The factors that are related to functional recovery in this study shed light on the complexity of the recovery process in hip fracture patients. The rate of recovery in postsurgical PADL and IADL function is not constant over time; postsurgical IADL function among disoriented patients (without dementia) continues to deteriorate over time compared with the nondisoriented group; this difference in trends of deterioration on IADL function is most profound in the oldest-old aged group, those 85 and older. The types of surgical procedure performed was not significantly associated with postsurgical functional recovery.
It is not uncommon for studies examining factors associated with functional recovery 1 year after hip fracture to be presented from the perspective of clinicians or researchers. Few studies have examined factors that facilitate functional recovery from the patient's perspective. This article discusses community‐dwelling older adults age 65 and older who sustained a hip fracture and received surgical repair and postacute rehabilitation. Data were collected 1 year after postacute rehabilitation. Content analysis was used for the descriptive study. Participants reported that rehabilitation services greatly facilitated their recovery. Participants also recognized the importance of their own motivation, and noted it was essential to maintain a positive attitude and fully engage in recommended rehabilitation activities. The keys to functional recovery were active participation in rehabilitation and following instructions from care providers. In addition, self‐determination, a positive attitude, and social support played significant roles in making rehabilitation work.
In this study we measure the concurrent validity of administering FIM™ instrument ("FIM") by interview. Data from twenty-eight community-dwelling, cognitively intact, elderly patients with hip fracture were collected in five post-acute rehabilitation facilities. Within 72 hours of admission to (and at discharge from) the post-acute facilities, both a FIM-certified interviewer and a multidisciplinary team administered the FIM instrument to each participant concurrently. At admission, the mean FIM ratings assigned by the interviewer and by the team were 84.3 and 80.5, respectively (p<0.001). At discharge, the mean FIM ratings were 104.4 and 103.4 (p>0.50), reflecting the participants' functional recovery during post-acute rehabilitation. The intra-class correlation between the FIM ratings assigned by the interviewer and by the team was 0.74 (95% CI = 0.58-0.91) at admission and 0.76 (95% CI = 0.60-0.92) at discharge. FIM ratings assigned by FIM-certified interviewers are valid indicators of the functional status of groups of older people recovering from hip fracture, and feasible for longitudinal study.
Intervention strategies should monitor the first 6 mos after discharge from inpatient rehabilitation, during which the maximum level of functional improvement is expected. However, the individuals who have had a stroke had poor functional improvement at 1 yr (adjusted mean FIM score, 5.74) than those who have not had a stroke (adjusted mean FIM score, 6.56). The patients who have had a stroke required human supervision at 12 mos after rehabilitation. Therefore, long-term care needs should be monitored in the discharge plan.
Efficient and effective care depends on continuity of communication between nurses and physicians and adequate access to patients' medical history, laboratory results, and ECGs. The following operational strategies may help institutions reduce potentially preventable hospitalizations: ensure effective communication between nursing staff and physicians regarding patients' condition; provide physicians with easy access to stat laboratory results in less than 4 hours on weekends and adequate access to the patient's medical history, laboratory results, and ECGs; and motivate physicians to treat residents within the nursing home whenever possible.
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