually worsened from admission until follow-up (MD = - .29, p < .05, Cohen's d = .32). The biopsychosocial model revealed that personality traits and control beliefs best predicted SWB at follow-up. CONCLUSIONS Although geriatric rehabilitation has a positive effect on affect, it does not consistently improve other SWB indicators. Moreover, paying attention to psychological parameters such as personality in the daily geriatric routine could help to identify patients for whom longer-term SWB is particularly at risk.
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Pramsohler S, Burtscher M, Faulhaber M, Gatterer H, Rausch L, Eliasson A, Netzer NC. Endurance Training in Normobaric Hypoxia Imposes Less Physical Stress for Geriatric Rehabilitation. Front Physiol 2017; 8:514. [PMID: 28785224 PMCID: PMC5517449 DOI: 10.3389/fphys.2017.00514] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/05/2017] [Indexed: 01/05/2023] Open
Abstract
Rationale: Evidence suggests that training in hypoxia can be very effective even while requiring less physical effort. We therefore aimed to measure the effect of endurance training under hypoxic conditions on pulmonary and cardiovascular parameters in an elderly population undergoing inpatient rehabilitation. Methods: Forty patients over age 65 years with multiple co-morbid conditions were recruited during a 3-week stay in a geriatric rehabilitation center. Using a randomized, single-blinded, placebo-controlled design, patients were assigned to a hypoxic (HG) or normoxic (NG) group. HG patients completed seven training sessions of 30 min duration on a treadmill in a normobaric chamber with inspired oxygen fraction (FiO2) of 15.27%, with 10-30 min active training. Training was conducted with target heart rate at 80% of peak oxygen consumption (VO2-peak). NG group performed similar training in sham hypoxia (room air or FiO2 = 20.94%). At pre- and post-test completion, measures included: (1) cycle ergometry with ECG monitoring and measurement of VO2-peak, and (2) echocardiography for ejection fraction. Results: The physical effort required of patients to reach target heart rate was reduced significantly (-28%, p = 0.043) in the HG compared to NG. Cardiopulmonary parameters showed no differences between groups. Conclusion: Endurance training at 3,000 meters elevation imposes less stress on the locomotor systems while resulting in a similar physiological strain (i.e., heart rate). Hypoxic training holds promise for successful geriatric rehabilitation by being more accommodating to physical limitations in geriatric patients. Trial registration: Registration at DRKS. (Approval No. 359/12, Trial No. DRKS00005241).
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Affiliation(s)
- Stephan Pramsohler
- Hermann Buhl Institute for Hypoxia and Sleep Medicine ResearchBad Aibling, Germany
| | - Martin Burtscher
- Department of Sport Science, University of InnsbruckInnsbruck, Austria
| | - Martin Faulhaber
- Department of Sport Science, University of InnsbruckInnsbruck, Austria
| | - Hannes Gatterer
- Department of Sport Science, University of InnsbruckInnsbruck, Austria
| | - Linda Rausch
- Hermann Buhl Institute for Hypoxia and Sleep Medicine ResearchBad Aibling, Germany
| | - Arn Eliasson
- Department of Medicine, Uniformed Services University of the Health SciencesBethesda, MD, United States
| | - Nikolaus C. Netzer
- Hermann Buhl Institute for Hypoxia and Sleep Medicine ResearchBad Aibling, Germany
- Department of Sport Science, University of InnsbruckInnsbruck, Austria
- Division of Sports Medicine and Rehabilitation, Department of Medicine, University of UlmUlm, Germany
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Freidel K, Linck-Eleftheriadis S, Röhrig B, Schilling S, Heckmann J. [A 10-year evaluation of geriatric rehabilitation in Rhineland-Palatinate]. Z Gerontol Geriatr 2016; 50:365-373. [PMID: 27412584 DOI: 10.1007/s00391-016-1101-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 05/23/2016] [Accepted: 06/10/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND An evaluation of geriatric rehabilitation has been carried out in Rhineland-Palatinate for over 10 years by collecting data of patients absolving an inpatient geriatric rehabilitation program. The aim of the project was to improve the transparency of outcome quality. The procedure is equally supported by geriatric rehabilitation clinics, health insurance companies and the Medical Service of Health Insurance (MDK). MATERIAL AND METHODS Consented information about the rehabilitation process has been collected from every geriatric rehabilitation clinic in Rhineland-Palatinate. The data were pseudonymized and sent to the MDK in Rhineland-Palatinate for statistical analysis. The dataset included age, diagnosis, life circumstances before rehabilitation, duration of the rehabilitation, therapy implemented and need for support (with or without personal assistance) in eight activities of daily living at the beginning and at the end of rehabilitation. RESULTS The results of 45,751 participants who underwent rehabilitation between 2005 and 2014 are presented. There was a slight tendency towards an increase in the number of very old geriatric patients undergoing rehabilitation. The average duration of rehabilitation decreased slightly during the observation period, while the frequency of therapy increased. The reduction in the need for assistance during rehabilitation remained constant over the observation period. CONCLUSION Systematic evaluation improves the transparency of the rehabilitation process.
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Affiliation(s)
- K Freidel
- Medizinischer Dienst der Krankenversicherung (MDK) Rheinland-Pfalz, Albiger Str. 19d, 55232, Alzey, Deutschland.
| | - S Linck-Eleftheriadis
- Medizinischer Dienst der Krankenversicherung (MDK) Rheinland-Pfalz, Albiger Str. 19d, 55232, Alzey, Deutschland
| | - B Röhrig
- Medizinischer Dienst der Krankenversicherung (MDK) Rheinland-Pfalz, Albiger Str. 19d, 55232, Alzey, Deutschland
| | - S Schilling
- Geriatrische Rehabilitationsklinik St. Irminen, Trier, Deutschland
| | - J Heckmann
- Geriatrische Fachklinik Rheinhessen-Nahe, Bad Kreuznach, Deutschland
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[Mobile geriatric rehabilitation in statutory health insurance: Conceptual strategy and results of a nationwide treatment documentation (Part 1)]. Z Gerontol Geriatr 2016; 50:226-232. [PMID: 26902905 DOI: 10.1007/s00391-016-1032-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/16/2015] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Insurants have a statutory right to mobile rehabilitation in which a multidisciplinary team carries out treatment in the familiar home environment. Framework recommendations in geriatric medicine were presented by the statutory health insurance (SHI) and a standardized treatment documentation was implemented nationwide. OBJECTIVE This article presents the conceptual design and selected results from this treatment documentation and reports on the established practice. MATERIAL AND METHODS A total of 1879 anonymized cases of mobile geriatric rehabilitation carried out between 2011 and 2014 from 11 participating institutions were analyzed with respect to patient and process-related features. RESULTS The patients were on average 81 years old and 61 % were female. The mobile rehabilitation was provided on average over 22 treatment days over a period of 8 weeks and in 84 % of cases following hospital treatment. Of the rehabilitation patients 27 % lived in a care home prior to treatment and 73 % were already allocated to a care level. The statistically significant gain in capacity for self-sufficiency was 18 points on the Barthel index at the end of the rehabilitation. The majority of treatment was provided by physiotherapists and occupational therapists followed by speech therapists and nursing personnel. Relevant differences were detected between the institutions regarding the indications, access route, therapy combinations, treatment frequency, scope and duration. At the same time individual requirements from the framework recommendations were sometimes not met. CONCLUSION Even though the treatment documentation does not replace any external mobile rehabilitation quality assurance, it provides transparency in a still very limited range of services that are sometimes differently implemented at institutions. It therefore provides the basis for further development of mobile out-patient rehabilitation in SHI.
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Grund S, Mettlach M, Kieser M, Rath K, Schäfer HG. [Outcomes of multimorbid vascular surgery patients with and without major amputation in a German geriatric rehabilitation clinic]. Z Gerontol Geriatr 2015; 51:335-342. [PMID: 25612790 DOI: 10.1007/s00391-014-0848-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 11/27/2014] [Accepted: 12/16/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the course of demographic developments, an increase of vascular surgical procedures including major amputations in very elderly, multimorbid geriatric patients is expected. Due to the high vulnerability of these patients, geriatric rehabilitation directly following the acute inpatient treatment is likely to improve the abilities of these patients. This issue is not well analyzed in Germany up to now. MATERIALS AND METHODS This retrospective study includes all patients who were admitted to our clinic for geriatric rehabilitation after vascular surgery between 01 June 2012 and 31 December 2013. Geriatric assessments at the time of admission and discharge were considered. The group was divided into rehabilitation patients with major limb amputation and nonmajor limb amputation. Both groups were analyzed with respect to functional parameters and activities in daily life (ADL) during the course of rehabilitation as well as the discharge location (home versus nursing home). RESULTS A total of 30 major-limb-amputee and 77 nonmajor-limb-amputee rehabilitants could be analyzed. Before surgical intervention, 100 % of patients lived in a home care situation. The median age was 78.3 years. During rehabilitation, both groups showed highly significant improvements in ADL (Barthel index), Timed Up and Go test, walking distance, and stair climbing; however the nonmajor amputees surpassed the major amputees in most mobility assessments especially in the five chair-rising test. The rehabilitation time (median) was 41.8 days for major and 23.9 days for nonmajor amputees. More than 90 % of the rehabilitants in both groups could be discharged home. CONCLUSION The data from this retrospective study indicate that even advanced old age, multimorbid patients benefit from geriatric rehabilitation after vascular surgery intervention. Although less distinct than the group of minor amputee rehabilitants, highly significant improvements were also demonstrated in the group of major amputee rehabilitants as assessed in the discharge mobility and ADL results compared to the admission assessment results. These improvements were achieved in an adequate time period and led to discharge into home care for the majority of patients.
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Affiliation(s)
- Stefan Grund
- Klinik für geriatrische Rehabilitation, Diakonissenkrankenhaus Mannheim, Speyerer Straße 91-93, 68163, Mannheim, Deutschland.
| | - Manuela Mettlach
- Klinik für geriatrische Rehabilitation, Diakonissenkrankenhaus Mannheim, Speyerer Straße 91-93, 68163, Mannheim, Deutschland
| | - Meinhard Kieser
- Institut für Medizinische Biometrie und Informatik der Ruprecht-Karls Universität Heidelberg, INF 305, 69120, Heidelberg, Deutschland
| | - Konrad Rath
- Klinik für geriatrische Rehabilitation, Diakonissenkrankenhaus Mannheim, Speyerer Straße 91-93, 68163, Mannheim, Deutschland
| | - Hans-Georg Schäfer
- Klinik für geriatrische Rehabilitation, Diakonissenkrankenhaus Mannheim, Speyerer Straße 91-93, 68163, Mannheim, Deutschland
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