Rehabilitation for older people in long-term care (Review)

Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, UK, BD9 6RJ.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2009; 2(1):CD004294. DOI: 10.1002/14651858.CD004294.pub2
Source: PubMed


Rehabilitation treatments may be effective in improving the physical health of older people in long-term care. In 2010, 7.6% of the world's population were over 65 years old, and this is predicted to increase to 13% by 2035. It is expected that this will lead to a rise in demand for long-term residential care. This has increased interest in ways to prevent deterioration in health and activities of daily living, for example, walking and dressing, among care home residents. Physical rehabilitation (interventions based on exercising the body) may have a role, and this review examines the evidence available. This review included 67 trials, 36 of which were conducted in North America, 20 in Europe, and seven in Asia. In total, 6300 participants with an average age of 83 years were involved. Most interventions in some way addressed difficulties in activities of daily living. This review investigates the effects of physical rehabilitation on activities of daily living, strength, flexibility, balance, mood, cognition (memory and thinking), exercise tolerance, fear of falling, death, illness, and unwanted effects associated with the intervention, such as injuries. While variations between trials meant that we could not make specific recommendations, individual studies were often successful in demonstrating benefits to physical health from participating in different types of physical rehabilitation.

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    • "An important amount of evidence (Abdulla et al., 2013; Crocker et al., 2013; Karinkanta, Piirtola, Sievänen, Uusi-Rasi, & Kannus, 2010; Rubenstein, 2006; Valenzuela, 2012; Warburton, Charlesworth, Ivey, Nettlefold, & Bredin, 2010; Weening- Dijksterhuis, de Greef, Scherder, Slaets, & van der Schans, 2011) suggests that exercise should be implemented as a preventive and therapeutic intervention for older nursing home (NH) residents. Despite this, very little information is available about the real amount of exercise (i.e., planned and purposeful physical activities generally developed to improve participants' physiological and physical capacities) NH residents do in their daily lives. "
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    ABSTRACT: Abstract Information on the amount of exercise practised by nursing home (NH) residents is scarce. This study aimed at describing NH residents' participation in exercise classes, as well as to examine whether the presence of a professional exercise instructor in the facilities is associated with residents' exercise habits. The cross-sectional data of 5402 residents (median age = 88 years; mostly women (75.2%)) from 163 NHs in France were analysed. Adjusted logistic and linear regressions were performed to examine whether the presence of a professional exercise instructor in the NH was associated with exercise habits: exercise participation, frequency, duration, and levels. From the 5402 participants, 1914 were participating in exercise classes provided in the NH. Most of them had an exercise frequency of 1x/week or less. Median duration of exercise sessions was 45 min. Exercise levels were rated as: highly active (n = 487), intermediately active (n = 1096), and poorly active (n = 331). The presence of a professional exercise instructor working in the facility was significantly associated with exercise participation and with higher exercise frequencies and levels, and session duration. In conclusion, the presence of professional exercise instructors is associated with better exercise habits in NH residents. Improved exercise habits may potentially be translated into better health in this population.
    Journal of Sports Sciences 07/2014; 33(2):1-9. DOI:10.1080/02640414.2014.928828 · 2.25 Impact Factor
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    • "To date, exercise is the interventional modality that has most consistently shown benefit in treating frailty and its key components.85–88 Exercise has physiologic impacts on almost all organ systems, particularly musculoskeletal, endocrine, and immune systems. "
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    ABSTRACT: Frailty is a common and important geriatric syndrome characterized by age-associated declines in physiologic reserve and function across multiorgan systems, leading to increased vulnerability for adverse health outcomes. Two major frailty models have been described in the literature. The frailty phenotype defines frailty as a distinct clinical syndrome meeting three or more of five phenotypic criteria: weakness, slowness, low level of physical activity, self-reported exhaustion, and unintentional weight loss. The frailty index defines frailty as cumulative deficits identified in a comprehensive geriatric assessment. Significant progress has recently been made in understanding the pathogenesis of frailty. Chronic inflammation is likely a key pathophysiologic process that contributes to the frailty syndrome directly and indirectly through other intermediate physiologic systems, such as the musculoskeletal, endocrine, and hematologic systems. The complex multifactorial etiologies of frailty also include obesity and specific diseases. Major clinical applications include risk assessment and stratification. This can be applied to the elderly population in the community and in a variety of care settings. Frailty may also be useful for risk assessment in surgical patients and those with cardiovascular diseases, cancer, or human immunodeficiency virus infection, as well as for assessment of vaccine effectiveness in older adults. Currently, exercise and comprehensive geriatric interdisciplinary assessment and treatment are key interventions for frailty. As understanding of the biologic basis and complexity of frailty further improves, more effective and targeted interventional strategies and innovative geriatric-care models will likely be developed.
    Clinical Interventions in Aging 03/2014; 9:433-441. DOI:10.2147/CIA.S45300 · 2.08 Impact Factor
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    • "[19,20]. Structured RAC interventions have demonstrated success in functional outcomes [21] and falls [22], but apart from large scale model change, actual reductions in hospitalisations are not yet proven. "
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    ABSTRACT: For residents of long term care, hospitalisations can cause distress and disruption, and often result in further medical complications. Multi-disciplinary team interventions have been shown to improve the health of Residential Aged Care (RAC) residents, decreasing the need for acute hospitalisation, yet there are few randomised controlled trials of these complex interventions. This paper describes a randomised controlled trial of a structured multi-disciplinary team and gerontology nurse specialist (GNS) intervention aiming to reduce residents’ avoidable hospitalisations. This Aged Residential Care Healthcare Utilisation Study (ARCHUS) is a cluster- randomised controlled trial (n = 1700 residents) of a complex multi-disciplinary team intervention in long-term care facilities. Eligible facilities certified for residential care were selected from those identified as at moderate or higher risk of resident potentially avoidable hospitalisations by statistical modelling. The facilities were all located in the Auckland region, New Zealand and were stratified by District Health Board (DHB). The intervention provided a structured GNS intervention including a baseline facility needs assessment, quality indicator benchmarking, a staff education programme and care coordination. Alongside this, three multi-disciplinary team (MDT) meetings were held involving a geriatrician, facility GP, pharmacist, GNS and senior nursing staff. Hospitalisations are recorded from routinely-collected acute admissions during the 9-month intervention period followed by a 5-month follow-up period. ICD diagnosis codes are used in a pre-specified definition of potentially reducible admissions. This randomised-controlled trial will evaluate a complex intervention to increase early identification and intervention to improve the health of residents of long term care. The results of this trial are expected in early 2013. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN 12611000187943
    BMC Geriatrics 09/2012; 12(1):54. DOI:10.1186/1471-2318-12-54 · 1.68 Impact Factor
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