A Geriatric Multidisciplinary and Tailor-Made Hospital-At-Home Method in Nursing Home Residents With Hip Fracture

Abstract

Introduction: Nursing home residents represent a large proportion of patients hospitalized with hip fracture. Generally, residents do not achieve the same physical ability level as before their fracture and have an increased risk of death within few days after discharge. This study aims to compare 2 new approaches to geriatric intervention in residents with hip fracture. . Median LOS was 2 days in both the groups. A total of 7 follow-up visits were performed with tailor-made intervention versus 3 visits with standardized intervention. In both the groups, the physical ability decreased significantly within the first 30 postoperative days, with no difference between groups (b ¼ 1.01 [95% CI: 0.82, 1.24]).Conclusion: A multidisciplinary and tailor-made geriatric intervention in nursing home residents has a positive effect on readmission rate and short-term mortality. Still, it is not obvious which part of the tailor-made intervention is most crucial.

What are physiotherapists and occupational therapists doing in services that replace acute hospital admission? A systematic review

“…The majority of included studies describe ESD services (12/15), and the remainder describe HaH type services. Two of these studies self‐identified their service as “Hospital at Home”, but described ESD‐type services, where patients were admitted to hospital for a period prior to being managed at home. These two services have therefore been analyzed as ESD.…”

“…Physiotherapy roles: The most commonly reported physiotherapist role (in 46.7% of included studies) was conducting baseline and outcome measure assessments for the study . These assessments included the modified Barthel Index and Rankin Scale, Borg rating scale, Mini Mental State Examination, nine‐hole peg test, Katz ADL index, 10m walk test and Sickness Impact profile, among others.…”

“…These assessments included the modified Barthel Index and Rankin Scale, Borg rating scale, Mini Mental State Examination, nine‐hole peg test, Katz ADL index, 10m walk test and Sickness Impact profile, among others. The next most commonly reported roles (in 33.3% of included studies each) were rehabilitation, mobility practice and exercise prescription …”

“…Four therapist‐specific roles were reported in at least half the included studies in this sub‐analysis, for either physiotherapists or both therapist groups. The most commonly reported role was conducting study assessments (eight included studies, of which seven reported that a physiotherapist conducted the assessments), followed by the provision of personalized care plans, mobility practice and exercise prescription (each reported in six studies). There was also a wide range of less frequently reported roles, with 61% of roles described in two or fewer included studies.…”

“…A number of the reported roles have been investigated in other healthcare settings—for example, passive range of movement following shoulder arthroplasty, ADL practice, mobility practice, task‐specific training and augmented coughing . Additionally, services replacing acute hospital admission, including those in the studies included in this review, have demonstrated effectiveness in improving patient and service level outcomes (eg, lower cost, greater short‐term survival and reduced readmission rate) following presentation for an acute deterioration in health status . Given that at least some of the roles that therapists are undertaking in these services have proven effective in other contexts, the absence of evidence within this setting is not evidence of absence of effect …”