BackgroundThe purpose of this study was to evaluate outcomes for older persons post-hip fracture repair, including those with cognitive impairment (CI), following implementation of a novel model of care – the Patient-Centered Rehabilitation Model including persons with CI (PCRM-CI). The PCRM-CI is an interdisciplinary rehabilitation program that incorporates education for healthcare professionals (HCPs), including nurses, which is focused on geriatric care including management of dementia and delirium, support for HCPs from an Advanced Practice Nurse, and family support and education. Primary outcome measures were mobility gain from admission to discharge and whether or not patients returned home post-discharge.MethodsThe PCRM-CI intervention was evaluated using a quasi-experimental design, following implementation in two community hospital inpatient rehabilitation units. One hundred forty-nine patients aged 65 and older participated as patients in the usual care (76) or PCRM-CI intervention (73) groups. Patient mobility was assessed at admission and discharge by the Functional Independence Measure Motor Subscale (FIMM); the difference in mobility scores was defined as mobility gain. Patient discharge location was also captured to determine whether or not patients returned home from inpatient rehabilitation.ResultsNo difference in mobility gain was found between the usual care and PCRM-CI groups as measured by the FIMM. Patients in the intervention group were more likely to return home post-discharge than those in the usual care group (p = 0.02).ConclusionsResults of the PCRM-CI evaluation suggest that older adults with CI can successfully be rehabilitated post-hip fracture repair using this novel, interdisciplinary rehabilitation program.Trial registrationThis trial has been registered with the US National Institutes of Health (ID: NCT01566136)

Objectives To determine the contribution of cognitive impairment, prefracture functional impairment, and treatment as predictors of functional status and mobility 6 months after discharge from rehabilitation for older adults with hip fracture. Design Longitudinal. Setting Inpatient rehabilitation units of two community hospitals. Participants Adults with hip fractures aged 65 and older who were discharged from a rehabilitation unit and had been living in the community before the fracture (N = 133). Measurements Mini‐Mental State Examination ( MMSE ) score at discharge from rehabilitation was used to identify the presence and severity of cognitive impairment. Outcomes were measured using questions from two subscales of the Functional Independence Measure (Self‐Care Function and Functional Mobility) and the New Mobility Scale ( NMS ). Measurements were made at discharge from a rehabilitation setting and 3 and 6 months after discharge. Results Prefracture functional impairment was associated with worse outcomes throughout the 6 months after discharge and with lower rates of improvement, or in some cases decline, after discharge. Cognitive impairment was associated with worse outcomes throughout the 6 months after discharge but was only weakly associated with lower rates of improvement or decline. The Patient Centered Rehabilitation Model of care targeting persons with cognitive impairment ( PCRM ‐ CI ) intervention group had higher NMS scores after discharge than a usual care group. Conclusion Although cognitive impairment and prefracture functional impairment contribute to poor outcomes, prefracture functional impairment was more strongly associated with poor outcomes than cognitive impairment. There is evidence to show that individuals with cognitive impairment are able to regain their mobility, which suggests a need for postdischarge targeted interventions that include a focus on activities of daily living for older adults with cognitive impairment and functional impairment to stabilize gains from inpatient rehabilitation.

Social network capital reduced the chances of smoking relapse. Smoking cessation programs might aim to increase network diversity so as to prevent relapse.

BackgroundResearch has shown network social capital associated with a range of health behaviours and conditions. Little is known about what social capital inequalities in health represent, and which social factors contribute to such inequalities.MethodsData come from the Montreal Neighbourhood Networks and Healthy Aging Study (n=2707). A position generator was used to collect network data on social capital. Health outcomes included self-reported health (SRH), physical inactivity, and hypertension. Social capital inequalities in low SRH, physical inactivity, and hypertension were decomposed into demographic, socioeconomic, network and psychosocial determinants. The percentage contributions of each in explaining health disparities were calculated.ResultsAcross the three outcomes, higher educational attainment contributed most consistently to explaining social capital inequalities in low SRH (% C=30.8%), physical inactivity (15.9%), and hypertension (51.2%). Social isolation, contributed to physical inactivity (11.7%) and hypertension (18.2%). Sense of control (24.9%) and perceived cohesion (11.5%) contributed to low SRH. Age reduced or increased social capital inequalities in hypertension depending on the age category.ConclusionsInterventions that include strategies to reduce socioeconomic inequalities and increase actual and perceived social connectivity may be most successful in reducing social capital inequalities in health.