Home rehabilitation for older adults with fractured hips: How many will take part?

Abstract

Rehabilitation at home is a new 'technology' which has been promoted as an efficient alternative to hospital rehabilitation for older patients with conditions such as fractured hip. In Australia, no formal description of elderly patients with fractured hips likely to be eligible for home rehabilitation has been made and the acceptability of such services is unclear. Using information obtained prospectively from a consecutive sample of 188 patients with a fractured hip we describe the characteristics of older adults who were eligible for a trial examining home versus hospital rehabilitation. While staff assessed 36% of patients as eligible, only 20% were both eligible and agreeable. Reasons for refusal to participate included a preference for inpatient rehabilitation (26%), family reluctance (26%) and anxiety regarding the ability to manage at home (16%). Our results suggest that home rehabilitation is suitable for the least disabled group but is still unacceptable to many elderly patients and their families. As the population ages and hip fractures increase, home rehabilitation in its current form will have little impact on future bed needs.

Association of home care needs and functional recovery among community-dwelling elderly hip fracture patients

“…In the transition period after discharge home, elderly with hip fractures are very dependent on caregivers due to their limited ability to perform the activities of daily life (Chen, Lin, & Dai, 1997), and family members provide crucial care for them during the recovery period (Wu & Lin, 1999). However, most family caregivers report that they lack the information needed to care for the elderly after discharge (Bull, 1990;Hu, Kuo, & Wang, 1996), burdening not only patients but also caregivers (Crotty, Kittel, & Hayball, 2000;Wolinsky, Fitzgerald, & Stump, 1997). Chen et al (1997) reported that in the first month after discharge from a medical center patients face such problems as physiological barriers, limitations in daily activities, wound and catheter care, illness, and difficulty in changing.…”

Mutuality

“…Courtney et al [36] discussed a framework of obtrusiveness of telecare from the perspective of older people. In the issue of choice, [37] found that older people living alone had low acceptance of early discharge from the hospital following a hip fracture treatment and used telecare technology to recover at home. Demiris et al [38] stated that there is stigma attached with wearable monitoring devices among the elderly, among other concerns such as the replacement of human contact with technology, privacy and usability issues.…”

Referrer and service provider beliefs and attitudes towards rehabilitation in the home; factors related to utilisation of Early Supported Discharge

“…This is an important area of investigation as there is evidence to suggest that health professionals in inpatient services play a key role in determining the suitability of their patients for ESD and that they may influence patients' beliefs about the effectiveness of these services and their ability to cope with early discharge home [8,15,24,25]. Donnelly et al [15] conducted a randomised controlled trial of ESD home-based rehabilitation for patients with stroke and observed that a relatively small number of patients took part in the research compared to the number of potential ESD recipients.…”

“…They postulated that this may have been related to hesitancy among staff, ''regarding service change & the process of developing inter-sectoral professional trust & confidence in new ways of organising and delivering rehabilitation as well as with eligibility criteria'' [15, p. 132]. Crotty et al [25] investigated the eligibility and acceptability of EDHAH to patients following a fractured neck of femur and reported that patients received conflicting information from medical and nursing staff on their ability to manage at home and that this may have influenced their decisions about accepting early discharge home for rehabilitation.…”

“…Beliefs and attitudes of hospital staff towards ESD services may affect a patient's willingness to consent to early discharge and may directly relate to the number of referrals made and to the timing of referral to such services [15,25].…”