Factors determining eligibility and access to subacute rehabilitation for elderly people with dementia and hip fracture

With hip fracture and dementia increasing in incidence in the global ageing population, there is a need for the development of specific procedures targeting optimal treatment outcomes for these patients. This paper looks primarily at the factors that limit access to subacute rehabilitation services as a growing body of evidence suggests that access to timely inpatient rehabilitation increases functional outcomes for patients both with dementia and without. Information was gathered by searching electronic data bases (SCOPUS, Medline, CINAHL, Health Source Nursing/Academic Addition, Psychinfo and the Cochrane Library) for relevant articles using the search terms dementia OR Alzheimer* AND hip fracture AND subacute rehabilitation OR convalescence for the period 2005–2015. Abstracts were scanned to identify articles discussing eligibility and access. A total of nine papers were identified that directly addressed this topic. Other papers discussing success or failure of rehabilitation and improved models of care were also reviewed. Barriers to access discussed in the literature include information management, management of comorbidities, attitudes, resource availability, and the quality of evidence and education. By identifying these factors we can identify strategic points of intervention across the trajectory of prevention, treatment and rehabilitation that may improve outcomes for this growing group of vulnerable patients. Emerging best practice for these patients is also discussed.

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Facilitators of Attendance and Adherence to Group-Based Physical Activity for Older Adults: A Literature Synthesis

Journal of Aging and Physical Activity ◽

10.1123/japa.2016-0363 ◽

2018 ◽

Vol 26 (1) ◽

pp. 155-167 ◽

Cited By ~ 4

Author(s):

Cassandra J. de Lacy-Vawdon ◽

Ruth Klein ◽

Joanna Schwarzman ◽

Genevieve Nolan ◽

Renee de Silva ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Social Factors ◽

Best Practice ◽

Qualitative Studies ◽

Cochrane Library ◽

Future Research ◽

Literature Synthesis ◽

Instructor Characteristics ◽

The Cochrane Library

This review examines program features that influence attendance and adherence to group-based physical activity (PA) by older adults. Medline, PubMed, CINAHL plus, PsycINFO, and the Cochrane Library were searched for studies published from 1995–2016. Quantitative and qualitative studies investigating factors related to PA group attendance or adherence by persons aged 55 years and over were included. Searching yielded eight quantitative and 13 qualitative studies, from 2,044 titles. Quantitative findings identified social factors, instructor characteristics, PA types, class duration and frequency, and perceived PA outcomes as important for attendance and adherence, whilst qualitative studies identified settings, leadership, PA types, observable benefits, and social support factors. Studies were predominantly low- to moderate-quality. This review identified design and delivery considerations for group-based PA programs to inform best-practice frameworks and industry capacity building. Future research should use longitudinal and mixed-methods designs to strengthen evidence about facilitators of program reach and engagement.

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The Prevalence of Intradialytic Hypotension in Patients on Conventional Hemodialysis: A Systematic Review with Meta-Analysis

American Journal of Nephrology ◽

10.1159/000500877 ◽

2019 ◽

Vol 49 (6) ◽

pp. 497-506 ◽

Cited By ~ 13

Author(s):

Johanna Kuipers ◽

Loes M. Verboom ◽

Karin J.R. Ipema ◽

Wolter Paans ◽

Wim P. Krijnen ◽

...

Keyword(s):

Best Practice ◽

Meta Analysis ◽

Symptom Burden ◽

Female Gender ◽

Cochrane Library ◽

Intradialytic Hypotension ◽

Interdialytic Weight Gain ◽

Lower Body Weight ◽

Wide Range ◽

The Cochrane Library

Background: Intradialytic hypotension (IDH) is considered to be a frequent complication of hemodialysis (HD) and is associated with symptom burden, increased incidence of access failure, cardiovascular events, and higher mortality. This systematic literature review aims to analyse studies that investigated the prevalence of IDH. A complicating factor herein is that many different definitions of IDH are used in literature. Methods: A systematic literature search from databases, Medline, Cinahl, EMBASE, and the Cochrane library to identify studies reporting on the actual prevalence of IDH was conducted. Studies were categorized by the type of definition used for the prevalence of IDH. A meta-analysis of the prevalence of IDH was performed. Results: In a meta-analysis comprising 4 studies including 1,694 patients and 4 studies including 13,189 patients, the prevalence of HD sessions complicated by IDH was 10.1 and 11.6% for the European Best Practice Guideline (EBPG) definition and the Nadir <90 definition, respectively. The proportion of patients with frequent IDH could not reliably be established because of the wide range in cutoff values that were used to identify patients with frequent IDH. There was a large variety in the prevalence of symptoms and interventions. Major risk factors associated with IDH across studies were diabetes, a higher interdialytic weight gain, female gender, and lower body weight. Conclusion: Our meta-analysis suggests that the prevalence of IDH is lower than 12% for both the EBPG and the Nadir <90 definition which is much lower than stated in most reviews.

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A Paradigm Shift for Acute Rehabilitation of Stroke

Journal of Stroke Medicine ◽

10.1177/2516608519848948 ◽

2019 ◽

Vol 2 (1) ◽

pp. 17-22

Author(s):

Susan Camillieri

Keyword(s):

Best Practice ◽

Inpatient Rehabilitation ◽

Prospective Payment System ◽

The United States ◽

Therapeutic Benefit ◽

Models Of Care ◽

Individual Therapy ◽

Regulatory Standards ◽

Practice Standards ◽

Therapeutic Encounters

Current best practice standards for rehabilitation after stroke call for increasing the dose and intensity of interventions for optimal therapeutic benefit. Despite this, those within inpatient rehabilitation during the acute phase are often sedentary, and they receive a lower dose and intensity of therapy than recommended. This may be due to the lack of therapeutic opportunities outside of therapies, program structure characteristics, or a lack of efficiency in therapeutic encounters, all of which have the potential to reduce therapeutic outcomes. Circuit class therapies and group therapies provide a method of increasing the dose and intensity of therapy provided, and may reduce redundancy and inefficiency within programs, but do not satisfy the 3-hour rule under the current Prospective Payment System in the United States. The Centers for Medicare and Medicaid Services require that individual therapy be the primary mode of intervention provision, which limits programs from providing these evidence-based interventions, at a higher volume in a group or circuit format. Providing an enriched environment outside of structured therapies should be mandated to maximize benefits experienced by patients and reduce sedentary time. Empirical study is required to determine which interventions may be effectively delivered when provided via a nonindividual basis, and to explore the feasibility and fiscal implication of alternative models of care. Reform of regulatory standards may be required to align with best practice standards.

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A systematic meta-review of self-management support for people with dementia

Dementia ◽

10.1177/1471301218772894 ◽

2018 ◽

Vol 19 (2) ◽

pp. 253-269

Author(s):

Judith G Huis in het Veld ◽

Renate Verkaik ◽

Berno van Meijel ◽

Anneke L Francke

Keyword(s):

Systematic Reviews ◽

Well Being ◽

Self Management ◽

Cochrane Library ◽

Future Research ◽

Management Support ◽

People With Dementia ◽

Literature Searches ◽

Meta Review ◽

The Cochrane Library

Self-management support for people with dementia is important to help them and their family caregivers to cope with challenges in daily live. Insight into the effects of self-management support interventions on people with dementia is however lacking, despite existing relevant systematic reviews. We therefore conducted a meta-review of relevant systematic reviews, following the PRISMA statement. Systematic literature searches were conducted in PubMed, CINAHL, the Cochrane Library, Embase and PsycINFO. The searches were done in December 2015, and all relevant references until then were taken into consideration. No conclusions about the effects of self-management support interventions on people with dementia could be drawn. Recommendations for future research and practice include that self-management support interventions and effect measurements should be wider in scope than psychological well-being.

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Awareness and the use of evidence-based medicine resources among physicians

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v6i10.02 ◽

2019 ◽

Vol 6 (10) ◽

pp. 4612-4614

Author(s):

Amjad Alhelo ◽

Bashar Samara

Keyword(s):

Evidence Based Medicine ◽

Best Practice ◽

Response Rate ◽

Cross Sectional Study ◽

Cochrane Library ◽

Evidence Based ◽

Cross Sectional ◽

Evidenced Based ◽

The Cochrane Library ◽

Based Medicine

Aim: to evaluate awareness and the use of evidence-based medicine resources among physicians in Jordan. Method: A cross-sectional study by internet was performed among 517 doctors who were responsive from a total of 717 doctors, a total of 72.1% response rate. Doctors from all specialties were contacted from a Facebook group called doctors café in Jordan. A questionnaire was given to each one of them to measure their awareness and use of Evidence based database. Result: From 517 physicians 377 they are using evidenced based resources frequently, and 91 using resources but not frequently and 49 not using evidence-based resources. The resource that was mostly used by the doctors was PubMed, followed by other resources such as Up to date, National Guideline Clearinghouse, Medscape, BMJ best practice, e-books and other online journals for published papers. The Cochrane Library was surprisingly not so familiar amongst physicians. Conclusion: There is good awareness about EBM among physicians in Jordan, and that benefits health care in Jordan.

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Predictors of in-hospital mortality post hip fracture in Ireland 2013-2017

European Journal of Public Health ◽

10.1093/eurpub/ckz187.224 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

H Ferris ◽

L Brent ◽

J Martin ◽

P Crowley ◽

T Coughlan

Keyword(s):

Multivariate Analysis ◽

Hip Fracture ◽

Hospital Mortality ◽

Hip Fractures ◽

Best Practice ◽

Secondary Analysis ◽

Specific Reference ◽

Ageing Population ◽

The Republic ◽

Organisational Factors

Abstract Background Hip fractures are associated with considerable mortality, morbidity and healthcare expenditure. There are approximately 3,500 hip fractures in Ireland per annum with this figure set to increase considerably over the coming years due to the ageing population. Internationally, mortality following hip fracture is approximately 10% at 1 month and 30% at 1 year, with less than half of survivors regaining their preoperative level of function. The authors aimed to identify the determinants of in-hospital mortality post hip fracture in the Republic of Ireland 2013-2017, with specific reference to the Irish Hip Fracture Standards. Methods A secondary analysis of 15,603 patients in the Irish hip fracture database was conducted. Results 31% (n = 4,769) were male and 69% (n = 10,807) were female. Mean age for males was 75 years (SD 13.5) and 79 years for females (SD 10.5). The largest proportion of hip fractures occurred in the 80-89 age category, with 72.3% (n = 4,600) of these being female. Median in-hospital mortality was 4.7% (n = 711) (Range 2.7-6.2). Univariate logistic regression revealed 11 statistically significant predictors of in-hospital mortality; however, only 4 remained statistically significant on multivariate analysis [mobilised day of/after surgery (OR 1.46, 95% CI 1.25-1.70, p < 0.000), pre-fracture mobility (OR 0.84, 95% CI 0.79-0.89, p < 0.000), gender (OR 0.56, 95% CI 0.41-0.76, p < 0.000) and age (OR 1.05, 95% CI 1.03-1.06, p < 0.000)]. Conclusions Older males with poor pre-fracture mobility who were not mobilised the day of/after surgery had the highest risk of in-hospital mortality. The ability to be mobilised on the day of/after surgery is a good composite measure of both patient and organisational factors in hip fracture care. This research supports the inclusion of mobilisation on the day of/after surgery as a new formal best practice standard. Key messages Patients not mobilised on the day of/after surgery are 46% more likely to die in hospital. In-hospital mortality of 4.7% in Ireland is comparable internationally. None of the IHFSs significantly influenced in-hospital mortality after multivariate analysis, but may well affect other outcomes such as ability to return home.

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Potential of telepresence robots to enhance social connectedness in older adults with dementia: an integrative review of feasibility

International Psychogeriatrics ◽

10.1017/s1041610217001776 ◽

2017 ◽

Vol 29 (12) ◽

pp. 1951-1964 ◽

Cited By ~ 21

Author(s):

Wendy Moyle ◽

Urska Arnautovska ◽

Tamara Ownsworth ◽

Cindy Jones

Keyword(s):

Social Connectedness ◽

Feasibility Studies ◽

Dementia Care ◽

Integrative Review ◽

Cochrane Library ◽

Social Connection ◽

Assistive Robots ◽

People With Dementia ◽

Telepresence Robots ◽

The Cochrane Library

ABSTRACTBackground:Socially assistive robots are increasingly used as a therapeutic tool for people with dementia, as a means to improve quality of life through social connection. This paper presents a mixed-method integrative review of telepresence robots used to improve social connection of people with dementia by enabling real-time communication with their carers.Methods:A systematic search of Medline, ProQuest, PubMed, Scopus, Web of Science, CINAHL, EMBASE, and the Cochrane library was conducted to gather available evidence on the use of telepresence robots, specifically videoconferencing, to improve social connectedness, in people with dementia. A narrative synthesis was used to analyze the included studies.Results:A review of 1,035 records, identified four eligible peer-reviewed publications, reporting findings about three different mobile telepresence robots. The study designs included qualitative and mixed-methods approaches, focusing primarily on examining the feasibility and acceptability of the telepresence robots within the context of dementia care. These studies reported both positive outcomes of using telepresence robots to connect people with dementia to others, as well as barriers, such as a lack of experience in using a robot and technological issues.Conclusion:Although limited, the current literature suggests that telepresence robots have potential utility for improving social connectedness of people with dementia and their carers. However, more systematic feasibility studies are needed to inform the development of telepresence robots followed by clinical trials to establish efficacy within dementia care.

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Musculoskeletal Rehabilitation after Hip Fracture: A Review

Osteologie/Osteology ◽

10.1055/a-0962-2043 ◽

2019 ◽

Vol 28 (03) ◽

pp. 183-191

Author(s):

Michael Pfeifer ◽

Yannis Dionyssiotis

Keyword(s):

Vitamin D ◽

Hip Fracture ◽

Tai Chi ◽

Balance Training ◽

Evidence Base ◽

Cochrane Library ◽

Hip Protectors ◽

Coagulation Therapy ◽

The Individual ◽

The Cochrane Library

AbstractWith increasing longevity, hip fractures become more and more a serious burden not only for societies in developed civilization, but also for emerging countries. According to world-wide projections 1.5 million people are affected each year. Although a lot of research has been performed over the last decade, there is still a lack of standardized and evidence-based approaches for prevention, treatment, and rehabilitation of this worst complication of osteoporosis.Therefore, the evidence base for this article was synthesized in accordance with SIGN methodology. Databases searched include Medline, Embase, Cinahl and the Cochrane Library between March 1999 and March 2019. The following terms are used: osteoporosis, hip fracture, rehabilitation, falls, muscle strength, nutrition, exercise, balance, sway, and hip protectors. Moreover, reference lists from included studies were checked and author`s names were searched for additional studies.Possibly, the best approach to rehabilitation after hip fracture is a multi-disciplinary team co-ordinating medical, social, educational and vocational measure for training or retraining the individual to the highest possible level of function. In order to prevent thromboembolism low-dose anti-coagulation therapy (e. g. fondaparinux, rivaroxaban) may be used for approximately two weeks after surgery. This should be accompanied by a daily nutritional intake of at least 20 g protein, 1200 mg of elemental calcium and 800 I. U. of vitamin D, whereas in severe vitamin D insufficiencies recommendations may be certainly higher.After surgical repair of the hip fracture, an anti-resorptive medication may be started. While balance training and performing of Tai Chi has been shown to reduce fall risk and thereby also decrease hip fracture risk, the use of hip protectors is still under evaluation and cannot be generally advocated.

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‘I can see clearly now’: clarifying the role of psychiatry in global disaster

Australasian Psychiatry ◽

10.1177/1039856220986725 ◽

2021 ◽

pp. 103985622098672

Author(s):

William Pridmore

Keyword(s):

Disaster Response ◽

Best Practice ◽

Reference Lists ◽

Cochrane Library ◽

Positive Outcomes ◽

Front Line ◽

Specific Knowledge ◽

Global Events ◽

The Cochrane Library

Objective: First, to review the principles and practice of disaster psychiatry, in light of recent global events. Second, to identify opportunities for research. Method: A literature review of the MEDLINE database, UpToDate and the Cochrane Library was conducted. Reference lists were also reviewed. Results: Psychiatrists are well-positioned to contribute to positive outcomes at all stages of the disaster response. These contributions derive from their roles as doctors, mental illness specialists and clinical leaders. Conclusion: A novel framework for the psychiatrist’s contributions was proposed. Specific knowledge of disaster psychiatry may be worthwhile, and establishment of a public disaster psychiatry centre is reasonable. Research should further examine the role of tele-psychiatry and pursue a best practice for community and front-line employee psychological preparedness.

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Strategies for implementing music-based interventions for people with dementia: A systematic review

Innovation in Aging ◽

10.1093/geroni/igab046.2427 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 644-644

Author(s):

Takashi Amano ◽

Joe Strong ◽

Cole Hooley ◽

Megumi Inoue

Keyword(s):

Nursing Home ◽

Structural Changes ◽

Nursing Home Residents ◽

Implementation Strategies ◽

Cochrane Library ◽

Qualitative Synthesis ◽

Intervention Delivery ◽

People With Dementia ◽

Implementation Studies ◽

The Cochrane Library

Abstract Previous research has found that music-based interventions are effective at improving several outcomes related to dementia for nursing home residents. Some studies have investigated the implementation of music-based interventions. However, to date, there is no synthesis available regarding strategies and outcomes of these implementation studies. This study aims to synthesize available evidence regarding implementation strategies and outcomes of music-based interventions for nursing home residents with dementia. We conducted a systematic literature search in PsychInfo, PubMed, MEDLINE, CINAHL, and The Cochrane Library. A total of 8 studies were included for the qualitative synthesis. Of the eight studies, half were studies of music therapy and the other half were on individualized music. We identified 49 implementation strategies. The most frequently reported category of strategies was planning (34.7%), followed by education (24.5%), quality management (24.5%), restructuring (12.2%), and finance (4.1%). No strategies under the category of attending to the policy context were reported. We identified 21 implementation outcomes. The most frequently reported category was adoption (33.3%), followed by fidelity (28.6%), appropriateness (19.0%), sustainability (9.5%), acceptability (4.8%), and cost (4.8%). No studies measured feasibility or penetration. Although various implementation strategies have been utilized, most of them are under the categories related to intervention methods. Less attention has been paid to strategies that aim at structural changes of intervention delivery systems. Future studies should investigate facilitators and barriers of implementing music-based interventions especially focusing on organizational and structural aspects.

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