Post-discharge rehabilitation interventions for older adults with cognitive impairment following a hip fracture
The objective of this research project was to find evidence of effective community, including home-based, rehabilitation interventions for older adults with cognitive impairment (CI) following a hip fracture.
Findings: After analysis, three RCTs with 563 participants were included. Significant improvements in activities of daily living and mobility were reported in two studies for those with CI. All three interventions began during inpatient hospitalization, followed by discharge planning, and physiotherapist visits at home. All three interventions varied in length and components (i.e. only one included nurse home visits). All studies were conducted outside of North America. From the studies, no intervention was specifically designed for people with CI and none of the studies evaluated cost-effectiveness. The results of the review suggest promising results to improve physical function, mobility and ADLs within 1-year of participating in community-based rehabilitation interventions post hospital discharge from inpatient care for older adults with CI. Review results also showed an increased likelihood of returning home for a short (3-month) period post-discharge.
The project led us to suggest that interventions in this realm should: (1) start early in the trajectory of care while the patient is in inpatient rehabilitation and pre-emptively include discharge planning discussions; (2) be designed with the inclusion of physiotherapy to address the physical components of rehabilitation; and (3) be executed by an interdisciplinary team to provide multifaceted care that continues into the community setting.
Impact of findings: Critical gaps were identified from our review which will inform the development of a multifaceted outpatient community-based rehabilitation program for older adults with cognitive impairment. Future rehabilitation interventions should be focused and tailored to those with CI and include a cost analysis.
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About the Project
Each year in Canada, many seniors experience a hip fracture complicated by the presence of CI such as delirium or dementia. Following inpatient rehabilitation, the maintenance of functional gains among persons with CI is of utmost importance.
A structured rehabilitation plan provided to patients post-discharge that includes effective community- and home-based interventions informed by evidence-based best practice will ensure that this population remains independent in the community and will reduce the burden on both caregivers and the health care system.
For more details on the project rationale, objectives and research plan, click here.
Katherine McGilton, PhD, RN -- Toronto Rehabilitation Institute, University Health Network
Paula van Wyk, PhD -- University of Windsor
Dina Brooks, PhD, PT -- University of Toronto
Martine Puts, PhD, RN -- University of Toronto
Knowledge Users and Partners:
Lauren Beaupre, PhD -- Canadian Bone and Joint Network
John Flannery, MD, BSc -- Toronto Rehabilitation Institute, University Health Network
Margaret Keatings -- retired Chief Nursing Officer, caregiver
Charissa Levy, MHSc, BSc -- GTA Rehabilitation Network
Rhona McGlasson, PT, MBA -- Canadian Bone and Joint Network
Project Contact: Paula van Wyk -- firstname.lastname@example.org