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Scerri A, Innes A, Scerri C. Healthcare professionals' perceived challenges and solutions when providing rehabilitation to persons living with dementia-A scoping review. J Clin Nurs 2023; 32:5493-5513. [PMID: 36710398 DOI: 10.1111/jocn.16635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/31/2023]
Abstract
AIM This review aimed to map studies related to healthcare professionals' perceptions and attitudes towards the rehabilitation for persons living with dementia and extract what they perceive are the barriers and solutions. BACKGROUND Rehabilitation can improve the quality of life and integration of persons living with dementia into society. However, there are several barriers to accessing rehabilitation services. Healthcare professionals are a source of information to understand the challenges and provide solutions to improve these services. DESIGN Arksey and O' Malley (International Journal of Social Research Methodology, 8, 2005 and 19) five-step framework for scoping reviews and the PRISMA-ScR checklist was used. The PAGER (Patterns, Advances, Gaps, Evidence for practice and Research recommendations) framework was used to identify research and practice recommendations. METHOD Seven databases including Medline Complete, Academic Search Ultimate, Ageline, CINAHL, PsycInfo, Pubmed and Google Scholar were searched. The healthcare professionals' perceived challenges and solutions were categorised using Braun & Clarke (Qualitative Research in Psychology, 3, 2006 and 77) thematic analysis. RESULTS Fifteen articles were selected for review. The challenges and solutions were organised according to their association with three stakeholders; the persons living with dementia/informal caregivers, healthcare professionals and the organisation providing the service. Nine of the studies focused on persons living with dementia following a fall or a hip fracture. Most of the studies focused on the perceptions of allied healthcare professionals, with nurses working in rehabilitation settings being underrepresented. CONCLUSION Healthcare professionals have to consider the complexity of rehabilitating persons living with dementia irrespective of the rehabilitation speciality. Moreover, more studies are needed that focus on the views of rehabilitation nurses. RELEVANCE TO CLINICAL PRACTICE This review provides further evidence of the healthcare professionals' misconceptions about the rehabilitation potential of persons living with dementia. There is a need to educate healthcare professionals about the societal, attitudinal and environmental barriers faced by persons living with dementia and their caregivers. PATIENT CONTRIBUTION No Patient or Public Contribution-scoping review.
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Affiliation(s)
- Anthony Scerri
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Anthea Innes
- Gilbrea Chair Aging and Mental Health (Health, Aging and Society), McMaster University, Hamilton, Ontario, Canada
| | - Charles Scerri
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Graff L, Timm H, Thuesen J. Organizational narratives in rehabilitation-focused dementia care - Negotiating identities, interventions and personhood. DEMENTIA 2023; 22:709-726. [PMID: 36919376 PMCID: PMC10088340 DOI: 10.1177/14713012231161487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Rehabilitation is increasingly being introduced in dementia care but studies highlight extensive heterogeneity in practices, conceptual confusion and divergent perceptions of its relevance across care organizations and national contexts. As this have implications for development of dementia care as well as for people with dementia's access to care it is important to study the organizational narratives and practices in rehabilitation-oriented dementia care organizations. METHODS The study build on qualitative interviews (individual and group interviews) with health professionals (N = 26) engaged with dementia care and rehabilitation in two Danish municipalities. The interviews were conducted in 2018-2019. The empirical data was analyzed using abductive analysis and theory-based narrative analysis, using Loseke's conceptualizations of and approach to analyzing formula stories. FINDINGS Four dominant organizational narratives were constructed from the data. Each narrative produced a specific organizational narrative of client identity: the active participant in individualized rehabilitation, the inactive individual benefitting from enhanced social environments, the disengaging self and the vulnerable self. CONCLUSION Introducing rehabilitation in dementia care may amplify the organizational polyphonic and provide a plurality of organizational identities each expressing different perceptions of personhood and agency for people with dementia. The organizational narratives were negotiated within a specific structural context where national regulation and dominant discourses on economic challenges and ageing gave precedence to some narratives more than others. In Danish elder care, the first narrative is the most influential but risks excluding people with dementia. Instead, rehabilitation in dementia care is positioned within a social and relational perspective, which may silence important discussion of agency and resistance.
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Affiliation(s)
- Lea Graff
- The Danish Center for Social Science Research
| | - Helle Timm
- The National Institute of Public Health, 74340University of Southern Denmark; UCSF - Center for Health Research, Rigshospitalet; University of the Faroe Islands
| | - Jette Thuesen
- University of Southern Denmark, Department of Public Health, Center for User Perspectives and Community-based Interventions; Absalon University College, Center for Nutrition and Rehabilitation; REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care
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3
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McGilton KS, Campitelli MA, Bethell J, Guan J, Vellani S, Krassikova A, Omar A, Maxwell CJ, Bronskill SE. Impact of Dementia on Patterns of Home Care After Inpatient Rehabilitation Discharge for Older Adults After Hip Fractures. Arch Phys Med Rehabil 2021; 102:1972-1981. [PMID: 34242626 DOI: 10.1016/j.apmr.2021.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 06/02/2021] [Accepted: 06/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe differences in home care use in the 30 days after discharge from inpatient rehabilitation after a hip fracture among older adults with dementia compared with those without dementia. DESIGN Retrospective cohort study of individually linked health administrative data. SETTING Community-dwelling older adults after discharge from inpatient rehabilitation facilities in Ontario, Canada. PARTICIPANTS A total of 17,263 older adults (N=17,263), of whom 2489 had dementia (14.4%), who were treated for hip fracture in acute care and then admitted to inpatient rehabilitation facilities between January 1, 2011 and March 31, 2017. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The proportion receiving home care services and number of visits (physiotherapy, occupational therapy, nursing, personal/homemaking) in the 30 days after discharge were compared by dementia status with multivariate models, stratified by sex. RESULTS Compared with those without dementia, adults with dementia were older, had lower functional scores, and were more likely to receive home care services in the 30 days after discharge from inpatient rehabilitation (87.0% vs 79.0%, P<.001), including personal/homemaking services (66.1% vs 46.4%, P<.001) and occupational therapy (45.3% vs 37.4, P<.001) but not physiotherapy (55.8% vs 56.2%, P=.677) or nursing (19.6% vs 18.7%, P=.268). After adjustment, older adults with dementia were more likely to receive home care in both men (odds ratio [OR] =2.01; 95% confidence interval [CI], 1.57-2.57) and women (OR=1.50; 95% CI, 1.30-1.74) as well as more services (rate ratio men=1.60; 95% CI, 1.44-1.79; rate ratio women=1.50; 95% CI, 1.41-1.60). CONCLUSIONS Among older adults discharged from inpatient rehabilitation, older adults with dementia received home care services more often than older adults without dementia. However, irrespective of sex and dementia status, almost half of this population (44%) did not receive physiotherapy. We recommend that, resources permitting, all older adults receive physiotherapy to facilitate recovery.
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Affiliation(s)
- Katherine S McGilton
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario.
| | | | - Jennifer Bethell
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Institute for Clinical Evaluative Science, Toronto, Ontario; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Jun Guan
- Institute for Clinical Evaluative Science, Toronto, Ontario
| | - Shirin Vellani
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario
| | - Alexandra Krassikova
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Abeer Omar
- Trent/Fleming School of Nursing, Trent University, Peterborough, Ontario
| | - Colleen J Maxwell
- Institute for Clinical Evaluative Science, Toronto, Ontario; Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Science, Toronto, Ontario; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
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Hang JA, Francis-Coad J, Naseri C, Jacques A, Waldron N, Purslowe K, Hill AM. Identifying the Association Between Older Adults' Characteristics and Their Health-Related Outcomes in a Transition Care Setting: A Retrospective Audit. Front Public Health 2021; 9:688640. [PMID: 34307282 PMCID: PMC8294153 DOI: 10.3389/fpubh.2021.688640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/04/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Continued evaluation of Transition Care Programs (TCP) is essential to improving older adults' outcomes and can guide which older adults may benefit from undertaking TCP. The aim of this study was to audit a transition care service to identify the association between the characteristics of older adults undertaking a facility-based TCP and (i) discharge destination and (ii) functional improvement. Materials and methods: An audit (n = 169) of older adults aged 60 years and above who completed a facility-based TCP in Australia was conducted. Outcomes audited were performance of activities of daily living (ADL) measured using the Modified Barthel Index (MBI) and discharge destination. Data were analyzed using logistic regression and linear mixed modeling. Results: Older adults [mean age 84.2 (±8.3) years] had a median TCP stay of 38 days. Fifty-four older adults (32.0%) were discharged home, 20 (11.8%) were readmitted to hospital and 93 (55%) were admitted to permanent residential aged care. Having no cognitive impairment [OR = 0.41 (95% CI 0.18-0.93)], being independent with ADL at admission [OR = 0.41 (95% CI 0.16-1.00)] and a pre-planned team goal of home discharge [OR = 24.98 (95% CI 5.47-114.15)] was significantly associated with discharge home. Cases discharged home showed greater improvement in functional ability [MBI 21.3 points (95% CI 17.0-25.6)] compared to cases discharged to other destinations [MBI 9.6 points (95% CI 6.5-12.7)]. Conclusion: Auditing a facility-based TCP identified that older adults who were independent in ADL and had good cognitive levels were more likely to be discharged home. Older adults with cognitive impairment also made clinically significant functional improvements.
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Affiliation(s)
- Jo-Aine Hang
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | | | - Chiara Naseri
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Angela Jacques
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Nicholas Waldron
- Department of Aged Care and Rehabilitation, Armadale Kelmscott Memorial Hospital, East Metropolitan Health Service, Armadale, WA, Australia
| | | | - Anne-Marie Hill
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
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McGilton KS, Cumal A, Corsi D, Gingrich S, Zheng N, Escrig-Pinol A. Context matters when implementing patient centred rehabilitation models for persons with cognitive impairment: a case study. BMC Health Serv Res 2021; 21:204. [PMID: 33676516 PMCID: PMC7937255 DOI: 10.1186/s12913-021-06206-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background There is a growing number of older adults with cognitive impairment (CI) that require inpatient rehabilitation, and as such patient centred rehabilitation models have been developed. However, implementing evidence-based models without attending to the fit of the model to the new context could lead to an unsuccessful outcome. Researchers collaborated with administrators and staff in one rural site to adapt a patient centred rehabilitation model of care in the Canadian province of Ontario. This paper reports on the contextual factors that influenced the implementation of the model of care. Methods The study takes a case study approach. One rural facility was purposefully selected for its interest in offering rehabilitation to persons with CI. Four focus group discussions were conducted to explore healthcare professionals’ perceptions on the contextual factors that could affect the implementation of the rehabilitation model of care in the facility. Twenty-seven professionals with various backgrounds were purposively sampled using a maximum diversity sampling strategy. A hybrid inductive-deductive approach was used to analyze the data using the Context and Implementation of Complex Interventions (CICI) Framework. Results Across the domains of the CICI framework, three domains (political, epidemiological, and geographical) and seven corresponding sub-domains of the context were found to have a major influence on the implementation process. Key elements within the political domain included effective teamwork, facilitation, adequate resources, effective communication strategies, and a vision for change. Within the epidemiological domain, a key element was knowing how to tailor rehabilitation approaches for persons with CI. Infrastructure, an aspect of the geographical domain, focused on the facility’s physical layout that required attention. Conclusions The CICI framework was a useful guide to identify key factors within the context that existed and were required to fully support the implementation of the model of care in a new environment. The findings suggest that when implementing a new program of care, strong consideration should be paid to the political, epidemiological, and geographical domains of the context and how they interact and influence one another. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06206-9.
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Affiliation(s)
- Katherine S McGilton
- KITE-Toronto Rehabilitation Institute, University Health Network, Bickle Centre, 550 University Avenue, Suite 236B, Toronto, Ontario, M5G 2A2, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8, Canada.
| | - Alexia Cumal
- KITE-Toronto Rehabilitation Institute, University Health Network, Bickle Centre, 550 University Avenue, Suite 236B, Toronto, Ontario, M5G 2A2, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8, Canada
| | - Dana Corsi
- North East Specialized Geriatric Centre, Health Sciences North, 960 D Notre Dame Avenue, Sudbury, Ontario, P3A 2T4, Canada
| | - Shaen Gingrich
- North East Specialized Geriatric Centre, Health Sciences North, 960 D Notre Dame Avenue, Sudbury, Ontario, P3A 2T4, Canada
| | - Nancy Zheng
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8, Canada
| | - Astrid Escrig-Pinol
- KITE-Toronto Rehabilitation Institute, University Health Network, Bickle Centre, 550 University Avenue, Suite 236B, Toronto, Ontario, M5G 2A2, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St., Room 500, Toronto, ON, M5T3M7, Canada.,The Mar Nursing School (ESIMar), Pompeu Fabra University, Doctor Aiguader, 80, 3a Planta, 08003, Barcelona, Spain
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McGilton KS, Vellani S, Zheng N, Wang D, Yeung L, Escrig-Pinol A. Healthcare professionals' perspectives on rehabilitating persons with cognitive impairment. DEMENTIA 2020; 20:1772-1790. [PMID: 33222528 PMCID: PMC8216319 DOI: 10.1177/1471301220969615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Objectives Despite emerging evidence that persons with cognitive impairment (CI) (including dementia and/or delirium) can be rehabilitated post-hip fracture surgery, there still remains a paucity of research on best practice rehabilitation strategies that help healthcare providers effectively rehabilitate persons with CI. Therefore, this qualitative study explores healthcare professionals’ (HCPs) perspectives who have been successfully providing rehabilitation for people with CI. Research Design and Methods Sixteen HCPs with a specialty in rehabilitating persons with CI from one inpatient rehabilitation facility with various professional backgrounds were purposively sampled using a maximum diversity sampling strategy. Three focus group discussions were conducted to explore their experiences of providing rehabilitation to persons with CI. A hybrid inductive–deductive approach was used to analyze the data. Findings HCPs acknowledged that older adults with CI deserved the opportunity for inpatient rehabilitation and that good outcomes were achievable; however, their knowledge, skills, and attitudes required reframing. The analysis identified three essential components to rehabilitation: (1) staff education and support, (2) tailored rehabilitation approaches, and (3) care partner involvement and support. Discussion and Implications Rehabilitation of persons with CI post-hip fracture surgery is achievable, and HCPs can learn to modify their practices to achieve positive patient outcomes. The attitudes of the healthcare team members had to be shifted to embrace the belief that persons with CI can be rehabilitated. However, it takes a steep learning curve, creativity, ingenuity, and tailored approaches to rehabilitate persons with CI successfully. This involves knowing the individual, maintaining routines, and learning the best ways to engage and motivate the person. As well, care partners’ knowledge and understanding of the individual improved the chances of a successful rehabilitation stay and discharge. Essential to the success of rehabilitation of persons with CI includes a supportive management team to help create the processes to enable their staff to succeed.
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Affiliation(s)
- Katherine S McGilton
- 7961KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shirin Vellani
- 7961KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Zheng
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
| | - Daniel Wang
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
| | - Lydia Yeung
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
| | - Astrid Escrig-Pinol
- 7961KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Mar Nursing School (ESIMar), Pompeu Fabra University, Barcelona, Spain
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7
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Mine Y, Muramatsu K, Fushimi K, Matsuda S. Hospitalization and discharge routes of elderly hip fracture patients with and without dementia: a nationwide cross-sectional exploratory study using the Japanese Diagnostic Procedure Combination database. Disabil Rehabil 2020; 44:1268-1274. [PMID: 32730727 DOI: 10.1080/09638288.2020.1800107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION 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.IMPLICATIONS FOR REHABILITATIONIn 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.
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Affiliation(s)
- Yuko Mine
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.,Secretariat of the Japanese Physical Therapy Association, Tokyo, Japan
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Ganorkar S, Kabir ZN, Rustomfram N, Thakur H. Experiences of Older Persons in Seeking Care at a Private Hospital in Urban India. Gerontol Geriatr Med 2020; 6:2333721420910639. [PMID: 32284954 PMCID: PMC7139167 DOI: 10.1177/2333721420910639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/14/2020] [Accepted: 02/10/2020] [Indexed: 10/27/2022] Open
Abstract
Objective: The study aims to describe the experiences of older persons in seeking health care in a private hospital in urban India. Methods: Semi-structured interviews were conducted with 50 older persons admitted in or visiting a private hospital in Hyderabad city in India between the period November 2017 and April 2018. The data were analyzed using Content Analysis. Results: Dimensions related to payment mechanisms, quality of health care staff, and hospital quality were reported to be important for the older persons. Payment mechanisms were related to discounts, insurance support, and reducing out-of-pocket expenditure. Quality of care was related to optimizing hospital operational processes like discharge time, standard of treatment, and trustworthiness of the medical staff. Discussion: Payment mechanism can be made friendly for the older persons. Quality of hospital including its staff can be enhanced by developing geriatric-specific competencies which can help them to understand and treat complex health problems specific for the older population.
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Affiliation(s)
| | | | | | - Harshad Thakur
- Tata Institute of Social Sciences,
Mumbai, India
- National Institute of Health and Family
Welfare, New Delhi, India
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Mitchell R, Fajardo Pulido D, Ryder T, Norton G, Brodaty H, Draper B, Close J, Rapport F, Lystad R, Harris I, Harvey L, Sherrington C, Cameron ID, Braithwaite J. Access to rehabilitation services for older adults living with dementia or in a residential aged care facility following a hip fracture: healthcare professionals' views. Disabil Rehabil 2019; 43:834-845. [PMID: 31335212 DOI: 10.1080/09638288.2019.1643418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To enhance understanding of access to rehabilitation services in Australian and New Zealand acute care facilities for older adults living with dementia and/or living in residential aged care facilities (RACFs) following a hip fracture. METHODS Information on hip fracture rehabilitation was obtained from an online survey of 40 health professionals who were members of the Australian and New Zealand Hip Fracture Registry Network. This information was supplemented with key informant interviews with five geriatricians and five rehabilitation physicians. RESULTS Availability of hip fracture rehabilitation services differed by region and country. Around one in 10 respondents indicated that their facility had specific rehabilitation protocols for people living in RACFs or who were living with dementia. Barriers to providing hip fracture rehabilitation were commonly related to availability of resources. Rehabilitation pathways were determined according to individual patient characteristics and perceived potential benefit. Decision making was mainly informed by the patient's pre-fracture morbidity and residence. Three key themes and nine sub-themes emerged from the interviews. CONCLUSIONS The development of consistent decision criteria and pathways for access to hip fracture rehabilitation could provide a standard approach to access to rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.IMPLICATIONS FOR REHABILITATIONNeed to establish evidence-based criteria for patients who will benefit from hip fracture rehabilitation.Consistent decision criteria for access to hip fracture rehabilitation will assist in guiding a standard approach to providing rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.There is a need to ensure the availability of physiotherapy services in RACFs to assist with rehabilitation provision.Rehabilitation provided to patients with cognitive impairment and/or who are living in RACFs should be tailored to their physical and mental ability.
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Affiliation(s)
- Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Tayhla Ryder
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Grace Norton
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Henry Brodaty
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - Brian Draper
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Reidar Lystad
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Ian Harris
- Whitlam Orthopaedic Research Centre, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Lara Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | | | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
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10
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[Multidisciplinary geriatric rehabilitation in the patient with hip fracture and dementia]. Rev Esp Geriatr Gerontol 2018; 54:220-229. [PMID: 30606498 DOI: 10.1016/j.regg.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 12/14/2022]
Abstract
Hip fracture and dementia rates increase with age, and both groups of patients suffer increased morbidity and mortality and functional impairment. The management of these patients is a challenge for the orthogeriatric and rehabilitation team process, as despite the evidence on the benefit, the results analysed are still worse than in patients without cognitive impairment. For this reason, and due to the limitation in health resources, many of them have problems in accessibility to them, or are limited to a less intense rehabilitation. There are insufficient studies on the best rehabilitation interventions in this group of patients, but it is suggested: 1) to use a multidisciplinary rehabilitation model adapted to the patient with dementia, and 2) to redefine results of the rehabilitation of these patients not only in terms of functional improvement, without highlighting other concepts, such as quality of life, decrease in complications or improved social support.
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11
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Cooper AL, Nagree Y, Goudie A, Watson PR, Arendts G. Ultrasound-guided femoral nerve blocks are not superior to ultrasound-guided fascia iliaca blocks for fractured neck of femur. Emerg Med Australas 2018; 31:393-398. [PMID: 30198199 DOI: 10.1111/1742-6723.13172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine if an ultrasound-guided femoral nerve block (FNB) is superior to an ultrasound-guided fascia iliaca compartment block (FICB) in providing pain relief to patients with a neck of femur or proximal femoral fracture. METHODS A double-blind randomised controlled trial was conducted. All participants received two blocks, one active and one placebo. An active FICB was administered to 52 participants and 48 participants received an active FNB. RESULTS Analysis was completed on data collected from 100 participants. Most patients were elderly and the majority were female. Both FICB and FNB achieved clinically significant mean reductions in pain scores (2.62 for FICB and 2.3 for FNB). There was no significant difference in reduction in pain scores between the two cohorts, P = 0.408. CONCLUSIONS Ultrasound-guided FNB is not superior to ultrasound-guided FICB, with both facilitating an equivalent analgesia effect in patients with a neck of femur or proximal femur fracture.
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Affiliation(s)
- Alannah L Cooper
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Nursing and Midwifery Research, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Yusuf Nagree
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Adrian Goudie
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Peter R Watson
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Glenn Arendts
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
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Pajulammi HM, Pihlajamäki HK, Luukkaala TH, Jousmäki JJ, Jokipii PH, Nuotio MS. The Effect of an In-Hospital Comprehensive Geriatric Assessment on Short-Term Mortality During Orthogeriatric Hip Fracture Program-Which Patients Benefit the Most? Geriatr Orthop Surg Rehabil 2017; 8:183-191. [PMID: 29318079 PMCID: PMC5755836 DOI: 10.1177/2151458517716516] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/24/2017] [Accepted: 05/27/2017] [Indexed: 11/16/2022] Open
Abstract
Aims To examine the association of patient-related factors with the effect of an in-hospital comprehensive geriatric assessment (CGA) on hip fracture mortality. Methods Population-based, prospective data were collected on 1425 consecutive hip fracture patients aged ≥65 in a central hospital providing orthogeriatric service. Outcome was mortality at 1 month after hip fracture associated with receiving versus not receiving CGA. Results Of the patients receiving CGA compared to those who did not, 8.5% versus12.0% had died within 1 month of the hip fracture (P = .028). In the age- and sex-adjusted Cox proportional hazards model, CGA was associated with a decreased risk of 1-month mortality in patients aged 80 to 89 years (hazard ratio [HR] 0.46, 95% confidence interval [CI]: 0.29-0.73), females (HR: 0.57, 95% CI: 0.38-0.86), having American Society of Anesthesiologists (ASA) score 1 to 3 (HR: 0.60, 95% CI: 0.37-0.99), taking 4 to 10 daily medications (HR: 0.59, 95% CI: 0.38-0.91), with a diagnosis of memory disorder (HR: 0.50, 95% CI: 0.29-0.88), with an estimated glomerular filtration rate <30 mL/min/1.73m2 (HR: 0.28, 95% CI: 0.10-0.76), or living in an assisted living accommodation (HR: 0.40, 95% CI: 0.21-0.76). Conclusion Several modifiable and patient-related factors were associated with decreased risk of 1-month mortality when CGA was performed during hospitalization for hip fracture. Between "younger and fitter" and "oldest and frailest," there is a large group of hip fracture patients whose survival can be improved by in-hospital CGA.
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Affiliation(s)
- Hanna M Pajulammi
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Harri K Pihlajamäki
- Division of Orthopedics and Traumatology, Seinäjoki Central Hospital, Seinäjoki, Finland.,University of Tampere, Seinäjoki, Finland
| | - Tiina H Luukkaala
- Research and Innovation Center, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland
| | - Janne J Jousmäki
- Division of Orthopedics and Traumatology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Pekka H Jokipii
- Division of Orthopedics and Traumatology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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13
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Poulos CJ, Bayer A, Beaupre L, Clare L, Poulos RG, Wang RH, Zuidema S, McGilton KS. A comprehensive approach to reablement in dementia. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:450-458. [PMID: 29067351 PMCID: PMC5654482 DOI: 10.1016/j.trci.2017.06.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As society grapples with an aging population and increasing prevalence of disability, “reablement” as a means of maximizing functional ability in older people is emerging as a potential strategy to help promote independence. Reablement offers an approach to mitigate the impact of dementia on function and independence. This article presents a comprehensive reablement approach across seven domains for the person living with mild-to-moderate dementia. Domains include assessment and medical management, cognitive disability, physical function, acute injury or illness, assistive technology, supportive care, and caregiver support. In the absence of a cure or ability to significantly modify the course of the disease, the message for policy makers, practitioners, families, and persons with dementia needs to be “living well with dementia”, with a focus on maintaining function for as long as possible, regaining lost function when there is the potential to do so, and adapting to lost function that cannot be regained. Service delivery and care of persons with dementia must be reoriented such that evidence-based reablement approaches are integrated into routine care across all sectors. We present a comprehensive reablement approach in dementia. The reablement approach is described across seven domains. Reablement aims to maintain or regain function, or adapt to lost function. Evidence-based reablement should be integrated into routine care across all sectors.
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Affiliation(s)
- Christopher J Poulos
- HammondCare, Centre for Positive Ageing, Sydney, Australia.,School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Antony Bayer
- Division of Population Medicine, Cardiff University, Penarth, Wales, UK
| | - Lauren Beaupre
- Departments of Physical Therapy and Surgery (Division of Orthopaedic Surgery), University of Alberta, Edmonton, Canada
| | - Linda Clare
- REACH, School of Psychology, University of Exeter, Exeter, UK
| | - Roslyn G Poulos
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Rosalie H Wang
- Intelligent Assistive Technology and Systems Lab, Deptarment of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center, University of Groningen, Groningen, Netherlands
| | - Katherine S McGilton
- Faculty of Nursing, Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada
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14
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Isbel ST, Jamieson MI. Views from health professionals on accessing rehabilitation for people with dementia following a hip fracture. DEMENTIA 2016; 16:1020-1031. [PMID: 26843421 DOI: 10.1177/1471301216631141] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The literature reports that rehabilitation for elderly patients with mild-to-moderate dementia who have a hip fracture improves functional outcomes. However, access to rehabilitation may be difficult due to misconceptions about the ability of these patients to engage in and benefit from rehabilitation. Additionally, people who are admitted from residential care may not have the same options for rehabilitation as those admitted from home. This study sought to understand from expert clinicians how and why decisions are made to accept a person with dementia post-fracture for rehabilitation. In this Australian-based qualitative study, 12 health professionals across a state and territory were interviewed. These clinicians were the primary decision makers in accepting or rejecting elderly patients with dementia post-fracture into rehabilitation. Three key themes emerged from the data: criteria for accessing rehabilitation, what works well and challenges to rehabilitation. The participants were unanimous in the view that access to rehabilitation should be based on the ability of the patient to engage in a rehabilitation programme and not assessed solely on cognition. In terms of clinical care, a coherent rehabilitation pathway with integration of geriatric and ortho-geriatric services was reported as ideal. Challenges remain, importantly, the perception of some health care staff that people with dementia have limited capability to benefit from rehabilitation. Rehabilitation for this growing group of patients requires multiple resources, including skilled practitioners, integrated clinical systems and staff education regarding the capabilities of people with dementia. Future research in this area with patients with moderate-to-severe dementia in residential care is warranted.
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