Association between patient activation level and functional outcomes in older adults with hip fractures

BACKGROUND

Hip fractures can significantly impact older adults' mobility and function. Effective rehabilitation is crucial to help them regain independence and quality of life. However, little is known about the association between patient activation and hip fracture rehabilitation. This study aims to assess the association between the PAM-13 scores and the level of physical function, mobility, and activities of daily living in older adults following a hip fracture rehabilitation program.

METHOD

An exploratory outcome study from a cluster-randomized stepped-wedge clinical controlled trial. Two hundred thirty-nine patients were classified into four Patient Activation Measure-Levels (PAM-13) according to their PAM-13 scores, reflecting their confidence and preparedness to manage their health. Level 1 represents the lowest level of confidence. The patient's mobility, function, and daily activities were evaluated at discharge and after 12 and 24 weeks.

RESULTS

The cohort had a median age of 78; 67% were female, and 50% lived alone. There were no significant differences in demographics between the PAM-Levels. PAM-Level 1 patients had longer hospital stays and lower mobility scores than PAM-Level 4 patients. However, all patients improved over time, and higher initial PAM levels resulted in better outcomes. PAM-Level 1 patients improved in Time Up and Go score from a median score of 54 seconds to 14 seconds at 24 weeks, while PAM-Level 4 patients improved from 26 to 9 seconds.

CONCLUSION

Our study found an association between PAM levels and functional outcomes in hip fracture rehabilitation. Patients with higher activation levels had better mobility and functional outcomes.

From fear to control: Older adults' thoughts and feelings about empowerment-oriented rehabilitation after a hip fracture

BACKGROUND

It is essential to focus on how older adults remain active and regain control of their daily lives after hip fractures. 'Rehabilitation of Life' is an empowerment-orientated hip fracture intervention focused on continuous rehabilitation and care between sectors in Denmark. We aimed to understand and explore older adults' experience participating in the intervention 'Rehabilitation of Life' and how this relates to their sense of empowerment.

METHOD

Qualitative data were generated from 16 semi-structured interviews with patients experiencing a hip fracture and subsequent rehabilitation in the program "Rehabilitation of Life' The data was analysed using Graneheim and Lundman's concept-guided qualitative content analysis method.

RESULTS

The analysis revealed five themes that the participants emphasised as vital to their rehabilitation: getting information and care when hospitalised, early visits from healthcare professionals after returning to their homes, the social aspect of training together with others, rehabilitation provision by skilled and empathic staff, and acceptance of a new me. The five themes indicated that adults aged >65 years generally experienced rehabilitation after hip fractures as motivating and reassuring.

CONCLUSION

Social support and peer programs can significantly improve the rehabilitation of older adults with hip fractures. The Rehabilitation of Life intervention has shown that promoting successful rehabilitation requires patient-centred strategies that encourage collaboration between different sectors. To increase patients' empowerment and engagement in their health journey, it is important to consider changes in patients' behaviour, increase their autonomy and ensure their independence after rehabilitation.

Enzyme-based antifouling coatings: a review

A systematic overview is presented of the literature that reports the antifouling (AF) protection of underwater structures via the action of enzymes. The overall aim of this review is to assess the state of the art of enzymatic AF technology, and to highlight the obstacles that have to be overcome for successful development of enzymatic AF coatings. The approaches described in the literature are divided into direct and indirect enzymatic AF, depending on the intended action of the enzymes. Direct antifouling is used when the enzymes themselves are active antifoulants. Indirect antifouling refers to the use of enzymes to release an active biocide with AF activity. For direct AF, several patents have been granted, and a commercial product has been launched. However, the achievement of an efficient broad-spectrum AF coating based on a single or a few enzymes has not yet been achieved. An indirect AF coating is not yet available commercially. The technology is mainly limited by the instability of substrate supply, whether the substrates are found in the surrounding seawater or in the coating itself. Legislative issues regarding which part(s) of an enzyme system should be regarded as biocidal for product registration purposes are also considered. The above question currently remains unanswered for technologies utilising indirect enzymatic AF.