State of the art in geriatric rehabilitation. Part II: Clinical challenges

doi:10.1016/S0003-9993(02)04930-4

Archives of Physical Medicine and Rehabilitation

Volume 84, Issue 6, June 2003, Pages 898-903

https://doi.org/10.1016/S0003-9993(02)04930-4 Get rights and content

Abstract

Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in geriatric rehabilitation. Part II: Clinical challenges. Arch Phys Med Rehabit 2003;84:898-903.

Objectives:

To examine common clinical problems in geriatric rehabilitation and to make recommendations for current practice based on evidence from the literature.

Data Sources:

A CINAHL database and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search was completed by using the Cochrane database.

Study Selection:

One author reviewed the references for relevance and another for quality. A total of 336 articles were considered relevant. Excluded articles were unrelated to geriatric rehabilitation or were anecdotal or descriptive reports on a small number of patients.

Data Extraction:

The following areas were the major geriatric rehabilitation subtopics identified in the search: frailty, comprehensive geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. This article focuses on the latter 5 subtopics. The literature was reviewed by using a level-of-evidence framework. Level 1 evidence was a randomized controlled trial (RCT) or meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts, descriptive studies, or reports of expert committees.

Data Synthesis:

Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic according to the level of evidence in the specific area. In cases in which several articles were written on a topic with similar conclusions, we selected the articles with the strongest level of evidence, thereby reducing the total number of references.

Conclusions:

Frail older patients with hip fracture should receive geriatric rehabilitation. They should also be screened for nutrition, cognition, and depression. Older persons should receive nutritional supplementation when malnourished. If severe dysphagia occurs in stroke patients, gastrostomy tube feeding is superior to nasogastric tube feeding.

Section snippets

Methods

A comprehensive review of the literature in geriatric rehabilitation for 1980 to 2001 was completed by using the MEDLINE, CINAHL, and Cochrane databases. For a complete review of the methodology, refer to “State of the Art in Geriatric Rehabilitation. Part I: Review of Frailty and Comprehensive Geriatric Assessment.”1

Conclusion

Maintaining and restoring the health and independence of the growing senior population in a cost-efficient manner is important. Geriatric rehabilitation will be increasingly considered in the planning of health care services in coming years. Geriatric rehabilitation is an emerging area in health care, and some issues of caring for seniors in this rehabilitation setting are not well understood. There are differences between the rehabilitation of younger adults and that of frail older adults. The

Acknowledgements

We thank Karen Cory for assistance with the literature searches.

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^☆: Supported by the Ontario Ministry of Health and Long-Term Care and the Ontario Neurotrauma Foundation.

¹: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

View full text

Review articleState of the art in geriatric rehabilitation. Part II: Clinical challenges1☆,

Abstract

Objectives:

Data Sources:

Study Selection:

Data Extraction:

Data Synthesis:

Conclusions:

Section snippets

Methods

Conclusion

Acknowledgements

Arch Phys Med Rehabil

Am J Clin Nutr

Lancet

Clin Nutr

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Phys Med Rehabil Clin North Am

Arch Phys Med Rehabil

Arch Phys Med Rehabil

The impact and consequences of hip fracture in Ontario

Can J Surg

Comorbidity and adverse clinical events in the rehabilitation of older adults after hip fracture

J Am Geriatr Soc

Mortality, independence in living and re-fracture1 year following hip fracture in Canadians

Soc Obstet Gynecol J

Rate of mortality for elderly patients after fracture of the hip in the 1980’s

J Bone Joint Surg Am

Decline in physical function following hip fracture

J Am Geriatr Soc

The beneficial effects of joint orthopedic-geriatric rehabilitation

Age Ageing

Effectiveness of geriatric rehabilitative care after fractures of the proximal femur in elderly womena randomized clinical trial

BMJ

The care of elderly patients with hip fracture

N Engl J Med

Geriatric rehabilitationstate of the art

J Am Geriatr Soc

Early inpatient rehabilitation after elective hip and knee arthroplasty

JAMA

Feasibility of day-hospital rehabilitation program early post-discharge after hip fractures

Ann CRMCC

Geriatric rehabilitation following fractures in older peoplea systematic review

Health Technol Assess

Post-stroke rehabilitationa review of the guidelines for patient management

Geriatrics

Collaborative systematic review of the randomized trials of organized inpatient (stroke unit) care after stroke

BMJ

Stroke unit treatmentlong-term effects

Stroke

Stroke inpatient rehabilitationa comparison across age groups

J Am Geriatr Soc

Predictors of favorable outcome in elderly stroke patients 2 years after discharge from geriatric rehabilitation

Z Gerontol Geriatr

Outcome predictors and the effectiveness of stroke rehabilitation

Phys Med Rehabil

Post-stroke rehabilitation

Clinical Practice Guideline No. 16. Rockville:US Dept of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research

Review article
State of the art in geriatric rehabilitation. Part II: Clinical challenges¹☆,