Rehabilitation for the frail elderly: models of care and quality indicators (Final Results of CFN Knowledge Synthesis Grant)

20 minutes a day, once a week. It is barely enough time to get many a long term care (LTC) resident up and moving around, yet that is the average time now allotted for individualized physiotherapy (PT) in LTC. PT can maintain or restore function in LTC residents, yet a cost-effective model of delivery remains elusive. In 2013, there were funding cuts to rehabilitation in LTC in Ontario, and an environmental scan revealed that access to individualized exercise and rehabilitation has been severely limited and replaced with generic group exercise programs that are not suitable for frail elderly adults with complex needs. There were calls for guidance on evolving models of care in the face of budget shortages, and quality indicators (QIs) to help advocate for resources for the seriously ill elderly in LTC. Dr. Lora Giangregorio and Caitlin McArthur of the University of Waterloo discussed the results of a scoping review describing the types of rehabilitation interventions evaluated in LTC, the outcomes used to evaluate the interventions, and tools or models used to guide allocation of services. The results of an associated consensus process to determine which current quality indicators could be used to evaluate physical rehabilitation in long-term care was also discussed. The results of this project will not only provide clinicians and policy-makers with knowledge on how to evaluate the impact and quality of rehabilitation services in LTC (e.g. what QIs to use), but also identify the gaps in knowledge and identify areas for future research for rehabilitation for the frail elderly.

CFN believes that caring for the frail elderly is a complex, Canada-wide issue that requires multi-faceted, national strategies and solutions, and our monthly webinars are one way we bring together talented people to focus on this goal.

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Dr. Lora Giangregorio is an Associate Professor in the Department of Kinesiology at the University of Waterloo. She is also an adjunct scientist at the University Health Network: Toronto Rehabilitation Institute. Her research focuses on reducing the burden of osteoporotic fractures in high-risk individuals through use of medical imaging technologies that evaluate bone and muscle size/density in response to intervention after neurologic injury, evaluating new methods for image analysis, and conducting epidemiologic studies that inform fracture risk assessment algorithms.

Ms. Caitlin McArthur is a PhD Candidate in the Department of Kinesiology at the University of Waterloo. She is a registered physiotherapist with clientele of mostly individuals 65+ years old. Her Research focuses to improve mobility and quality of life of clinically complex, frail older adults across continuum of care by exploring aspects of physical rehabilitation including fall prevention strategies, targeted exercise programs and interventions to improve lifestyle physical activity.