Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1718 (Published 20 April 2010) Cite this as: BMJ 2010;340:c1718
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It is no surprise that specifically designed
rehabilitation can improve the outcomes including quality of
life in elderly patients. Whilst inpatient admission
generally increases the risk of functional decline and care
home placements in the elderly, well designed programmes can
reduce care home placements, thereby also reducing long term
costs.
Besides the ones covered by Bachmann et
al1, there are a few
other psychosocial factors that play a significant part in
recovery and subsequent rehabilitation. It is commonly known
that the prevalence of depression is higher in the elderly
with chronic physical illnesses and amongst inpatients. Many
a times it is rationalised as inevitable and often unnoticed
and untreated. Depression is associated with increased
morbidity in post stroke patients 2 and post myocardial infarction patients
3. Although it can
prolong inpatient admission, contrary to common belief,
presence of depression or mild-moderate cognitive impairment
does not reduce the benefit of rehabilitation in hip
fractures4. Social isolation
can be due to living alone, loss of family members, poverty,
lack of social integration and also as a consequence of
physical health problems. Social isolation can lead to
apathy and amotivation, resulting in depression and or delay
in recovery from physical health problems5. There is a growing incidence of alcohol and illicit
substance misuse in elderly.
Increasing awareness of the above risk
factors amongst the rehabilitation teams and close liaison
with psychiatric services will favourably improve the
outcomes further. More work is needed to look into the cost
effectiveness of the rehabilitation programmes.
References:1. Stefan Bachmann, Christoph
Finger, Anke Huss, Matthias Egger, Andreas
E Stuck and Kerri M Clough-Gorr. Inpatient rehabilitation
specifically designed for geriatric patients: systematic
review and meta-analysis of randomised controlled
trials. BMJ 2010;340:c1718
2. Gump BB, Matthews KA, Eberly LE, Chang YF
and MRFIT Research Group. Depressive Symptoms and Mortality
in Men Results From the Multiple Risk Factor Intervention
Trial (MRFIT). Stroke 2005;36;98-102.
3. Blanchette CM, Simoni-Wastila L, Shaya FT,
Orwig D, Noel J and Stuart .. Depression following
thrombotic cardiovascular events in elderly medicare
beneficiaries: risk of morbidity and mortality. Cardiol Res
Pract. 2009;2009:194528.
4. Eric J. Lenze, Elizabeth R.
Skidmore, Mary Amanda Dew, Meryl A. Butters, Joan C.
Rogers, Amy Begley, Charles F. Reynolds and Michael C.
Munin. Does depression, apathy, or cognitive impairment
reduce the benefit of inpatient rehabilitation facilities
for elderly hip fracture patients? Gen Hosp
Psychiatry. 2007 ; 29(2): 141–146.
5. Erin York Cornwell and Linda J. Waite;
Social Disconnectedness, Perceived Isolation, and Health
among Older Adults Journal of Health and Social Behavior,
(2009) Vol. 50, No. 1, 31-48.
Competing interests:
None declared
Competing interests: No competing interests
Correction of description of Naglie et al. (2002) study intervention
Table 2 of the systematic review relating to orthopaedic geriatric
rehabilitation incorrectly states that the Naglie et al. (2002) study
intervention did not include team meetings for goal setting. The methods
section of the Naglie et al. paper states that the staff on the
interdisciplinary intervention unit "held twice-weekly rounds to develop
and monitor treatment plans". These meetings of the multidisciplinary
team included the setting and monitoring of patient goals.
Competing interests:
None declared
Competing interests: No competing interests