Geriatric Rehabilitation as an Integral Part of Geriatric Medicine in the Nordic Countries

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: Firstly to outline the theoretical and practical framework for geriatric rehabilitation in Iceland and other Nordic countries and secondly to survey the scientific medical publications for evidence based geriatric rehabilitation. Methods: Brain storming on geriatric rehabilitation in a working group of Nordic teachers in geriatric medicine. Papers on scientific programs for geriatric rehabilitation from Internet sources were collected and analyzed. All articles describing randomized studies in geriatric rehabilitation were selected for overview. The papers were divided into four groups according to diseases, infirmity and resource settings; 1) stroke, 2) hip-fractures, 3) acute admissions and 4) programs conducted in nursing homes, day hospitals and home services. Results: A spectrum of biological and social events creates the conditions underlying most causes for illness and disability in old people. The process of established geriatric services promotes the efficiency of geriatric rehabilitation. The literature survey included 27 scientific studies (8586 patients) on randomized studies with valid endpoints. Geriatric rehabilitation programs for stroke patients in geriatric settings, six studies (1138 patients), reduced mortality and the need for nursing home placement but the outcome for ADL. Function and length of stay was more variable between the studies. The outcome of geriatric rehabilitation was even more decisive in the randomized hip-fracture studies, six studies (2171 patients). Eight studies were found comparing the outcome between acute admission of frail elderly to either geriatric (GEMU, GRU) or general medical wards. The outcome as regards to mortality rate at one year, placement to a nursing home, physical function, contentment with services, readmission rate and cost was all significantly better in the geriatric settings. Internal comparisons of geriatric programs in nursing homes, day hospitals and in home service, seven studies (1261 patient), revealed some differences in outcomes in function, contentment and costs. Conclusions: Specialized geriatric rehabilitation is complicated but effective when properly performed. Interdisciplinary teamwork, targeting of patients, comprehensive assessment and intensive and patient-targeted rehabilitation seem to characterize the most effective programs. Rehabilitation of frail elderly people poses a major challenge for the future and has to be developed further for the sake of quality of life of elderly people as well as for economic reasons.Markmið: Að gera úttekt á öldrunarendurhæfingu á Íslandi og öðrum Norðurlöndum, marka hinn hugmyndafræðilega grunn, tengja hann norrænum veruleika og taka saman vísindalegar niðurstöður um árangur öldrunarendurhæfingar. Aðferð: Hugarflugsfundir vinnuhóps kennara í öldrunarlækningum um öldrunarendurhæfingu. Sértæk leit í helstu læknatímarita á Medline í greinum sem fjalla um aðferðir og meðferðarleiðir endurhæfingar fyrir aldraða á vísindalegan hátt. Um er að ræða samantekt á rannsóknum sem notast við slembiúrtök og taka til elstu aldurshópa. Greinunum var skipt niður í fjóra flokka eftir sjúkdómum, færni og staðsetningu; 1) heilablóðfall, 2) mjaðmarbrot, 3) bráðveikir og hrumir, 4) prógrömm á hjúkrunarheimilum, dagspítölum og í heimaþjónustu. Niðurstöður: Lífeðlisfræðilegir og félagslegir þættir marka veikindaferli og fötlun aldraðra. Verklag öldrunarþjónustunnar skiptir miklu um árangur öldrunarendurhæfingar. Leit í 27 tímaritsgreinum náði til 8586 sjúklinga en þær báru saman slembiúrtök og höfðu haldbærar viðmiðanir. Endurhæfing aldraðra heilablóðfallssjúklinga á öldrunarlækningadeild, sex rannsóknir (1138 sjúklingar), dró úr dánarlíkum og minnkaði þörf fyrir stofnanavist en breyting á mælanlegri færni og legudagafjöldi varð ekki afgerandi hjá öllum. Enn betri árangur náðist við endurhæfingu eftir mjaðmarbrot, sex rannsóknir (2171 sjúklingur). Átta rannsóknir (4016 sjúklingar) báru saman árangur öldrunarlækningadeilda borið saman við almennar lyflæknisdeildir í meðhöndlun bráðveikra og hrumra sjúklinga. Niðurstöður voru flestar afgerandi betri á öldrunarlækningadeildum hvað varðar dánartíðni að ári, vistun á hjúkrunarheimili, líkamlega færni, ánægju, endurinnlagnir og kostnað. Innbyrðis samanburður á endurhæfingaraðferðum fyrir aldraða á hjúkrunarheimilum, dagspítölum og í heimaþjónustu, sjö rannsóknir (1261 sjúklingur), sýndu mun á nokkrum viðmiðunum í færniþáttum, ánægju og kostnaði. Ályktanir: Sérhæfð endurhæfing aldraðra er flókin en skilar árangri þegar rétt er á haldið. Bestur árangur næst með fjölfaglegri teymisvinnu, val á þeim sjúklingum sem mestu áhættuna hafa, alhliða öldrunarmati og virkri og einstaklingsmiðaðri endurhæfingu. Endurhæfing á hrumu gömlu fólki er og verður vaxandi viðfangsefni fyrir heilbrigðisþjónustuna og mikilvægt að hún nái því markmiði að auka lífsgæði aldraðs fólks. Benda rannsóknir einnig til að við það skapist einnig efnahagslegur ávinningur fyrir land og þjóð

Proposal of a service delivery integration index of home care for older persons: application in several European cities.

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldPURPOSE: To propose an integration index of home care delivery to older persons, to study its validity and to apply it to home care services of European cities. THEORY: Home care delivery integration was based on two dimensions referring to process-centred integration and organisational structure approach. METHOD: Items considered as part of both dimensions according to an expert consensus (face validity) were extracted from a standardised questionnaire used in "Aged in Home care" (AdHoc) study to capture basic characteristics of home care services. Their summation leads to a services' delivery integration index. This index was applied to AdHoc services. A factor analysis was computed in order to empirically test the validity of the theoretical constructs. The plot of the settings was performed. RESULTS: Application of the index ranks home care services in four groups according to their score. Factor analysis identifies a first factor which opposes working arrangement within service to organisational structure bringing together provisions for social care. A second factor corresponds to basic nursing care and therapies. Internal consistency for those three domains ranges from 0.78 to 0.93. When plotting the different settings different models of service delivery appear. CONCLUSION: The proposed index shows that behind a total score several models of care delivery are hidden. Comparison of service delivery integration should take into account this heterogeneity

Proposal of a service delivery integration index of home care for older persons : application in several European cities

Purpose: To propose an integration index of home care delivery to older persons, to study its validity and to apply it to home care services of European cities. Theory: Home care delivery integration was based on two dimensions referring to process-centred integration and organisational structure approach. Method: Items considered as part of both dimensions according to an expert consensus (face validity) were extracted from a standardised questionnaire used in ‘‘Aged in Home care’’ (AdHoc) study to capture basic characteristics of home care services. Their summation leads to a services’ delivery integration index. This index was applied to AdHoc services. A factor analysis was computed in order to empirically test the validity of the theoretical constructs. The plot of the settings was performed. Results: Application of the index ranks home care services in four groups according to their score. Factor analysis identifies a first factor which opposes working arrangement within service to organisational structure bringing together provisions for social care. A second factor corresponds to basic nursing care and therapies. Internal consistency for those three domains ranges from 0.78 to 0.93. When plotting the different settings different models of service delivery appear. Conclusion: The proposed index shows that behind a total score several models of care delivery are hidden. Comparison of service delivery integration should take into account this heterogeneity

Method for Assigning Priority Levels in Acute Care (MAPLe-AC) predicts outcomes of acute hospital care of older persons - a cross-national validation

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field.BACKGROUND: Although numerous risk factors for adverse outcomes for older persons after an acute hospital stay have been : identified, a decision making tool combining all available information in a clinically meaningful way would be helpful for daily hospital practice. The purpose of this study was to evaluate the ability of the Method for Assigning Priority Levels for Acute Care (MAPLe-AC) to predict adverse outcomes in acute care for older people and to assess its usability as a decision making tool for discharge planning. METHODS: Data from a prospective multicenter study in five Nordic acute care hospitals with information from admission to a one year follow-up of older acute care patients were compared with a prospective study of acute care patients from admission to discharge in eight hospitals in Canada. The interRAI Acute Care assessment instrument (v1.1) was used for data collection. Data were collected during the first 24 hours in hospital, including pre-morbid and admission information, and at day 7 or at discharge, whichever came first. Based on this information a crosswalk was developed from the original MAPLe algorithm for home care settings to acute care (MAPLe-AC). The sample included persons 75 years or older who were admitted to acute internal medical services in one hospital in each of the five Nordic countries (n = 763) or to acute hospital care either internal medical or combined medical-surgical services in eight hospitals in Ontario, Canada (n = 393). The outcome measures considered were discharge to home, discharge to institution or death. Outcomes in a 1-year follow-up in the Nordic hospitals were: living at home, living in an institution or death, and survival. Logistic regression with ROC curves and Cox regression analyses were used in the analyses. RESULTS: Low and mild priority levels of MAPLe-AC predicted discharge home and high and very high priority levels predicted adverse outcome at discharge both in the Nordic and Canadian data sets, and one-year outcomes in the Nordic data set. The predictive accuracy (AUC's) of MAPLe-AC's was higher for discharge outcome than one year outcome, and for discharge home in Canadian hospitals but for adverse outcome in Nordic hospitals. High and very high priority levels in MAPLe-AC were also predictive of days to death adjusted for diagnoses in survival models. CONCLUSION: MAPLe-AC is a valid algorithm based on risk factors that predict outcomes of acute hospital care. It could be a helpful tool for early discharge planning although further testing for active use in clinical practice is still needed.Reykjavik Hospital Research Fund St. Joseph's Research Fund, Iceland Norwegian Medical Society 2 Diakonhjemmet Hospital Diakonhjemmet University College Diakonhjemmet Research Fund, Norway Sweden's Lions Fund, Sweden Health Transition Fund Health Canada Canadian Institutes for Health Research (CIHR) Nordic Lions Red Feather Fund Nordic Council of Ministers Roikjer Fund, Denmark Finnish Lions Fund, Finland Icelandic Lions Fund Memorial Fund of Helgu Jensdottur and Sigurliða Kristjanssona