Geriatric rehabilitation for patients with advanced chronic obstructive pulmonary disease

Abstract

In view of the worldwide aging population, disease-specific geriatric rehabilitation (GR) programs are needed. Therefore, we developed and implemented a postacute GR program for patients with advanced chronic obstructive pulmonary disease (COPD) (the GR-COPD program). The aim of this study is to investigate the feasibility of the GR-COPD program and to present clinical data on patient characteristics and course of functional capacity and health status. This is a naturalistic prospective cohort study of patients with advanced COPD. A total of 61 patients entered the GR-COPD program and were eligible to participate in this study. All patients suffered from advanced COPD, and comorbidities were frequent. On admission, functional capacity and health status were severely limited but showed significant and clinically relevant improvement during the GR-COPD program. Patients with advanced COPD admitted to hospital for an acute exacerbation suffer from severely impaired functional capacity and poor health status. Development and implementation of a postacute GR program for these patients are feasible and likely to offer substantial improvements. Further research is essential and should focus on designing a controlled intervention trial to investigate the efficacy of the program.

Effectiveness and implementation of palliative care interventions for patients with chronic obstructive pulmonary disease: A systematic review

“…The Kingdom (n = 4). Three RCTs, [28][29][30] two non-randomized controlled trials, [31][32][33] seven uncontrolled before-and-after studies, [34][35][36][37][38][39][40][41] six qualitative studies, [42][43][44][45][46][47] one non-comparative study, 48 and 10 pilot/feasibility studies 37,[49][50][51][52][53][54][55][56][57] were included. The study design of one article was unclear.…”

“…Their study and that of Aiken et al 28 found significant differences between the intervention and control group on specific subscales but not on the total scale. The uncontrolled study of Van Dam et al 40 reported an improvement on health-related quality of life; all other studies found no differences. 28,29,31,32,35,37 Breathlessness-In two RCTs evaluating holistic breathlessness services, 29,30 intervention patients showed higher levels of mastery of breathlessness, but only one study found a statistically significant difference.…”

“…[29][30][31]35,37,[55][56][57] Other health-related outcomes -Aiken et al found lower symptom distress in intervention patients at three months, but not at six months. 28 Further, positive effects were reported for the resumption of activities, 28 sleep quality, 32 functional capacity 40 and nutritional status. 40 Spiritual Well-being / Hope-In the study of Rabow et al, intervention patients reported higher overall spiritual well-being than control patients.…”

“…The emergency department appeared not to be a feasible recruitment setting for a home-based program, 51 but barriers were also encountered in the ambulatory setting 53 and during computerized screening. 33 Using a natural transition point to identify patients with palliative care needs proactively, such as hospitalization for an acute exacerbation, 31,35,40,52 has been recommended in previous research 61 and could possibly facilitate identification of patients. Further, palliative care can best be integrated within existing services to prevent duplication of assessments 52 and to guarantee continuity of care.…”

Functional decline in geriatric rehabilitation ward; is it ascribable to hospital acquired infection? A prospective cohort study

“…In some European countries, including France, older patients with functional decline in acute units are transferred to geriatric rehabilitation units [ 1 , 17 – 19 ] that are inpatient units specialized in the multidisciplinary rehabilitation of older frail patients with chronic diseases and geriatric syndromes [ 20 ]. A meta-analysis showed that these units may improve functional status and may limit nursing-home transfer and mortality [ 21 ].…”