Geriatric rehabilitation for patients with advanced COPD: programme characteristics and case studies

Abstract

Considering the worldwide ageing of populations, there is a growing need for rehabilitation programmes specifically designed for geriatric patients. The authors developed and implemented a post-acute geriatric rehabilitation programme in a skilled nursing facility for patients with advanced chronic obstructive pulmonary disease (COPD)-the GR-COPD programme. This paper describes the characteristics of the programme and presents three case studies to illustrate its possible benefits for individual patients. The case studies show that integration of rehabilitation and palliative care components is essential, as patients with advanced COPD admitted to hospital for an acute exacerbation often suffer from high symptom burden, deteriorating quality of life, and poor prognosis. Development and implementation of a post-acute GR-COPD programme is feasible and can offer substantial benefits for patients with advanced COPD admitted to hospital for an acute exacerbation.

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

“…dyspnoea severity, exercise tolerance, frailty) affect pulmonary rehabilitation outcomes. 10,58,59 Four qualitative studies explored experiences of, and reasons for (non-)participation in, exercise-based interventions (primarily pulmonary rehabilitation [60][61][62][63] ). One case series described three peoples' journeys through geriatric rehabilitation.…”

“…Authors noted how this population frequently present with lower levels of function and health, and higher levels of dyspnoea, distress relating to dyspnoea, disability, and comorbidities, 10,19,21,48,[59][60][61][62][63][64][65][66][67][68]73,74 including comorbid psychiatric illness and cognitive dysfunction. 56,61 This was further complicated by their risk of significant health events or deterioration during exercise-based interventions.…”

“…10,19,21,61,64,68 People's health influenced how they saw themselves and services, contributing to feelings of shame 60 or losses of control. 62,63,66 Participants reported feeling too unwell or too frail to participate in exercise, 60,61,63,65 especially in the context of other comorbidities. 60,63 Our service user and professional stakeholders also felt social isolation was important, acting as both a barrier to, and facilitator of, participation.…”

Geriatric rehabilitation for patients with advanced chronic obstructive pulmonary disease

“…A detailed description of the program has recently been published. 14 The GR-COPD program contains several modules concerning different aspects of rehabilitation and palliative care: optimizing pulmonary medication use and inhalation techniques, support smoking cessation, adequate symptom control, physiotherapy (endurance and strength training, inspiratory muscle training, relaxation techniques, breathing regulation skills and mucus evacuation techniques), occupational therapy, analysis of nutritional status and dietary supplementation, analysis of speech, breathing and swallowing techniques, psychosocial intervention (mostly aimed at depression, anxiety or adverse coping strategies), education focusing on self-management strategies, peer support contact and advance care planning. Goal setting is tailored to the individual patient and the program is weekly evaluated and adjusted (as needed) by the multidisciplinary team and the pulmonologist who makes monthly visits to all patients.…”

“…13 Considering these facts, our group developed and implemented a postacute GR program for patients with advanced COPD (the GR-COPD program). 14 Aim of the present study is to investigate feasibility of the program and to present clinical data on patient characteristics and courses of functional capacity and health status.…”