Rehabilitation in Primary Health Care for the ageing population: A secondary analysis from a scoping review of rehabilitation models for the ageing population

Abstract

Background: The world population is ageing rapidly. Rehabilitation is one of the most effective health strategies for improving the health and functioning of older persons. An understanding of the current provision of rehabilitation services in primary health care (PHC) is needed to optimise access to rehabilitation for the ageing population. The objectives of this scoping review are a) to describe how rehabilitation services are currently offered in PHC to the ageing population, and b) to explore age-related differences in the type of rehabilitation services provided. Methods: We conducted a secondary analysis of a scoping review examining rehabilitation models for older persons, with a focus on PHC. Medline and Embase (2015-2022) were searched to identify studies published in English on rehabilitation services for people aged 50+. Two authors independently screened records and extracted data using the World Health Organization (WHO)'s operational framework, the PHC systems (PRIMASYS) approach and the WHO paper on rehabilitation in PHC. Data synthesis included quantitative and qualitative analysis. Results: We synthesised data from 96 studies with 31,956 participants and identified five models for rehabilitation in PHC for the ageing population: community, home, telerehabilitation, outpatient and eldercare. Nurses, physiotherapists, and occupational therapists were the most common providers, with task-shifting reported in 15.6% of studies. The most common interventions were assessment of functioning, rehabilitation coordination, therapeutic exercise, psychological interventions, and self-management education. Environmental adaptations and assistive technology were rarely reported. Conclusions: By understanding models of rehabilitation service delivery in PHC, stakeholders can work towards developing more comprehensive and accessible services that meet the diverse needs of the ageing population, considering multimorbidity, evidence of heterogeneity in the ageing process, and the importance of using limitations in functioning as a starting point. Our findings, highlight rehabilitation's role in healthy ageing and are a valuable resource for informing policy, practice, and future research in the context of the United Nations Decade of Healthy Ageing. They can also inform WHO's ongoing efforts to strengthen PHC for the provision of rehabilitation, as recommended by the Rehab2030 initiative and reaffirmed by the recently adopted World Health Assembly (WHA) resolution on strengthening rehabilitation in health systems.

Are healthy ageing trajectories suitable to identify rehabilitation needs of the ageing population? An exploratory study using ATHLOS cohort data

“…We argue, based on our results, that potential rehabilitation services for the ageing population need to have as an entry point functioning and not diseases. However, as shown in two recent scoping reviews, most rehabilitation services delivered to the ageing population are disease-centered [ 40 , 41 ].…”