Geriatric Rehabilitation Inpatients Roam at Home! A Matched Cohort Study of Objectively Measured Physical Activity and Sedentary Behavior in Home-Based and Hospital-Based Settings

Ramsey, Keenan A.; Loveland, Paula; Rojer, Anna G M; Denehy, Linda; Goonan, Rose; Marston, Celia; Kay, Jacqueline E; Brenan, Jacinta; Trappenburg, Marijke C.; Lim, Wen Kwang; Reijnierse, Esmee M.; Meskers, Carel G. M.; Maier, Andrea B.

doi:10.1016/j.jamda.2021.04.018

Cited by 12 publications

(10 citation statements)

References 47 publications

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“…OGR mainly takes place at the patients’ home with the advantage to stimulate and practice ADL activities in the own environment [ 9 ]. This could promote mobilisation and participation rehabilitation goals [ 77 ]. Still, we lack a precise description of the interventions including therapy exercises, intensity, frequency and place [ 78 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis

et al. 2023

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Background Due to the increasing number of older people with multi-morbidity, the demand for outpatient geriatric rehabilitation (OGR) will also increase. Objective To assess the effects of OGR on the primary outcome functional performance (FP) and secondary outcomes: length of in-patient stay, re-admission rate, patients’ and caregivers’ quality of life, mortality and cost-effectiveness. We also aim to describe the organisation and content of OGR. Methods Systematic review and meta-analysis. Five databases were queried from inception to July 2022. We selected randomised controlled trials written in English, focusing on multidisciplinary interventions related to OGR, included participants aged ≥65 and reported one of the main outcomes. A meta-analysis was performed on FP, patients’ quality of life, length of stay and re-admissions. The structural, procedural and environmental aspects of OGR were systematically mapped. Results We selected 24 studies involving 3,405 participants. The meta-analysis showed no significant effect on the primary outcome FP (activity). It demonstrated a significant effect of OGR on shortening length of in-patient stay (P = 0.03, MD = −2.41 days, 95%CI: [−4.61—0.22]). Frequently used elements of OGR are: inpatient start of OGR with an interdisciplinary rehabilitation team, close cooperation with primary care, an OGR coordinator, individual goal setting and education for both patient and caregiver. Conclusion This review showed that OGR is as effective as usual care on FP activity. It shows low certainty of evidence for OGR being effective in reducing the length of inpatient stay. Further research is needed on the various frequently used elements of OGR.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis

et al. 2023

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“… 35 Surprisingly, falls during rehabilitation were not reported in any of the home‐based rehabilitation studies discussed. 10 , 15 , 16 , 17 , 19 However there is objective evidence that older adults are more active when they receive rehabilitation at home instead of hospital, 36 which may predispose to falls. Future home‐based rehabilitation studies, including older adults must include falls reporting, and service provision should include falls prevention and management.…”

Section: Discussionmentioning

confidence: 99%

Geriatric home‐based rehabilitation in Australia: Preliminary data from an inpatient bed‐substitution model

Loveland

Reijnierse

Island

et al. 2022

J American Geriatrics Society

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Background The REStORing health of acutely unwell adulTs (RESORT) is an observational longitudinal cohort, including geriatric rehabilitation inpatients aged ≥65 years admitted to a geriatrician‐led rehabilitation service at a tertiary hospital. The aim of this study is to describe a home‐based bed‐substitution rehabilitation model for geriatric inpatients, including patient phenotype, and health outcomes at preadmission, admission, discharge, and three‐month follow‐up. Methods A standardized Comprehensive Geriatric Assessment was performed on admission and discharge, including demographics (home situation, cognitive impairment, medical diagnoses, etc.), frailty (Clinical Frailty Scale (CFS)), mobility (patient‐reported and Functional Ambulation Classification), physical performance (Short Physical Performance Battery (SPPB), handgrip strength), and functional independence (Activities of Daily Living (ADL), Instrumental ADL (IADL)). Service provision data (health care staff visits, length of stay (LOS), and negative events (e.g., falls)) were extracted from medical records. Three‐month outcomes included mobility, ADL and IADL scores, institutionalization, and mortality. Results Ninety‐two patients were included with a mean age of 81.1 ± 7.8 years, 56.5% female. Twenty‐nine (31.5%) patients lived alone, 39 (42.4%) had cognitive impairment and the commonest geriatric rehabilitation admission reason was falls (n = 30, 32.6%). Patients received care from nurses, physicians, and a median of four (interquartile range (IQR) 3–6) allied health disciplines for a median LOS of 13.0 days (IQR 10.0–15.0). On a population level, patient mobility and functional independence worsened from preadmission to admission. CFS, SPPB, ADL, and IADL scores improved from admission to discharge, and seven (7.6%) patients fell. At three‐month follow‐up, patient‐reported mobility was comparable to preadmission baseline, but functional independence (ADL, IADL) scores worsened for 27/69 (39.1%) and 28/63 (44.4%), respectively. Conclusions Hospitalization‐associated decline in mobility and functional independence improved at discharge and three‐months, but was not fully reversed in the multidisciplinary home‐based geriatric rehabilitation bed‐substitution service. Future research should compare outcomes to equivalent hospital‐based geriatric rehabilitation and evaluate patient perspectives.

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“…A recent Australian-based observational cohort study by Ramsey, Loveland [ 25 ] compared ward based geriatric rehabilitation ( n = 145) and home-based geriatric rehabilitation ( n = 18). Those included in the home-based rehabilitation group would have otherwise been kept as inpatients in an acute hospital.…”

Section: Discussionmentioning

confidence: 99%

Early supported discharge for older adults admitted to hospital with medical complaints: a systematic review and meta-analysis

et al. 2022

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Introduction Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home and continue to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. The concept has shown reduced length of stay and improved functional outcomes in stroke patients. This systematic review aims to explore the totality of evidence for the use of early supported discharge in older adults hospitalised with medical complaints. Methods A literature search of CINAHL in EBSCO, Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), EMBASE and MEDLINE in EBSCO was carried out. Randomised controlled trials or quasi-randomised controlled trials were included. The Cochrane Risk of Bias Tool 2.0 was used for quality assessment. The primary outcome measure was hospital length of stay. Secondary outcomes included mortality, function, health related quality of life, hospital readmissions, long-term care admissions and cognition. A pooled meta-analysis was conducted using RevMan software 5.4.1. Results Five studies met the inclusion criteria. All studies were of some concern in terms of their risk of bias. Statistically significant effects favouring ESD interventions were only seen in terms of length of stay (REM, MD = -6.04, 95% CI -9.76 to -2.32, I2 = 90%, P = 0.001). No statistically significant effects favouring ESD interventions were established in secondary outcomes. Conclusion ESD interventions can have a statistically significant impact on the length of stay of older adults admitted to hospital for medical reasons. There is a need for further higher quality research in the area, with standardised interventions and outcome measures used.

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Geriatric Rehabilitation Inpatients Roam at Home! A Matched Cohort Study of Objectively Measured Physical Activity and Sedentary Behavior in Home-Based and Hospital-Based Settings

Cited by 12 publications

References 47 publications

Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis

Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis

Geriatric home‐based rehabilitation in Australia: Preliminary data from an inpatient bed‐substitution model

Early supported discharge for older adults admitted to hospital with medical complaints: a systematic review and meta-analysis

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