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The aim of this study was to quantify physical activity and sedentary behavior in older adults recovering from hip fracture and to identify groups based on movement patterns. In this cross-sectional cohort study, older adults (≥70 years) were included 3 months after surgery for proximal femoral fracture. Patients received an accelerometer for 7 days. Demographics and outcomes related to physical function, mobility, cognitive functions, quality of life, and hip fracture were assessed. In total, 43 patients with sufficient accelerometer wear time were included. Across all groups, participants engaged in very low levels of physical activity, spending an average of 11 hr/day in prolonged sedentary behavior. Based on the extracted components from a principal component analysis, three groups with substantial differences in levels of physical activity and sedentary behavior could be distinguished. [ABSTRACT FROM AUTHOR]

Background: With the rapid implementation of enhanced recovery after surgery, most gynecological patients are discharged without full recovery. Discharge planning is necessary for patients and their families to transition from hospital to home. Discharge teaching and discharge readiness are two core indicators used to evaluate the quality of discharge planning, which impacts the post-discharge outcomes. To improve post-discharge outcomes, the interaction mechanism of the three variables needs to be determined, but few studies have focused on it. Objectives: Explore the mediating effect of discharge readiness between discharge teaching and post-discharge outcomes of gynecological inpatients. Methods: Discharge teaching and discharge readiness were measured by the Quality of Discharge Teaching Scale (QDTS) and Readiness for Hospital Discharge Scale (RHDS). Post-discharge outcomes on postoperative Day 7 (POF-D7) and postoperative Day 28 (POF-D28) were measured by a self-designed tool. Spearman correlations, Kruskal‒Wallis tests and Mann‒Whitney U tests were conducted to explore the correlation between post-discharge outcomes and other variables. Mediation analysis was used to explore the mediating effect of discharge readiness between discharge teaching and post-discharge outcomes. Results: QDTS and RHDS showed strong positive correlations with post-discharge outcomes. The mediation analyses verified that RHDS was a full mediator between QDTS and POF-D7, and the indirect effect accounted for 95.6% of the total direct effect. RHDS was a partial mediator between QDTS and POF-D28, and the indirect effect accounted for 50.0% of the total direct effect. RHDS was a full mediator between QDTS and total scores of post-discharge outcomes, and the indirect effect accounted for 88.9% of the total direct effect. Conclusions: Discharge teaching can improve the post-discharge outcomes of gynecological inpatients through the intermediary role of discharge readiness. Doctors and nurses should value the quality of discharge teaching and the discharge readiness improving of gynecological inpatients. Future studies should note the interaction mechanism of the three variables to explore more efficient ways of improving post-discharge outcomes of gynecological inpatients. [ABSTRACT FROM AUTHOR]

Background: Geriatric rehabilitation aims at increasing physical and social activity and maintaining the functional reserve of older people. However, the continuity of geriatric rehabilitation in the outpatient setting is limited due to a lack of structured aftercare programs. In order to overcome this, a three-month multimodal home-based intervention program (GeRas) was implemented. The aim of this early qualitative process evaluation was to assess GeRas in terms of perceived reach, effectiveness/efficacy, adoption/uptake, implementation, and maintenance/sustainability (Domains within the RE-AIM Framework) from the perspective of patients who received the intervention and healthcare providers who were involved in the delivery of the intervention. Methods: In a qualitative process evaluation, 13 healthcare providers and 10 patients were interviewed throughout the beginning of the implementation period of GeRas to capture early experiences using a semi-structured interview guide. The interview guide and qualitative content analysis was guided by the RE-AIM Framework. Results: The GeRas program was perceived to be largely well implemented and beneficial by healthcare providers and patients. According to healthcare providers, GeRas showed more advantages compared to usual care. Additionally, outcome expectations were mainly met (Domain 1: Effectiveness). However, the implementation of the intervention delivered via the eHealth system was perceived as challenging (Domain 2: Adoption). Nevertheless, the outpatient physical exercise, the outpatient counselling, and the continuous care after discharge improved perceived well-being regardless of the intervention type (Domain 3: Implementation). To facilitate the continued use of GeRas, technical requirements should be created to increase user-friendliness and to motivate patients to continue the training in the long term (Domain 4: Maintenance). Conclusion: Although initial experiences with the implementation and effectiveness of GeRas were positive in general, organisational and technical issues need to be resolved to enhance sustainable and successful implementation of the GeRas program. Trial registration: German Clinical Trials Register (DRKS00029559). Registered 5/10/2022. [ABSTRACT FROM AUTHOR]

Introduction: Adherence to best practices for care of hip fracture patients is fundamental to decreasing morbidity and mortality in older adults. This includes timely transfer from the hospital to rehabilitation soon after their surgical care. Hospitals experience challenges in implementing several best practices. We examined the potential barriers associated with timely discharge for patients who underwent a hip fracture surgery in an academic hospital in Ontario, Canada. Methods: We conducted a retrospective cross-sectional review of a local database. We used descriptive statistics to characterize individuals according to the time of discharge after surgery. Multivariable binary logistic regression was used to evaluate factors associated with delayed discharge (>6 days post-surgery). Results: A total of 492 patients who underwent hip fracture surgery between September 2019 and August 2020 were included in the study. The odds of having a delayed discharge occurred when patients had a higher frailty score (odds ratios [OR] 1.19, 95% confidence interval [CI] 1.02;1.38), experienced an episode of delirium (OR 2.54, 95% CI 1.35;4.79), or were non-weightbearing (OR 3.00, 95% CI 1.07;8.43). Patients were less likely to have a delayed discharge when the surgery was on a weekend (OR.50, 95% CI.32;.79) compared to a weekday, patients had a total hip replacement (OR.28, 95% CI.10;.80) or dynamic hip screw fixation (OR.49, 95% CI.25;.98) compared to intramedullary nails, or patients who were discharged to long-term care (OR.05, 95% CI.02;.13), home (OR.26, 95% CI.15;.46), or transferred to another specialty in the hospital (OR.49, 95% CI.29;.84) compared to inpatient rehabilitation. Conclusions: Clinical and organizational factors can operate as potential barriers to timely discharge after hip fracture surgery. Further research is needed to understand how to overcome these barriers and implement strategies to improve best practice for post-surgery hip fracture care. [ABSTRACT FROM AUTHOR]

Background: The incidence of femoral neck fractures in older adults is increasing each year. Active and reasonable postoperative rehabilitation exercises can restore the activity of geriatric patients with femoral neck fractures to a great extent, while also avoiding bedridden complications and re-fractures. This study explores the perspectives, experiences, and recommendations of medical staff regarding the implementation status, existing problems, promoting factors, and hindering factors of post-surgical rehabilitation exercises for geriatric patients with femoral neck fractures. The ultimate goal is to further optimize rehabilitation exercise programs and to expedite this process for patients. Methods: A qualitative, descriptive phenomenological study was conducted. A total of 21 clinical medical staff were selected using the purposive sampling method for semi-structured interviews. A content analysis method was used to collate and analyze the collected interview data. Results: A total of 2 themes and 6 sub-themes were defined. The themes consisted of multiple obstacles occurring during the implementation of rehabilitation exercises and the scientific cognition of medical staff on these exercises. Respondents found that patient initiative during rehabilitation exercises was insufficient, that the comprehensiveness and continuity of exercises could not be guaranteed, and that unification between textbook theory and clinical practice was incomplete. Moreover, respondents believed that their professional quality should be excellent, but that staffing and organizational management required optimization, and that support was required for the implementation of rehabilitation exercises. Conclusion: This study investigated the opinions and experiences of medical staff during postoperative rehabilitation exercises in geriatric patients with femoral neck fractures. Collaborative efforts should fully engage hospitals, communities, and families, enhance the alignment of health education with patient needs, advance the scientific development of an integrated medical model by refining the curriculum and teaching system, and significantly elevate the level of medical science and technology. This study will serve as a valuable reference for the establishment of future professional, and personalized rehabilitation programs tailored for geriatric patients with femoral neck fractures. [ABSTRACT FROM AUTHOR]

Background: The role of rural family physicians continues to evolve to accommodate the comprehensive care needs of aging societies. For older individuals in rural areas, rehabilitation is vital to ensure that they can continue to perform activities of daily living. In this population, a smooth discharge following periods of hospitalization is essential and requires management of multimorbidity, and rehabilitation therapists may require support from family physicians to achieve optimal outcomes. Therefore, this study aimed to investigate changes in the roles of rural family physicians in patient rehabilitation. Methods: An ethnographic analysis was conducted with rural family physicians and rehabilitation therapists at a rural Japanese hospital. A constructivist grounded theory approach was applied as a qualitative research method. Data were collected from the participants via field notes and semi-structured interviews. Results: Using a grounded theory approach, the following three themes were developed regarding the establishment of effective interprofessional collaboration between family physicians and therapists in the rehabilitation of older patients in rural communities: 1) establishment of mutual understanding and the perception of psychological safety; 2) improvement of relationships between healthcare professionals and their patients; and 3) creation of new roles in rural family medicine to meet evolving needs. Conclusion: Ensuring continual dialogue between family medicine and rehabilitation departments helped to establish understanding, enhance knowledge, and heighten mutual respect among healthcare workers, making the work more enjoyable. Continuous collaboration between departments also improved relationships between professionals and their patients, establishing trust in collaborative treatment paradigms and supporting patient-centered approaches to family medicine. Within this framework, understanding the capabilities of family physicians can lead to the establishment of new roles for them in rural hospitals. Family medicine plays a vital role in geriatric care in community hospitals, especially in rural primary care settings. The role of family medicine in hospitals should be investigated in other settings to improve geriatric care and promote mutual learning and improvement among healthcare professionals. [ABSTRACT FROM AUTHOR]

Background: Approximately 50% of older patients hospitalized for hip fractures are admitted to a geriatric rehabilitation department at a skilled nursing home. Given the wide variation in rehabilitation stay lengths, predicting the length of stay upon hospital discharge would help manage patients' recovery expectations and create appropriate therapy schedules. Existing literature on length of stay predictors included both acute hospital and in-hospital rehabilitation phases or involved small sample sizes. The present study aims to identify predictors for the length of geriatric rehabilitation stay in skilled nursing homes for older patients after hip fracture surgery upon hospital discharge. Methods: This retrospective cohort study was conducted from 1 October 2017 to 1 July 2023, including 561 patients. Potential predictors of the length of geriatric rehabilitation stay were first tested univariately, with variables showing p < 0.15 entered into a multivariate forward linear regression model. Results: This model identified the following independent predictors of a longer length of geriatric rehabilitation stay: Functional Ambulation Categories (FACs) 0 (B = 29.9, 95% CI 24.1–35.7), 1 (B = 18.0, 95% CI 11.8–24.2), 2 (B = 12.0, 95% CI 7.1–17.0), or 3 (B = 3.6, 95% CI −1.2–9.4) at hospital discharge vs. FAC 4, living independently with home care services (B = 5.9, 95% CI 2.5–9.3) or in a residential home prior to the hip fracture (B = 0.2, 95% CI −7.4–7.8) vs. living independently without home care services, non- or partial weight-bearing mobilization vs. full weight-bearing mobilization (B = 15.4, 95% CI 8.5–22.2), internal fixation vs. hemiarthroplasty (B = 4.7, 95% CI 1.4–7.9), in-hospital delirium (B = 7.0, 95% CI 2.2–11.7), and in-hospital heart failure (B = 7.9, 95% CI 0.5–15.3). The explained variance was 32.0%. Conclusions: This study identified FAC at hospital discharge, premorbid living situation, postoperative weight-bearing protocol, surgery type, in-hospital delirium, and in-hospital heart failure as independent predictors of the length of geriatric rehabilitation stay. Future investigations are needed to identify additional predictors, such as cognitive functioning, to better predict the length of geriatric rehabilitation stay upon hospital discharge. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective machine learning (ML) classification study for prognostic modeling after anterior cervical corpectomy (ACC). Purpose: To evaluate the effectiveness of ML in predicting ACC outcomes and develop an accessible, user-friendly tool for this purpose. Overview of Literature: Based on our literature review, no study has examined the capability of ML algorithms to predict major short-term ACC outcomes, such as prolonged length of hospital stay (LOS), non-home discharge, and major complications. Methods: The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify patients who underwent ACC. Prolonged LOS, non-home discharges, and major complications were assessed as the outcomes of interest. ML models were developed with the TabPFN algorithm and integrated into an open-access website to predict these outcomes. Results: The models for predicting prolonged LOS, non-home discharges, and major complications demonstrated mean areas under the receiver operating characteristic curve (AUROC) of 0.802, 0.816, and 0.702, respectively. These findings highlight the discriminatory capacities of the models: fair (AUROC >0.7) for differentiating patients with major complications from those without, and good (AUROC >0.8) for distinguishing between those with and without prolonged LOS and non-home discharges. According to the SHapley Additive Explanations analysis, single- versus multiple-level surgery, age, body mass index, preoperative hematocrit, and American Society of Anesthesiologists physical status repetitively emerged as the most important variables for each outcome. Conclusions: This study has considerably enhanced the prediction of postoperative results after ACC surgery by implementing advanced ML techniques. A major contribution is the creation of an accessible web application, highlighting the practical value of the developed models. Our findings imply that ML can serve as an invaluable supplementary tool to stratify patient risk for this procedure and can predict diverse postoperative adverse outcomes. [ABSTRACT FROM AUTHOR]

Introduction Due to the increasing number of older patients in emergency departments (EDs) with frailty, cognitive impairment and multimorbidity, there is a need for geriatric expertise in EDs. Methods This retrospective study is of older patients visiting Turku University Hospital ED between 2 January and 31 December 2022. Patients aged 75 years of older were screened for frailty using Triage Risk Screening Tool (TRST) and Clinical Frailty Scale (CFS). Nonacute, frail patients (CFS ≥4) suitable for Targeted Geriatric Assessment (TGA) (n  = 1096) were scanned for the risk of delirium, cognitive impairment, change in functional status, falls, malnutrition and depression. A comprehensive patient record was made with recommendations for future care. Results TRST was completed in 70% of the ED visits, and two-thirds of those were considered high-risk. Among the patients assessed by the geriatric team (TGA), nonspecific complaint (38%) and falls (35%) were the main reasons for ED admission. Cognitive impairment was present in over 60% and orthostatic hypotension in 40% of the patients. The 72-hour revisit rate for TGA-patients was 2.3%. For the real-life control group, the 72-hour revisit rate was 4.6% (P  = .001). Thirty-day revisit rates were 10% and 16%, respectively (P  < .001). The need for rehabilitation, cognitive evaluation and intensifying home care were the main recommendations for future care. Conclusions TGA approach provides structured and accurate information on older patients' background. This may lead to more precise diagnostics, a thorough consideration of hospital intake and a secure discharge from the ED. Ensuring continuity of care may help to reduce readmissions to EDs. [ABSTRACT FROM AUTHOR]

Purpose: To determine the relationship between three postoperative physiotherapy activities (time to first postoperative walk, activity on the day after surgery, and physiotherapy frequency), and the outcomes of hospital length of stay (LOS) and discharge destination after hip fracture. Methods: A cohort study was conducted on 437 hip fracture surgery patients aged ≥ 50 years across 36 participating hospitals from the Australian and New Zealand Hip Fracture Registry Acute Rehabilitation Sprint Audit during June 2022. Study outcomes included hospital LOS and discharge destination. Generalised linear and logistic regressions were used respectively, adjusted for potential confounders. Results: Of 437 patients, 62% were female, 56% were aged ≥ 85 years, 23% were previously living in a residential aged care facility, 48% usually walked with a gait aid, and 38% were cognitively impaired prior to their injury. The median acute and total LOS were 8 (IQR 5–13) and 20 (IQR 8–38) days. Approximately 71% (n = 179/251) of patients originally living in private residence returned home and 29% (n = 72/251) were discharged to a residential aged care facility. Previously mobile patients had a higher total LOS if they walked day 2–3 (10.3 days; 95% CI 3.2, 17.4) or transferred with a mechanical lifter or did not get out of bed day 1 (7.6 days; 95% CI 0.6, 14.6) compared to those who walked day 1 postoperatively. Previously mobile patients from private residence had a reduced odds of return to private residence if they walked day 2–3 (OR 0.38; 95% CI 0.17, 0.87), day 4 + (OR 0.38; 95% CI 0.15, 0.96), or if they only sat, stood or stepped on the spot day 1 (OR 0.29; 95% CI 0.13, 0.62) when compared to those who walked day 1 postoperatively. Among patients from private residence, each additional physiotherapy session per day was associated with a -2.2 (95% CI -3.3, -1.0) day shorter acute LOS, and an increased log odds of return to private residence (OR 1.76; 95% CI 1.02, 3.02). Conclusion: Hip fracture patients who walked earlier, were more active day 1 postoperatively, and/or received a higher number of physiotherapy sessions were more likely to return home after a shorter LOS. [ABSTRACT FROM AUTHOR]

As chronic illness is common among older people, self-care practices for older people are needed to control health status, to prevent possible complications and to ensure optimal quality of life. The literature has demonstrated that integrated care approaches are one key success factor for delivering person-centered and sustainable care for older people, with rehabilitation being a cornerstone in tertiary care prevention for older citizens. The current paper addresses the state of the literature for person-centered geriatric rehabilitation (GR) and the importance of personalized and participatory goal setting. In accordance with the bio–psycho–social model of the International Classification of Functioning, Disability and Health (ICF), social participation and the related goals are of particular importance for the entire rehabilitation process. The social participation of individuals enrolled into GR is therefore one of the milestones to be achieved during GR. Personalized goal setting during the entire rehabilitation process, Comprehensive Geriatric Assessment (CGA) and shared decision making allow a comprehensive care approach separate from solely function-based rehabilitation. The review also focusses on recent developments in digitalization in healthcare and delivers insights into how healthcare professionals' collaborative practice supports sustainable rehabilitation results in patients of advanced chronological age. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONTo gain a rich understanding of the experiences and opinions of patients, healthcare professionals, and policymakers regarding the design of OGR with structure, process, environment, and outcome components.Qualitative research based on the constructive grounded theory approach is performed. Semi-structured interviews were conducted with patients who received OGR (n = 13), two focus groups with healthcare professionals (n = 13), and one focus group with policymakers (n = 4). The Post-acute Care Rehabilitation quality framework was used as a theoretical background in all research steps.The data analysis of all perspectives resulted in seven themes: the outcome of OGR focuses on the patient’s independence and regaining control over their functioning at home. Essential process elements are a patient-oriented network, a well-coordinated dedicated team at home, and blended eHealth applications. Additionally, closer cooperation in integrated care and refinement regarding financial, time-management, and technological challenges is needed with implementation into a permanent structure. All steps should be influenced by the stimulating aspect of the physical and social rehabilitation environment.The three perspectives generally complement each other to regain patients’ quality of life and autonomy. This study demonstrates an overview of the building blocks that can be used in developing and designing an OGR trajectory.There’s a growing preference for providing geriatric rehabilitation in an outpatient setting at the patients’ home (called outpatient geriatric rehabilitation), but little is known about the content, efficiency, and quality assurance of outpatient geriatric rehabilitation.The key elements for the outpatient geriatric rehabilitation framework consist of a specialized geriatric rehabilitation dedicated multidisciplinary team, patient-centered blended eHealth applications, collaboration with integrated care, especially in community care nursing, and physical and social rehabilitation environments.The outpatient geriatric rehabilitation design framework, which emerged from the thematic analysis, offers valuable insights, and can support healthcare professionals and policymakers to establish an effective rehabilitation pathway.There’s a growing preference for providing geriatric rehabilitation in an outpatient setting at the patients’ home (called outpatient geriatric rehabilitation), but little is known about the content, efficiency, and quality assurance of outpatient geriatric rehabilitation.The key elements for the outpatient geriatric rehabilitation framework consist of a specialized geriatric rehabilitation dedicated multidisciplinary team, patient-centered blended eHealth applications, collaboration with integrated care, especially in community care nursing, and physical and social rehabilitation environments.The outpatient geriatric rehabilitation design framework, which emerged from the thematic analysis, offers valuable insights, and can support healthcare professionals and policymakers to establish an effective rehabilitation pathway. [ABSTRACT FROM AUTHOR]

IntroductionMethodsResultsConclusionVirtual reality devices have been widely used for the rehabilitation among older people with cognitive impairments. They enable the user to navigate in three-dimensional environments, which are constructed by a computer. Recent studies have been focused on the cognitive benefits of virtual reality for people with cognitive deficits. The current study aimed to investigate the overall impact of community-based virtual reality interventions in older adults with dementia and/or cognitive impairment.A systematic review of the literature was conducted according to the PRISMA guidelines. Google Scholar, PubMed, Science Direct and Scopus databases were searched for the years 2010–2022.Of the 245 articles 20 met the inclusion criteria. The results of the current systematic review indicated that virtual reality improved older adults’ cognitive and motor skills and increased their positive emotions while minimizing less positive ones. However, there is insufficient data of its impact on their overall quality of life.There is a need to implement and evaluate interventions that examine its impact not only on cognitive functioning, but also on other aspects of older people with cognitive deficits. [ABSTRACT FROM AUTHOR]

To describe admission and discharge characteristics of participants admitted to prosthetic rehabilitation following a lower limb amputation and determine changes in participant characteristics including if the population has gotten older over time at admission. A retrospective chart audit of consecutive admissions to an amputee rehabilitation program. Study criteria were transtibial level LLA and above and ≥ 18 years old. Admission characteristics included: age, Montreal Cognitive Assessment (MoCA), Functional Comorbidity Index (FCI) and days between amputation surgery and admission. Discharge characteristics included the L -Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence (ABC) scale. Multivariable linear regression modelling quantified the association between participant characteristics and admission time. A total of 601 participants (62.3 ± 14.1 years) were included, 63 were (84.9 ± 3.7 years) aged 80 and over. FCI scores [β = 70.34, (95% CI: 20.93, 119.74), p = 0.005] and days between amputation surgery [β = −0.08, (95% CI: −0.13, −0.02), p = 0.011] were independently associated with admission time. People with an LLA are presenting with a higher number of comorbidities at admission over time while being admitted faster from amputation surgery. Future research should investigate the impact of these changing characteristics on rehabilitation outcomes to better assist this population. It is expected that the rate of inpatient prosthetic rehabilitation admissions due to lower limb amputations will increase amongst those over eighty. An analysis of participant characteristics of people admitted to inpatient prosthetic rehabilitation over time will inform modification and developments to future programs. Future prosthetic rehabilitation programs should consider an increased number of comorbidities when developing prognostic expectations for participants. A shortened interval between amputation surgery and admission should be considered when developing prosthetic rehabilitation programs. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to systematically review physical therapists' and physical therapist students' attitudes toward working with older adults. Methods CINAHL, EMBASE, ERIC, MEDLINE, Scopus, PsycINFO, and SocIndex databases were searched in duplicate (from inception to March 2023). Studies that assessed knowledge on aging, intention to work with older adults or attitudes toward older adults for physical therapist students and/or clinicians, and that were written in English, Finnish, Spanish, or Swedish were included. Grey literature, qualitative studies, or articles of people with a specific diagnosis (eg, dementia) were excluded. All articles were reviewed by 2 authors independently, and consensus was required for inclusion. Data extraction was completed using a standardized data extraction sheet. Results Of 2755 articles screened, 34 met the inclusion criteria. Twenty-five studies recruited only physical therapist students, 6 recruited only physical therapist clinicians, and 3 involved mixed samples of both. Ten intervention studies were included, all of which recruited physical therapist students. Overall, physical therapist students were observed to have predominantly positive attitudes toward older adults, while clinicians had neutral to weak positive attitudes toward older adults. Both physical therapist students and clinicians were observed to have low knowledge on aging and low intentions to work with older adults. Results from intervention studies suggest that education combined with clinical experience with older adults improves attitudes toward older adults. Conclusion A discrepancy is observed in physical therapists in that although attitudes toward older adults are positive, a lack of knowledge on aging and a disinterest in working with older adults exists. Intervention studies suggest that clinical experience may improve attitudes toward older adults in physical therapist students. Impact Predominantly positive attitudes toward older adults are reported by physical therapist students, while for clinicians mixed results are observed. Education coupled with clinical experiences appears to be effective interventions to improve attitudes toward older adults, but such research has only been explored in student samples. [ABSTRACT FROM AUTHOR]

Background: Maximum phonation time (MPT) is used to assess speech and other oral rehabilitation‐related issues. Various factors contribute to MPT decline in older individuals. Although the impact of physical frailty on MPT has been suggested, this has not been conclusively determined. Objective: To examine the relationship between MPT and physical frailty in community‐dwelling individuals aged ≥60 years who were independently mobile. MPT‐associated factors were investigated. Methods: This cross‐sectional study analysed the clinical data of 122 patients (age [interquartile range]: 80.0 [74.0–83.0] years) without dementia who visited a neurology department between 1 February 2021 and 31 January 2023. Investigated factors included age, sex, weight, height, body mass index, smoking history, grip strength, functional independence measure, vital capacity, oral diadochokinesis, MPT and the Japanese Cardiovascular Health Study score. Physical frailty was assessed based on the total score from five items (weight loss, weakness, exhaustion, slowness and low physical activity). The relationship between MPT and physical frailty was examined using Spearman's rank correlation coefficient and hierarchical multiple regression analysis. Results: The MPT was negatively correlated with age (r = −0.347, p <.01) and physical frailty (r = −0.681, p <.01) and positively correlated with vital capacity (r = 0.474, p <.01) and height (r = 0.248, p <.01). The hierarchical multiple regression analysis, conducted with MPT as the dependent variable, demonstrated that physical frailty (β = −.59, 95% confidence interval: −0.74 to 0.43, p <.001) had a strong influence on MPT. Conclusion: In older individuals, MPT is associated with physical frailty. When assessing MPT in clinical settings, it is advisable to perform a concurrent assessment of physical frailty. [ABSTRACT FROM AUTHOR]

There is growing interest in intelligent assistive technologies (IATs) in the rehabilitation and support of older adults, however, the factors contributing to or preventing their use in practice are not well understood. This study aimed to develop an overview of current knowledge on barriers and facilitators to the use of smart technologies in rehabilitative practice with older adults. We undertook a scoping review following guidelines proposed by Arksey and O'Malley (2005) and Levac et al. (2010). A computerised literature search was conducted using the Scopus and Ovid databases, yielding 7995 citations. Of these, 94 studies met inclusion criteria. Analysis of extracted data identified themes which were explored in semi-structured interviews with a purposefully selected sample of seven clinical rehabilitation practitioners (three physical therapists, two occupational therapists, and two speech-language pathologists). Barriers and facilitators to using these technologies were associated with accessibility, reported effectiveness, usability, patient-centred considerations, and staff considerations. Collaborative efforts of policy-makers, researchers, manufacturers, rehabilitation professionals, and older persons are needed to improve the design of technologies, develop appropriate funding and reimbursement strategies, and minimise barriers to their appropriate use to support independence and quality of life. Any strategies to improve upon barriers to prescribing smart technologies for older people should leverage the expertise of rehabilitation professionals operating at the interface between older people; their health/mobility; their families; and technology-based solutions. There is growing interest in intelligent assistive technologies (IATs) in the rehabilitation of older adults, as well as barriers to their use in practice. Rehabilitation professionals can play a key role in enabling access to IATs by recommending or prescribing their use to their older clients. Strategies to address barriers to the use of IATs for older people should leverage the expertise of rehabilitation professionals operating at the interface between older people, their families, and technology-based solutions. Older people and their families require technical support to initiate and continue to use IATs for rehabilitation. While rehabilitation providers may be well-placed to offer this support, they may require time and organizational support to build and maintain expertise in the fast-advancing field of smart technologies for rehabilitation. Cost and usability are universal challenges across the types of smart technologies considered in this review. Participatory approaches to involving older people in the design and development of smart assistive technologies contribute to better usability of these technologies. Devices and interventions that leverage more readily available devices and lower-cost components may overcome cost barriers to accessibility. [ABSTRACT FROM AUTHOR]

Background and Purpose: The international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool is a new instrument developed to evaluate the therapeutic quality of exercise interventions. Home-based exercise has been shown to improve physical fitness in older adults, but its effects may be influenced by therapeutic quality. The purpose of this systematic review was to describe the therapeutic quality of home-based exercise interventions for community-dwelling older adults and examine the relationship between therapeutic quality and changes in physical fitness. Methods: Six electronic databases and 2 clinical trial registries were searched for randomized controlled trials investigating the effects of home-based exercise on physical fitness in community- dwelling older adults (≥60 years). Therapeutic quality was evaluated using the i-CONTENT tool for items of patient selection, type of exercise, safety, type/timing of outcomes, exercise dose, and adherence. International Consensus on Therapeutic Exercise aNd Training items were used to explain heterogeneity in meta-regression analyses. Risk of bias, certainty of evidence and credibility of analyses were assessed. Results: Thirty-six trials (n = 6157 participants) were identified. Most studies (≥66.7%) had high or probably high therapeutic quality for i-CONTENT items, except exercise dose (47.2%) and adherence (16.7%). Interventions improved upper- (N = 20 trials; standardized mean difference [SMD] = 0.39; 95% CI, 0.13-0.64; low certainty of evidence) and lower-body strength (N = 28; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty), and aerobic fitness (N = 8; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty). For exercise dose, low- or probably low-quality studies negatively influenced effects on upper- (estimated β = -.48; P = .049; moderate credibility) and lower-body strength (estimated β = -.77; P = .048; moderate credibility). For adherence, low- or probably low-quality studies negatively influenced effects on aerobic fitness (estimated β = -.97; P = .02; low credibility). Conclusions: Home-based exercise may improve upper- and lower-body strength, as well as aerobic fitness in older adults. However, the effectiveness of interventions is affected by inadequate dosing of exercise programs and adherence issues. Physical therapists should have the best available evidence to support their clinical decision making, especially when designing and monitoring home programs. [ABSTRACT FROM AUTHOR]

Background: An analysis of practice is conducted by the American Board of Physical Therapy Specialties (ABPTS) every 10 years to revalidate, update, and revise the description of specialty practice (DSP) for each specialty. The Geriatric Specialty Council recently conducted an analysis of practice and revised its content consistent with established procedures by the ABPTS. Purpose: The purpose of this article is threefold: first, to describe the process of the most recent practice analysis; second, to report revisions to the description of specialty practice based on the analysis of practice; and third, to identify elements of practice that define current specialist practice in geriatric physical therapy. Methods: A 10-member committee of subject matter experts (SM Es) and a psychometric consultant developed a survey instrument addressing geriatric physical therapy specialty practice areas. The survey was initially pilot-tested and subsequently administered online to a sample of 801 board-certified geriatric clinical specialists. The consultant facilitated the consensus process to determine decision rules in selecting the final competencies describing current geriatric physical therapy specialty practice. Results: A total of 372 respondents fully or partially completed the survey, resulting in a response rate of 46.4%. Based on a priori decision rules regarding survey data, consensus of the group of SMEs, and input from the ABPTS, the DSP for geriatric physical therapy specialty practice was revised. Revisions (elimination [-] of prior items and addition [+] of new items) were made in Section 1: Knowledge Areas (-8 and +6), in Section 2: Professional Roles, Responsibilities, and Values (-14 and +4), and Section 3: Practice Expectations (-53 and +28). Conclusion: The revised DSP will be used as the basis for the development of the examination blueprint for the specialist examination in geriatric physical therapy and the curricula for residency programs in geriatric physical therapy. [ABSTRACT FROM AUTHOR]

This study compared handheld dynamometry (HHD) at the weakest point of the strength curve for hip extensors, hip abductors, and knee extensors in older adults and onerepetition maximum (1RM) of that same muscle groups with cuff weights. Fifty participants (62-94 years) were tested. Paired t tests indicated no significant differences between the 2 measures. Reliability testing for absolute agreement between 1RM and HHD yielded intraclass correlations of good to excellent. This demonstrates HHD at or near the weakest point of a muscle group provides an accurate measure of older individual's 1RM for knee extension, hip extension, and hip abduction. [ABSTRACT FROM AUTHOR]

Background: Frailty is an indicator of a decline in quality of life and functional capacity in cardiac rehabilitation (CR) patients. Currently, there is no standardized assessment tool for frailty used in CR. The aim of this study was to determine if the Clinical Frailty Scale (CFS) is feasible for assessing frailty in CR. Methods: Prospective, cross-sectional study within the framework of the ongoing multicenter prehabilitation study "PRECOVERY". Patients ≥75 years undergoing CR after cardiac procedure (n=122) were recruited in four German inpatient CR facilities. Assessments included: CFS, Katz-Index, hand grip strength (HGS), Short Physical Performance Battery (SPPB) and six-minute-walk test (6MWT). Outcomes were frailty (CFS≥4) and the correlation of frailty with assessments of functional capacity, activities of daily living and clinical parameters. Statistical analysis included descriptive statistics and correlations, using the spearman correlation coefficient and chi-square test to test for significance. Results: Data from 101 patients (79.9±4.0 years; 63% male) were analyzed. The mean CFS score was 3.2±1.4; 41.6% were defined as frail (CFS≥4). The mean time required to assess the CFS was 0.20 minutes. The findings show that CFS correlates significantly (p<0.001) with the following factors: Katz-Index, HGS, SPPB-Score and 6MWT (r≤-0.575). In addition, CFS correlated with small to moderate effects with co-morbidities (r=0.250), as-needed medications and need for nursing assistance (r≤0.248). Conclusions: The CFS assessment can be performed in under one minute and it correlates significantly with assessments of functional capacity, activities of daily living and clinical parameters in the CR setting. Trial registration: German Clinical Trials Register (DRKS; http:// www. drks. de; DRKS00032256). Retrospectively registered on 13 July 2023. [ABSTRACT FROM AUTHOR]

Abstract Background Geriatric rehabilitation aims at increasing physical and social activity and maintaining the functional reserve of older people. However, the continuity of geriatric rehabilitation in the outpatient setting is limited due to a lack of structured aftercare programs. In order to overcome this, a three-month multimodal home-based intervention program (GeRas) was implemented. The aim of this early qualitative process evaluation was to assess GeRas in terms of perceived reach, effectiveness/efficacy, adoption/uptake, implementation, and maintenance/sustainability (Domains within the RE-AIM Framework) from the perspective of patients who received the intervention and healthcare providers who were involved in the delivery of the intervention. Methods In a qualitative process evaluation, 13 healthcare providers and 10 patients were interviewed throughout the beginning of the implementation period of GeRas to capture early experiences using a semi-structured interview guide. The interview guide and qualitative content analysis was guided by the RE-AIM Framework. Results The GeRas program was perceived to be largely well implemented and beneficial by healthcare providers and patients. According to healthcare providers, GeRas showed more advantages compared to usual care. Additionally, outcome expectations were mainly met (Domain 1: Effectiveness). However, the implementation of the intervention delivered via the eHealth system was perceived as challenging (Domain 2: Adoption). Nevertheless, the outpatient physical exercise, the outpatient counselling, and the continuous care after discharge improved perceived well-being regardless of the intervention type (Domain 3: Implementation). To facilitate the continued use of GeRas, technical requirements should be created to increase user-friendliness and to motivate patients to continue the training in the long term (Domain 4: Maintenance). Conclusion Although initial experiences with the implementation and effectiveness of GeRas were positive in general, organisational and technical issues need to be resolved to enhance sustainable and successful implementation of the GeRas program. Trial registration German Clinical Trials Register (DRKS00029559). Registered 5/10/2022.

Geriatric rehabilitation inpatients have high levels of sedentary behaviour (SB) and low levels of physical activity (PA). Biological age predicted by blood biomarkers is indicative of adverse outcomes. The objective was to determine the association between blood biological age at rehabilitation admission and levels of SB and PA during rehabilitation in geriatric inpatients. Inpatients admitted to geriatric rehabilitation wards at the Royal Melbourne Hospital (Melbourne, Australia) from October 22, 2019, to March 29, 2020, in the REStORing health of acute unwell adulTs (RESORT) observational cohort were included. Blood biological age was predicted using SenoClock-BloodAge, a hematological ageing clock. Patients wore an inertial sensor to measure SB and PA. Logistic regression analyses were conducted. A total of 111 patients (57.7% female) with mean age 83.3 ± 7.5 years were included in the analysis. The mean blood biological age was 82.7 ± 8.4 years. Patients with 1-year higher blood biological age had higher odds of having high SB measured as non-upright time greater than 23 h/day (odds ratio (OR): 1.050, 95% confidence interval (CI): 1.000–1.102). Individuals having 1-year higher age deviation trended towards lower odds of having high levels of PA measured as stepping time greater than 7.4 min/day (OR: 0.916, CI: 0.836–1.005) and as greater than 19.5 sit-to-stand transitions/day (OR: 0.915, CI: 0.836–1.002). In conclusion, higher biological age was associated with higher levels of SB and trended towards lower PA. Incorporating blood biological age could facilitate resource allocation and the development of more tailored rehabilitation plans. [ABSTRACT FROM AUTHOR]

The multi-channel transcranial magnetic stimulator is commonly used for rehabilitation treatment of ischemic cerebrovascular disease, neurosis, and brain injury diseases in the elderly. And multiple high coherency signals are required as inputs for its test, which are with consistent frequency, adjustable amplitude, equal magnitude, and long-time phase consistency ⩽±1°. But ordinary signal sources have only one output channel, which is far from meeting the test requirements. If the traditional power division is used for the duplication, the phase difference between the channels will be larger than ±1°. If the multi-throw Radio Frequency (RF) switch is used, it will seriously affect the phase consistency of the input signal and increase the distortion of the signal. In order to solve the above problems, the method to extend the output of the microwave signal source has been proposed in the paper by using the integrated transceiver AD9361. The proposed method can realize the duplication of the number of signal channels according to user requirements. Then a signal replicator has been designed by combining AD9361 chip and Field-Programmable Gate Array (FPGA) control module. The experimental platform has been built to test the performance of the designed device. Experimental results show that the duplicated signals are highly consistent with the source signal in the power amplitude and frequency, meanwhile the phase of the duplicated signals are all highly consistent with each other.

Abstract Very old critically ill patients pose a growing challenge for intensive care. Critical illness and the burden of treatment in the intensive care unit (ICU) can lead to a long-lasting decline of functional and cognitive abilities, especially in very old patients. Multi-complexity and increased vulnerability to stress in these patients may lead to new and worsening disabilities, requiring careful assessment, prevention and rehabilitation. The potential for rehabilitation, which is crucial for optimal functional outcomes, requires a systematic, multi-disciplinary approach and careful long-term planning during and following ICU care. We describe this process and provide recommendations and checklists for comprehensive and timely assessments in the context of transitioning patients from ICU to post-ICU and acute hospital care, and review the barriers to the provision of good functional outcomes.

Background/Aim. A very limited amount of data regarding the rehabilitation outcome of surgical patients with COVID-19 is available in the current literature. The aim of this study was to point out the characteristics of early rehabilitation of these patients and determine the predictors of rehabilitation outcomes. Methods. The study was designed as a prospective clinical trial. It included patients who had surgical treatment from April 1, 2022, to March 31, 2023, at the University Clinical Center of Vojvodina, Serbia and either had positive results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) preoperatively or developed coronavirus disease 2019 (COVID-19) within 72 hrs after surgery. The rehabilitation program was planned for each patient according to the type of surgical treatment, age, clinical presentation and severity of the COVID-19, length of immobilization, and comorbidities. Rehabilitation treatment (RT) started with a minimum of one 30-minute daily session, up to three 30-minute sessions daily. Patients were assessed at the beginning of RT and discharge. Outcomes were assessed with the Modified Borg Scale (MBS) for dyspnoea, Barthel index (BI) for activities of daily living, Six-Minute Walk T est (6MWT) f or e xercise tolerance, and Timed up and Go (TUG) test for balance and lower limb mobility. Results. A total of 81 patients were included in the study. RT was successful for 42 patients (24 female and 18 male) with an average age of 62.10 ± 20.07 years. These patients exhibited significant functional improvement, which was measured by all tests that assessed rehabilitation outcome at discharge: BI (p < 0.001), MBS (p < 0.001), 6MWT (p < 0.001), and TUG test (p < 0.001). The remaining 31 patients had unsuccessful RT. The binary logistic regression analysis has shown that age (p = 0.009), cardiovascular disease (p = 0.017), and malignancy (p = 0.022) were significant predictors of rehabilitation outcome. Conclusion. Results of the present study implicate that individually tailored RT during the acute phase of COVID-19 in surgical patients is very challenging. Advanced age, cardiovascular disease, and malignancy are predictors of unfavorable outcomes, and careful consideration is needed when planning the treatment for these patients. [ABSTRACT FROM AUTHOR]

This study aims to explore the role of social resilience in providing community-based healthcare to older adults in Northeast Thailand during the COVID-19 pandemic. Purposive sampling was used to recruit 20 community-dwelling older adults in Maha Sarakham province, Thailand, and semi-structured interviews were conducted from 2020 to 2021. Interview transcripts were analyzed using an interpretative phenomenological analysis (IPA) approach with multiple coders to triangulate findings. The results of the IPA show that, during the pandemic, social resilience was related to social distancing, social isolation, social control, social safety, and social support. The respondents identified that providing community-based healthcare during the pandemic was associated with primary care, rehabilitative care, healthcare delivery, health behaviors, and distress intolerance. These findings highlight that social reciprocity, preventative healthcare, residential care, and good healthcare practices are important aspects of resilience among community-dwelling older adults in times of pandemic. [ABSTRACT FROM AUTHOR]

Background & objective: One of the most frequently performed anesthesia services is Non-Operating Room Anesthesia (NORA). In geriatric patients, there are several risk factors which are directly or indirectly related to post-NORA mortality. We aimed to find out the relationship between pre-NORA risk factors and the mortality of geriatric patients receiving NORA services. Methods: This observational analytical study used the convenient sampling method in seventy patients undergoing NORA. Data collected included pre-NORA risk factors; e.g., age, gender, Body Mass Index (BMI), quality of life, and cognitive function. Mortality within 30 days post-NORA was noted. The data was analyzed using an independent ttest and Spearman correlation with α= 5% and a confidence interval (CI) of 95%. Results: We included 70 patients as the subject of the study, with a mortality rate of 8.6%. There was a significant difference between BMI (P = 0.034), quality of life (P = 0.001), and cognitive function (P = 0.004) in patients who died with those who remained alive. There were correlations between cognitive function (P = 0.001, R= 0.379) and quality of life (P = 0.009, R= 0.309) with 30 days post-NORA mortality. Conclusion: There is a positive correlation between the risk factors of cognitive function and quality of life pre-NORA of geriatric patients with 30-day mortality post-NORA. Careful selection and maximum optimization of the geriatric patients selected for non-operating room anesthesia may reduce post-operative mortality. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal Stromal Tumors (GISTs) are the most common mesenchymal tumors of the GI tract. SEER is an extensive cancer database which proves useful in analyzing population trends. This analysis investigated GIST outcomes between geriatric & non‐geriatric patients. Methods: SEER*STAT 8.4.0.1 was used to extract relevant GIST data from 2000 to 2019. Geriatric age was defined as ≥70 years. Variables included age, sex, surgery, cancer‐specific death, and overall survival. Statistical tests included univariate analysis using KM survival estimate (95% confidence interval) to calculate 5‐year survival (5YS). Log‐Rank tests determined statistical significance. Multivariable Cox's PH regression estimated the geriatric hazard death ratio adjusted for sex, stage, and surgery. Results: The number of patients included was 13,579, yielding overall 5YS of 68.6% (95% CI 67.7–69.5). Cancer‐specific death was 39.11% in 2000 & 3.33% in 2019. Non‐geriatric & geriatric patient data yielded 5YS of 77.4% (76.4%–78.3%) and 53.3% (51.7%–54.8%) respectively (p < 0.0001). For no surgery/surgery, younger patient data yielded 5YS of 48.7% (45.8%–51.4%) and 83.7% (82.7%–84.7%) respectively (p < 0.0001); geriatric data yielded 5YS of 29.3% (26.5%–32.1%) and 62.8% (60.8%–64.6%) respectively (p < 0.0001). Multivariable analysis yielded a geriatric hazard death of 2.56 (2.42–2.70) (p < 0.0001). Conclusions: Cancer‐specific death decreased since 2000, indicating an improvement in survival & treatment methods. Observed lower survival rates overall in the geriatric group. Surgery appeared to enhance survival rates in both groups, suggesting that surgery is an important factor in GIST survival regardless of age. Large prospective studies will help define clinical management for geriatric patients. [ABSTRACT FROM AUTHOR]

This document presents the results of an international consensus study on core standards and core outcomes for prehabilitation in colorectal surgery. The study involved healthcare professionals and patients from various countries and aimed to establish a common set of standards and outcomes for future research in prehabilitation. The study used a systematic review, Delphi surveys, and consensus meetings to gather input and reach consensus on the core standards and outcomes. The final list includes 33 core standards and 21 core outcomes, which researchers are encouraged to use as a minimum standard in prehabilitation research. The implementation of these core standards and outcomes is expected to improve standardization and facilitate comparisons between studies, ultimately benefiting colorectal surgical patients. [Extracted from the article]

This study compared the effect of traditional exercise training and game-based exercise by TRAZER© on dynamic balance activities, vestibular ocular motor sensory (VOMS), falls efficacy scale-international (FES-I), and muscular performance in healthy older adults. Twenty-two older adults (mean age: 77.59 ± 6.20 years) randomly divided into two groups (1) exercise training (ET) and (2) ET + TRAZER©. Both groups participated in one-hour exercise sessions, three days a week for 10 wk. The ET + TRAZER© group completed the three dynamic/agility balance assessments each day. The results showed the three TRAZER© assessments significantly increased in the ET + TRAZER© group. However, there was not a statistically significant difference between the groups for timed up and go (TUG), sit-to-stand (STS), and FES-I. Our findings provided evidence that game-based exercise intervention improved muscular function and VOMS, especially dynamic balance and reaction time in older adults. [ABSTRACT FROM AUTHOR]

Introduction: Stroke poses challenges to the physiological, psychosocial and spiritual well‐being of affected individuals. As the impacts of stroke might not be reversible, a shift in focus to providing care is desirable. Visual art interventions using visual and symbolic art can help participants to express their feelings, give them a sense of choice and the feeling that they are retaining a sense of control, promote insights, restructure their sense of cognition and instil hope. There have been few studies on visual art interventions involving older people with stroke and none in residential care homes (RCHs). Theoretical support and rigorous research designs on the subject are lacking. Thus, this study seeks to address this research gap by examining the feasibility of a visual art intervention for older people in RCHs and exploring the impacts on their holistic well‐being. Methods: This was a single‐blinded, two‐arm, randomised controlled feasibility study grounded on Watson's Caring Theory. The Holistic Well‐Being Scale and Caring Factor Survey were used in the study, with three assessment time‐points: before the intervention (T1), at the mid‐point of the intervention (T2) and immediately after the intervention (T3). Results: Sixty‐one older people with stroke were recruited from 14 RCHs and randomised into the intervention and control groups. The recruitment rate was 44.53%, and the retention rate for the intervention group was 93.55%. Implementing the programme was affordable (at approximately US$126/head), the duration was acceptable (721 min) and the feedback from participants and staff of the RCHs was positive. Conclusions: The visual art intervention programme proved to be clinically feasible. This study adds new insights to the development of visual art interventions and to the caring sciences. The efficacy of the programme on holistic well‐being has yet to be confirmed. [ABSTRACT FROM AUTHOR]

Background: In Japan, the number of older adults requiring long-term care insurance (LTCI) is increasing and the cost is becoming a social problem. In these fields, the role of geriatric rehabilitation includes maintaining the physical function and LTCI certification levels. The prevalence of sarcopenia is high among older adults requiring LTCI certification, and there are many opportunities to assess the handgrip strength, walking speed, and muscle mass. This study aimed to identify sarcopenia-related assessments sensitive to transitions in LTCI certification levels and determine cut-off values to predict them. Methods: This prospective cohort study analyzed 98 daycare users (mean age ± standard error: 78.5 ± 0.8 years) between March 2019 and 2023. The participants received LTCI certification before the study, and their levels were renewed between baseline and follow-up (six months later). The measurements included handgrip strength, usual walking speed, body composition, and SARC-F score. Participants were classified into maintenance, deterioration, and improvement groups according to the changes in their LTCI certification levels. We identified factors contributing to the deterioration of LTCI certification levels using baseline and before and after comparisons, multivariate analyses, and receiver operating characteristic analyses. Results: No significant differences were observed in the baseline data among the groups. Only the deterioration group showed significant changes in the usual walking speed (baseline: 0.64 ± 0.25 m/s, follow-up: 0.53 ± 0.21 m/s, P = 0.008) and body fat percentage (baseline: 29.2 ± 9.9%, follow-up: 27.7 ± 10.3%, P = 0.047). Binomial logistic regression showed that changes in usual walking speed (P = 0.042) and body fat percentage (P = 0.011) were significantly associated with the deterioration of LTCI certification levels, even after adjustment. The cutoff values of change to discriminate the deterioration of LTCI certification levels were −0.14 m/s at the usual walking speed (P = 0.047) and −1.0% for body fat percentage (P = 0.029). Conclusions: Decreases in usual walking speed and body fat percentage may predict worse certification levels in older adults requiring LTCI. [ABSTRACT FROM AUTHOR]

Background This quality assurance study was conducted during the COVID-19 pandemic to describe the profile of patients aged 65 years and older admitted to a transition unit in a long-term care (LTC) facility and to evaluate the impact of admission modalities, compliance with screening and hand hygiene practices, risk of COVID-19, and time to access a geriatric rehabilitation unit (GRU). Methods A prospective study was conducted using administrative and medical records from three Montreal public LTC facilities offering a rehabilitation program for 312 patients admitted between May 2020 and February 2021. The results are reported for the entire sample and compared according to the mode of admission. Results The incidence of COVID-19 during the transition unit stay was estimated to be 11 cases or 3.5% in 14 days. Assessment of screening compliance showed deficiencies for 41.3% of patients, and the frequency of hand hygiene audits was not strictly adhered to. More COVID-19 cases were recorded in patients admitted to the transition unit by bed availability than in the cohort mode. The time to access a rehabilitation unit was 7.2 days or 23.5% shorter for patients admitted by bed availability. Conclusions The study, conducted from a continuous practice improvement perspective, showed that the implementation of a transition unit in the LTC facilities helped control the transmission of COVID-19, but also revealed flaws in screening and hand hygiene practices. [ABSTRACT FROM AUTHOR]

Introduction: There were no previous studies discussing the comparison of the complications among traumatic brain injury (TBI) cases during weekdays and weekends. The current study aims to retrospectively compare the TBI outcome of geriatric patients on weekdays versus weekends in the neurosurgery department in a tertiary hospital in Oman. Methods: This is a retrospective study, from December 2015 to December 2019. Medical records of 670 patients above 65 years and admitted to the neurosurgery ward were reviewed. From that, only 45 patients over 65 years, diagnosed with TBI and managed surgically were included. Results: The study included 28 patients admitted during weekdays and 17 patients admitted during weekends. Nevertheless, the highest number of admissions was during Friday. The male-to-female ratio was 3.6:1 during weekdays and 3.2:1 during weekends. The average length of stay (LOS) was 12.4 days among patients operated on weekdays compared to 36.5 days on weekends. For average ICU stay, it was 3.9 days during weekdays compared to 32.2 during weekends (p = 0.011). Complications were found to be more common among patients admitted on weekends (p = 0.015). Conclusion: Significant differences between weekdays and weekends were found. So, more trauma imaging facilities and neurosurgeons need to be available during the weekends. [ABSTRACT FROM AUTHOR]

Background: Information is scarce on unplanned transfers from geriatric rehabilitation back to acute care despite their potential impact on patients' functional recovery. This study aimed 1) to determine the incidence rate and causes of unplanned transfers; 2) to compare the characteristics and outcomes of patients with and without unplanned transfer. Methods: Consecutive stays (n = 2375) in a tertiary geriatric rehabilitation unit were included. Unplanned transfers to acute care and their causes were analyzed from discharge summaries. Data on patients' socio-demographics, health, functional, and mental status; length of stay; discharge destination; and death, were extracted from the hospital database. Bi- and multi-variable analyses investigated the association between patients' characteristics and unplanned transfers. Results: One in six (16.7%) rehabilitation stays was interrupted by a transfer, most often secondary to infections (19.3%), cardiac (16.8%), abdominal (12.7%), trauma (12.2%), and neurological problems (9.4%). Older patients (AdjORage≥85: 0.70; 95%CI: 0. 53–0.94, P =.016), and those admitted for gait disorders (AdjOR: 0.73; 95%CI: 0.53–0.99, P =.046) had lower odds of transfer to acute care. In contrast, men (AdjOR: 1.71; 95%CI: 1.29–2.26, P <.001), patients with more severe disease (AdjORCIRS: 1.05; 95%CI: 1.02–1.07, P <.001), functional impairment before (AdjOR: 1.69; 95%CI: 1.05–2.70, P =.029) and at rehabilitation admission (AdjOR: 2.07; 95%CI: 1.56- 2.76, P <.001) had higher odds of transfer. Transferred patients were significantly more likely to die than those without transfer (AdjOR 13.78; 95%CI: 6.46–29.42, P <.001) during their stay, but those surviving had similar functional performance and rate of home discharge at the end of the stay. Conclusion: A significant minority of patients experienced an unplanned transfer that potentially interfered with their rehabilitation and was associated with poorer outcomes. Men, patients with more severe disease and functional impairment appear at increased risk. Further studies should investigate whether interventions targeting these patients may prevent unplanned transfers and modify associated adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: Malnutrition increases the risk of poor prognosis in patients with cardiovascular disease, and our current research was designed to assess the predictive performance of the Geriatric Nutrition Risk Index (GNRI) for the occurrence of poor prognosis after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (SCAD) and to explore possible thresholds for nutritional intervention. Methods: This study retrospectively enrolled newly diagnosed SCAD patients treated with elective PCI from 2014 to 2017 at Shinonoi General Hospital, with all-cause death as the main follow-up endpoint. Cox regression analysis and restricted cubic spline (RCS) regression analysis were used to explore the association of GNRI with all-cause death risk and its shape. Receiver operating characteristic curve (ROC) analysis and piecewise linear regression analysis were used to evaluate the predictive performance of GNRI level at admission on all-cause death in SCAD patients after PCI and to explore possible nutritional intervention threshold points. Results: The incidence of all-cause death was 40.47/1000 person-years after a mean follow-up of 2.18 years for 204 subjects. Kaplan-Meier curves revealed that subjects at risk of malnutrition had a higher all-cause death risk. In multivariate Cox regression analysis, each unit increase in GNRI reduced the all-cause death risk by 14% (HR 0.86, 95% CI 0.77, 0.95), and subjects in the GNRI > 98 group had a significantly lower risk of death compared to those in the GNRI < 98 group (HR 0.04, 95% CI 0.00, 0.89). ROC analysis showed that the baseline GNRI had a very high predictive performance for all-cause death (AUC = 0.8844), and the predictive threshold was 98.62; additionally, in the RCS regression analysis and piecewise linear regression analysis we found that the threshold point for the GNRI-related all-cause death risk was 98.28 and the risk will be significantly reduced when the subjects' baseline GNRI was greater than 98.28. Conclusions: GNRI level at admission was an independent predictor of all-cause death in SCAD patients after PCI, and GNRI equal to 98.28 may be a useful threshold for nutritional intervention in SCAD patients treated with PCI. [ABSTRACT FROM AUTHOR]

Very old critically ill patients pose a growing challenge for intensive care. Critical illness and the burden of treatment in the intensive care unit (ICU) can lead to a long-lasting decline of functional and cognitive abilities, especially in very old patients. Multi-complexity and increased vulnerability to stress in these patients may lead to new and worsening disabilities, requiring careful assessment, prevention and rehabilitation. The potential for rehabilitation, which is crucial for optimal functional outcomes, requires a systematic, multi-disciplinary approach and careful long-term planning during and following ICU care. We describe this process and provide recommendations and checklists for comprehensive and timely assessments in the context of transitioning patients from ICU to post-ICU and acute hospital care, and review the barriers to the provision of good functional outcomes. [ABSTRACT FROM AUTHOR]

Objective: There is a scarcity of data on hospital length of stay (LOS) in the osteoarthritis population. Therefore, this study aimed to investigate hospital LOS and associated factors in patients with osteoarthritis from Germany. Methods: The present cross-sectional study included patients hospitalized for osteoarthritis in one of fourteen hospitals in Germany between 2018 and 2023 (hospital database; IQVIA). The study outcome was the duration of hospital stay in days. Study covariables included age, sex, hospital department, osteoarthritis type, co-diagnosis, and hospitalization-related procedure. Associations between covariables and hospital LOS were analyzed using hierarchical linear regression models. Results: There were 8770 patients included in the study (mean [standard deviation] age 68.7 [10.8] years; 60.2% women). The mean (standard deviation) hospital LOS was 8.5 (5.0) days. Factors positively and significantly associated with hospital LOS were older age, female sex, orthopedic surgery and other medical specialty departments (compared with other surgery departments), knee and other and unspecified osteoarthritis (compared with hip osteoarthritis), multiple co-diagnoses (e.g., acute posthemorrhagic anemia, other disorders of fluid, electrolyte, and acid–base balance, and disorders of purine and pyrimidine metabolism), and several hospitalization-related procedures (i.e., geriatric rehabilitation, hip arthroplasty, and knee arthroplasty). Conclusions: The mean hospital LOS was higher than eight days in this osteoarthritis population from Germany, with a spectrum of demographic, clinical, and hospitalization-related factors associated with this hospital LOS. In this context, interventions are needed to reduce the LOS of hospitalizations for osteoarthritis in Germany. [ABSTRACT FROM AUTHOR]

Background: An increasing number of older patients are undergoing emergency laparotomy (EL). Frailty is thought to contribute to adverse outcomes in this group. The best method to assess frailty and impacts on long‐term mortality and other important functional outcomes for older EL patients have not been fully explored. Methods: A prospective multicenter study of older EL patients was conducted across four hospital sites in New Zealand from August 2017 to September 2022. The Clinical Frailty Scale (CFS) was used to measure frailty—defined as a CFS of ≥5. Primary outcomes were 30‐day and one‐year mortality. Secondary outcomes were postoperative morbidity, admission for rehabilitation, and increased care level on discharge. A multivariate logistic regression analysis was conducted, adjusting for age, sex, and ethnicity. Results: A total of 629 participants were included. Frailty prevalence was 14.6%. Frail participants demonstrated higher 30‐day and 1‐year mortality—20.7% and 39.1%. Following adjustment, frailty was directly associated with a significantly increased risk of short‐ and long‐term mortality (30‐day aRR 2.6, 95% CI 1.5, 4.3, p = <0.001, 1‐year aRR 2.0, 95% CI 1.5, 2.8, p < 0.001). Frailty was correlated with a 2‐fold increased risk of admission for rehabilitation and propensity of being discharged to an increased level of care, complications, and readmission within 30 days. Conclusion: Frailty was associated with increased risk of postoperative mortality up to 1‐year and other functional outcomes for older patients undergoing EL. Identification of frailty in older EL patients aids in patient‐centered decision‐making, which may lead to improvement in outcomes. [ABSTRACT FROM AUTHOR]

Background After an acute infection, older persons may benefit from geriatric rehabilitation (GR). Objectives This study describes the recovery trajectories of post-COVID-19 patients undergoing GR and explores whether frailty is associated with recovery. Design Multicentre prospective cohort study. Setting 59 GR facilities in 10 European countries. Participants Post-COVID-19 patients admitted to GR between October 2020 and October 2021. Methods Patients' characteristics, daily functioning (Barthel index; BI), quality of life (QoL; EQ-5D-5L) and frailty (Clinical Frailty Scale; CFS) were collected at admission, discharge, 6 weeks and 6 months after discharge. We used linear mixed models to examine the trajectories of daily functioning and QoL. Results 723 participants were included with a mean age of 75 (SD: 9.91) years. Most participants were pre-frail to frail (median [interquartile range] CFS 6.0 [5.0–7.0]) at admission. After admission, the BI first steeply increased from 11.31 with 2.51 (SE 0.15, P  < 0.001) points per month and stabilised around 17.0 (quadratic slope: −0.26, SE 0.02, P  < 0.001). Similarly, EQ-5D-5L first steeply increased from 0.569 with 0.126 points per month (SE 0.008, P  < 0.001) and stabilised around 0.8 (quadratic slope: −0.014, SE 0.001, P  < 0.001). Functional recovery rates were independent of frailty level at admission. QoL was lower at admission for frailer participants, but increased faster, stabilising at almost equal QoL values for frail, pre-frail and fit patients. Conclusions Post-COVID-19 patients admitted to GR showed substantial recovery in daily functioning and QoL. Frailty at GR admission was not associated with recovery and should not be a reason to exclude patients from GR. [ABSTRACT FROM AUTHOR]

Background and Purpose: Patients with COPD-induced malnutrition and muscle wasting are often frail. Consequently, traditional rehabilitation may be even counterproductive due to energy costs and there is a need for specialized rehabilitation programs, which are lacking for these patients. We developed such a program, which includes resistance training, following Nonlinear Periodized Exercise principles and physical energy management, in combination with a restriction of physical activities. The purpose of the study was to investigate the feasibility and the potential effects of this program. Methods: Patients who are eligible for the program are those with COPD gold III/IV and a fat free mass index below standard. We conducted a qualitative feasibility study and interviewed both patients and healthcare professionals (HCPs), using a deductive approach. The open interviews were qualitatively analyzed focussing on six areas of Bowens' feasibility model: acceptability, demand, implementation, practicality, limited efficacy, and integration. Results and discussions: Seven patients and seven HCPs were interviewed. For patients, key factors that helped to adhere to the program were knowledge about energy management, alternative skills to cope with COPD, and social support. They found the program beneficial. However, several patients considered a limitation of walking and ADL activities challenging. HCPs considered the program feasible and beneficial especially for those patients who accept they need a behavior change and who adhere to the program. For HCPs, key factors were the consistent approach and coaching skills of the multidisciplinary team members, and the monitoring role of the nurses. The limitation of physical activity and endurance training deviates from existing geriatric rehabilitation programs which propagate functional activity and training. Still, evidence from the current study suggests that our tailored approach for these patients might be more appropriate and also potentially effective without harm for physical function. Conclusions: Our novel, multidisciplinary rehabilitation program is considered feasible and clinically relevant by both patients and healthcare professionals. The next step is to explore its effects on muscle strength, physical functioning, and quality of life. [ABSTRACT FROM AUTHOR]

Objectives: The aims of the study are to describe the frequency that functional goals are documented on the Minimum Data Set and to identify resident characteristics associated with meeting or exceeding discharge goals. Methods: We selected Medicare fee-for-service beneficiaries admitted to a skilled nursing facility within 3 days of hospital discharge fromOctober 1, 2018, to December 31, 2019 (N = 1,228,913). The admission Minimum Data Set was used to describe the discharge goal scores for seven self-care and 16 mobility items. We used the eight self-care and mobility items originally included in a publicly reported qualitymeasure to calculate total scores for discharge goals, admission performance, and discharge performance (n = 371,801). Results: For all self-care items, more than 70%of residents had a goal score of 1-6 points documented on the admissionMinimum Data Set. Chair/bed-to-chair transfer had the highest percentage of residents with a score of 1-6 points (77.1%) and walking up/down 12 steps had the lowest (23.2%). Approximately 44% of residents had a discharge performance score that met or exceeded their goal score. Older age, urinary incontinence, and cognitive impairment had the lowest odds of meeting or exceeding discharge goals. Conclusions: Assessing a resident's functional goals is important to providing patient-centered care. This information may help skilled nursing facilities determine whether a resident has made meaningful functional improvements. [ABSTRACT FROM AUTHOR]

Regaining independent living can be challenging in patients undergoing inpatient geriatric rehabilitation. Given the paucity of evidence-based physiotherapy programs for this particular heterogeneous group, the Geriatric Activation Program Pellenberg (GAPP) was developed. Investigate the evolution of functional performance, and predict detectable changes throughout 4 weeks of GAPP. Methods: Participants in this observational study (2017–2019) followed GAPP as part of their rehabilitation program. Functional balance (Berg balance scale (BBS)) and independence (Katz scale) were the primary outcomes, with gait speed, elbow and knee extension strength, cognitive processing speed, and mood as secondary outcomes. All outcomes were assessed at baseline, 2 weeks and 4 weeks later. Prediction analysis was conducted using logistic regression modeling. Previously reported minimal detectable change with 95% confidence interval (MDC95) was used as detectable change. We recruited 111 participants, with 83 completing 4 weeks of GAPP and all assessments. Over 4 weeks, all outcome measures showed a significant improvement (p ≤.007). Detectable change was found for BBS (mean improvement of 12.8 points (95% CI: 10.9–14.8), MDC95 = 6.6) and gait speed (mean improvement of 0.24 m/s (95% CI: 0.19–0.29), MDC95 = 0.1 m/s). We found that baseline scores lower than 26 on the BBS (75% sensitivity, 65% specificity) and gait speed lower than 0.34 m/s (53% sensitivity, 81% specificity) were associated with participants achieving detectable change at 4 weeks on BBS and gait speed, respectively. Functional performance of a heterogeneous group of geriatric inpatients improved notably after 4 weeks of GAPP. Baseline scores on BBS and gait speed can partially predict detectable changes in functional performance. [ABSTRACT FROM AUTHOR]

Type II odontoid fractures (OF) are among the most common cervical spine injuries in the geriatric population. However, there is a paucity of literature regarding their epidemiology. Additionally, the optimal management of these injuries remains controversial, and no study has evaluated the short-term outcomes of geriatric patients presenting to emergency departments (ED). This study aims to document the epidemiology of geriatric patients presenting to EDs with type II OFs and determine whether surgical management was associated with early adverse outcomes such as in-hospital mortality and discharge to skilled nursing facilities (SNF). This is a retrospective cohort study. Data was used from the 2016–2020 Nationwide Emergency Department Sample. Patient encounters corresponding to type II OFs were identified. Patients younger than 65 at the time of presentation to the ED and those with concomitant spinal pathology were excluded. The association between the surgical management of geriatric type II OFs and outcomes such as in-hospital mortality and discharge to SNFs. Patient, fracture, and surgical management characteristics were recorded. A propensity score matched cohort was constructed to reduce differences in age, comorbidities, and injury severity between patients undergoing operative and nonoperative management. Additionally, to develop a positive control for the analysis of geriatric patients with type II OFs and no other concomitant spinal pathology, a cohort of patients that had been excluded due to the presence of a concomitant spinal cord injury (SCI) was also constructed. Multivariate regressions were then performed on both the matched and unmatched cohorts to ascertain the associations between surgical treatment and in-hospital mortality, inpatient length of stay, encounter charges, and discharge to SNFs. A total of 11,325 encounters were included. The mean total charge per encounter was $60,221. 634 (5.6%) patients passed away during their encounters. In total, 1,005 (8.9%) patients were managed surgically. Surgical management of type II OFs was associated with a 316% increase in visit charge (95% CI: 291%–341%, p<.001), increased inpatient length of stay (IRR: 2.87, 95% CI: 2.62–3.12, p<.001), and increased likelihood of discharge to SNFs (OR=2.62, 95% CI: 2.26–3.05, p<.001), but decreased in-hospital mortality (OR=0.32, CI: 0.21-0.45, p<.001). The propensity score matched cohort consisted of 2,010 patients, matching each of the 1,005 that underwent surgery to 1,005 that did not. These cohorts were well balanced across age (78.24 vs 77.91 years), Elixhauser Comorbidity Index (3.68 vs 3.71), and Injury Severity Score (30.15 vs 28.93). This matching did not meaningfully alter the associations determined between surgical management and in-hospital mortality (OR=0.34, CI=0.21–0.55, p<.001) or SNF discharge (OR=2.59, CI=2.13–3.16, p<.001). Lastly, the positive control cohort of patients with concurrent SCI had higher rates of SNF discharge (50.0% vs 42.6%, p<.001), surgical management (32.3% vs 9.7%, p<.001), and in-hospital mortality (28.9% vs 5.6%, p<.001). This study lends insight into the epidemiology of geriatric type II OFs and quantifies risk factors influencing adverse outcomes. Patient informed consent should include a discussion of the protective association between definitive surgical management and in-hospital mortality against potential operative morbidity, increased lengths of hospital stay, and increased likelihood of discharge to SNFs. This information may impact patient treatment selection and decision making. [ABSTRACT FROM AUTHOR]

Objective: To systematically review the effectiveness of guided telerehabilitation on improving functional performance in community-dwelling older adults. Data sources: Articles published in PubMed, Cochrane Library and Embase (Ovid) from 01 January 2010 up to 17 October 2023. Review Methods: Included studies had (1) a randomised controlled trial design, (2) an average population age of 65 years or older, (3) a home-based setting and (4) evaluated the effectiveness of functional performance outcome measures. The intervention was considered telerehabilitation when guided by a healthcare professional using video, audio and/or text communication technologies with a minimum frequency of once per week. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement guideline was followed. Methodological quality was appraised using the revised Cochrane Risk of Bias tool. Results: A total of 26 randomised controlled trials were included. Telerehabilitation had superior (N = 15), non-superior (N = 16) or non-inferior (N = 11) effectiveness for improving functional performance outcome measures compared to control interventions. No studies found the control intervention to be superior over telerehabilitation. Between study differences in intervention characteristics contributed to significant clinical heterogeneity. Five studies were found to present an overall 'low' risk of bias, 12 studies to present 'some' risk of bias and 9 studies to present an overall 'high' risk of bias. Conclusion: The findings suggest that telerehabilitation could be a promising alternative to in-person rehabilitation for improving functional performance in community-dwelling older adults. Additional well-designed studies with minimised bias are needed for a better understanding of effective telerehabilitation intervention strategies. [ABSTRACT FROM AUTHOR]

Bone marrow biopsy (BMB) is a well-established diagnostic tool for various hematological, oncological, and other medical conditions. However, treatment options for geriatric patients (pts) facing these diseases are often constrained. In this single-center, retrospective analysis we assessed the diagnostic value of BMB in geriatric pts aged ≥ 85 years and examined its impact on therapeutic decisions. We examined 156 BMB procedures in 129 pts, extracting data from the electronic patient records and applying descriptive statistical methods. Nearly half of the primary diagnostic procedures (26; 44.1%) resulted in a modification of the initially suspected diagnosis. Notably, 15 (25.4%) of these procedures, led to changes in both the diagnosis and planned interventional treatment. Among the 15 follow-up procedures (36.6%), disease progression was initially suspected based on symptoms, but BMB results excluded such progression. In lymphoma staging biopsies, only 2 (3.6%) prompted a change in therapeutic intervention. Importantly, no BMB-related complications, such as bleeding, infection or nerve damage, were reported. Median survival after BMB was 16.1 months across all pts, yet it varied based on the diagnosis and comorbidity score. The survival of pts with a change in therapy based on BMB results did not significantly differ from those who did not undergo a therapy change. In conclusion, BMB proved to be generally safe and beneficial in this geriatric cancer patient cohort beyond the age of 85 years. However, the advantages of lymphoma staging in this patient population warrant further consideration. [ABSTRACT FROM AUTHOR]

Background and Purpose: Despite being associated with serious adverse outcomes, such as mortality, sarcopenia remains largely undiagnosed in older individuals. This study aimed to assess the awareness, practices, and barriers and enablers to clinical implementation of sarcopenia diagnosis and treatment among geriatric rehabilitation health care professionals in the Netherlands. Methods: As part of EMPOWER-GR, a cross-sectional survey among geriatric rehabilitation health care professionals working in the Netherlands was undertaken between September 23, 2020, and January 28, 2021. Professionals were recruited via a geriatric rehabilitation care provider, health care professional associations, professional networks of the research team, and social media. Descriptive statistics were used to assess the study outcomes. Results and Discussion: Of the 501 geriatric rehabilitation health care professionals, 12.2% were physicians, 23.0% physical therapist/occupational therapists, 30.3% dietitians, 19.6% nurses, and 11.0% health care assistants. The concept of sarcopenia was known by 83.8% of the participants, 92.5% correctly identified sarcopenia as low muscle mass and strength (and low physical performance), and 73.8% identified sarcopenia as very important in the management of older adults admitted for rehabilitation. Although 26.2% and 18.9% of the participants reported screening and diagnosing sarcopenia, respectively, in their current practice, only 3.0% adequately used the (revised) definition of the European Working Group on Sarcopenia in Older People. When sarcopenia has been diagnosed, 65.0% reported initiating treatment consisting of resistance exercise training (78.7%), food fortification/high-energy or protein diet (85.4%), and oral nutritional supplements (70.4%). Most important barriers to screening and diagnosis were lack of knowledge, access to tools, and equipment and time, while enablers were protocol implementation, access to training, and clear responsibilities. Conclusions: Sarcopenia awareness is high among geriatric rehabilitation health care professionals in the Netherlands, but adequate screening and diagnosis is almost nonexistent in current clinical practice, which hampers interventions. Better knowledge, clear responsibilities, and access to tools and protocols, as well as prioritization, are needed for sarcopenia to be diagnosed and treated in geriatric rehabilitation in the Netherlands. [ABSTRACT FROM AUTHOR]