Access to rehabilitation services for older adults living with dementia or in a residential aged care facility following a hip fracture: healthcare professionals’ views

Mitchell, Robert J.; Pulido, Diana Fajardo; Ryder, Tayhla; Norton, Grace; Brodaty, Henry; Draper, Brian; Close, Jacqueline C.T.; Rapport, Frances; Lystad, Reidar P.; Harris, Ian; Harvey, Lara; Sherrington, Catherine; Cameron, Ian D.; Braithwaite, Jeffrey

doi:10.1080/09638288.2019.1643418

Cited by 16 publications

(31 citation statements)

References 36 publications

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“…A collaborative work environment where staff shared approaches on best practices for specific patients with CI helped to positively influence staff’s attitudes and practices. This is in direct contrast to work by other clinicians who felt skeptical about the capacity of people with CI to participate in rehabilitation programs ( Cations et al, 2019 ; Mitchell et al, 2019 ). However, it takes creativity, ingenuity, and passion for rehabilitating persons with CI, as well as a supportive care partner to make the transition home a smooth one.…”

Section: Discussioncontrasting

confidence: 58%

“…The exploration was framed to capture the knowledge, skills, attitudes, and supports required to rehabilitate persons with CI following a hip fracture. Unlike earlier work (Cations et al, 2019;Mitchell et al, 2019), clinicians felt fulfilled working with this vulnerable population and took great pride in seeing patients return home. They were satisfied with their professional lives, as they were able to achieve profound improvements in functioning for persons with CI, despite how they first appeared on admission.…”

Section: Discussionmentioning

confidence: 90%

“…Some clinicians do not perceive that rehabilitation of persons with CI is relevant, which makes accessing rehabilitation unattainable. Researchers examining perspectives of clinicians concerning access ( Cations et al, 2019 ; Isbel & Jamieson, 2017 ; McFarlane et al, 2017 ; Mitchell et al, 2019 ) suggest that some clinicians did not see rehabilitation as appropriate for persons with CI because of their lack of capacity to participate in rehabilitation for reasons including poor insight into their own cognitive disabilities and inability to follow directions. Additional concerns have been discussed, such as uncertainty about the appropriate length of rehabilitation programs, the lack of resources to rehabilitate ( McFarlane et al, 2017 ), and a lack of evidence on standard interventions that can guide therapists, when rehabilitating persons with dementia ( Hall et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

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Healthcare professionals’ perspectives on rehabilitating persons with cognitive impairment

et al. 2020

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Background and Objectives Despite emerging evidence that persons with cognitive impairment (CI) (including dementia and/or delirium) can be rehabilitated post-hip fracture surgery, there still remains a paucity of research on best practice rehabilitation strategies that help healthcare providers effectively rehabilitate persons with CI. Therefore, this qualitative study explores healthcare professionals’ (HCPs) perspectives who have been successfully providing rehabilitation for people with CI. Research Design and Methods Sixteen HCPs with a specialty in rehabilitating persons with CI from one inpatient rehabilitation facility with various professional backgrounds were purposively sampled using a maximum diversity sampling strategy. Three focus group discussions were conducted to explore their experiences of providing rehabilitation to persons with CI. A hybrid inductive–deductive approach was used to analyze the data. Findings HCPs acknowledged that older adults with CI deserved the opportunity for inpatient rehabilitation and that good outcomes were achievable; however, their knowledge, skills, and attitudes required reframing. The analysis identified three essential components to rehabilitation: (1) staff education and support, (2) tailored rehabilitation approaches, and (3) care partner involvement and support. Discussion and Implications Rehabilitation of persons with CI post-hip fracture surgery is achievable, and HCPs can learn to modify their practices to achieve positive patient outcomes. The attitudes of the healthcare team members had to be shifted to embrace the belief that persons with CI can be rehabilitated. However, it takes a steep learning curve, creativity, ingenuity, and tailored approaches to rehabilitate persons with CI successfully. This involves knowing the individual, maintaining routines, and learning the best ways to engage and motivate the person. As well, care partners’ knowledge and understanding of the individual improved the chances of a successful rehabilitation stay and discharge. Essential to the success of rehabilitation of persons with CI includes a supportive management team to help create the processes to enable their staff to succeed.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Healthcare professionals’ perspectives on rehabilitating persons with cognitive impairment

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“…However, several studies have demonstrated that people with dementia can benefit from rehabilitation similarly to people without dementia [17][18][19][20], especially with the assistance of technology [21,22]. Achieving these similar outcomes does necessitate greater resource use, and health professionals cite this as one reason for their reluctance to refer or accept people with dementia for rehabilitation [16,23]. In addition, whether rehabilitative and palliative approaches to care can coexist remains an active matter of debate [16,[24][25][26].…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation for people with dementia: a multi-method study examining knowledge and attitudes

et al. 2020

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Background People with dementia are not routinely offered rehabilitation services despite experiencing disability associated with the condition and accumulating evidence for therapies such as exercise, occupational therapy, and cognitive or physical rehabilitation. It is important to understand the needs and preferences of people with dementia regarding rehabilitation services. The aim of this study was to explore thoughts and beliefs about rehabilitation amongst people with dementia and their families. Methods Interviews with people with dementia and family members regarding their experience of care following diagnosis and their attitudes and beliefs about rehabilitation for dementia. Surveys with older people with cognitive impairment and/or a diagnosis of dementia to determine preferences for services and understanding of rehabilitation programs. Results Interviews with 13 participants (n = 6 people living with dementia with mean age 60 and n = 7 care partners) revealed gaps in care post diagnosis. People reported having to seek out services and frequently sought out services which were rehabilitative in nature. Survey data (n = 91 participants, average age 82) showed that most people had heard of rehabilitation (92%) or had experience of rehabilitation (49%) at some point. There was a wide range of services identified as being beneficial. Rehabilitative interventions including case management, exercise and memory strategies were considered desirable. Conclusions People with dementia report having a wide variety of needs. There are gaps following diagnosis where people with dementia report having to seek out their own services. Some interview participants (who tended to be younger) clearly articulated the need for tailored interventions which maximised independence and quality of life. Survey participants, who were on average older, reported that they would participate in individually applicable rehabilitative therapies if they were available.

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“…Providing rehabilitative care is critical to the quality of life for older adults post hip fracture as it improves recovery, including those with CI (2). However, there are very few rehabilitation facilities that provide care for older adults with CI as there remains an assumption that this population cannot be rehabilitated (3,4) despite evidence that contradicts this myth (5)(6)(7). Of the patient centred rehabilitation models that exist, there is a lack of speci c strategies for implementing these models into other contexts especially when often the majority of the clinicians do not necessarily believe this population can be rehabilitated (3,8).…”

Section: Introductionmentioning

confidence: 99%

Context Matters: Using A Case Study Approach to Understand Implementing A Patient Centred Rehabilitation Model for Persons With Cognitive Impairment

McGilton

Cumal

Corsi³

et al. 2020

Preprint

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Background: There is a growing number of older adults with cognitive impairment (CI) that require inpatient rehabilitation. Patient centred rehabilitation models exist, yet there is a lack of specific strategies for implementing these models into other contexts. Researchers collaborated with administrators and staff in one rural site to adapt a patient centred rehabilitation model of care in the Canadian province of Ontario. This paper reports on the contextual factors that influenced the implementation of the model of care.Methods: The study takes a case study approach. One rural facility was purposefully selected for its interest in offering rehabilitation to persons with CI. Four focus group discussions were conducted to explore healthcare professionals’ perceptions on the contextual factors that could affect the implementation of the rehabilitation model of care in this facility. Twenty-seven professionals with various backgrounds were purposively sampled using a maximum diversity sampling strategy. A hybrid inductive-deductive approach was used to analyze the data using the Context and Implementation of Complex Interventions (CICI) Framework. Results: Across the domains of the CICI framework, three domains (political, epidemiological, and geographical) and seven corresponding sub-domains were found to have a major influence on the implementation process. Key elements within the political domain included effective teamwork, facilitation, adequate resources, effective communication strategies, and a vision for change. Within the epidemiological domain, a key element was knowing how to tailor rehabilitation approaches for persons with CI. Infrastructure was a key aspect of the geographical domain, which was focused on the facility’s physical layout.Conclusions: The study identified key factors within the context that supported and hindered the implementation of the model of care in a new environment. This work suggests that when implementing a new program of care, strong consideration should be paid to the political, epidemiological, and geographical domains of the context and how these aspects interact and influence one another. The CICI Framework was a useful guide to understand which elements existed and which were still required for successful implementation of the model of care.

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Access to rehabilitation services for older adults living with dementia or in a residential aged care facility following a hip fracture: healthcare professionals’ views

Cited by 16 publications

References 36 publications

Healthcare professionals’ perspectives on rehabilitating persons with cognitive impairment

Healthcare professionals’ perspectives on rehabilitating persons with cognitive impairment

Rehabilitation for people with dementia: a multi-method study examining knowledge and attitudes

Context Matters: Using A Case Study Approach to Understand Implementing A Patient Centred Rehabilitation Model for Persons With Cognitive Impairment

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