Rehabilitation potential in older people living with frailty: a systematic mapping review

Abstract

Background Following periods of acute ill-health and injury, older people are frequently assessed and provided with rehabilitation services. Healthcare practitioners are required to make nuanced decisions about which patients are likely to benefit from and respond to rehabilitation. The clinical currency in which these decisions are transacted is through the term “rehabilitation potential”. The aim of this study was to explore information about rehabilitation potential in older people to inform the development of an evidence-based assessment tool. Methods A systematic mapping review was completed to describe the extent of research and the concepts underpinning rehabilitation potential. We searched Medline, CINHAL, EMBASE, AMED, PsycINFO, PEDro, Cochrane Library, Web of Science, ProQuest, Trip and EThOS from inception to December 2020. We included studies which focused on rehabilitation potential and/or assessing for rehabilitation interventions for older people with comorbidities in the hospital and community setting. Reviewer pairs independently screened articles and extracted data against the inclusion criteria. A descriptive narrative approach to analysis was taken. Results 13,484 papers were identified and 49 included in the review. Rehabilitation potential was found to encompass two different but interrelated concepts of prognostication and outcome measurement. 1. Rehabilitation potential for prognostication involved the prediction of what could be achieved in programmes of rehabilitation. 2. Rehabilitation potential as an outcome measure retrospectively considered what had been achieved as a result of rehabilitation interventions. Assessments of rehabilitation potential included key domains which were largely assessed by members of the multi-disciplinary team at single time points. Limited evidence was identified which specifically considered rehabilitation potential amongst older people living with frailty. Conclusions Current approaches to rehabilitation potential provide a snapshot of an individual’s abilities and conditions which fail to capture the dynamic nature and fluctuations associated with frailty and rehabilitation. New approaches to measures and abilities over time are required which allow for the prognostication of outcomes and potential benefits of rehabilitation interventions for older people living with frailty.

Frail Older People Ageing in Place in Italy: Use of Health Services and Relationship with General Practitioner

“…As reported by ISTAT [ 26 ], the presence of health problems and the loss of autonomy determine a growth in healthcare consumption, especially after the age of 75, with increasing recourse to MSs and hospital admission. Moreover, frail older people with functional limitations use rehabilitation interventions (as reported by our respondents), which Cowley and colleagues [ 62 ] describe as having a great potential for recovery, especially after periods of acute illness or hospitalization. In this regard, a review evaluating 51 articles on the topic [ 63 ] highlighted that after hospitalization, 11% of older patients aged 75 years and over, are referred to rehabilitation facilities.…”

A non-randomised feasibility study of the Rehabilitation Potential Assessment Tool (RePAT) in frail older people in the acute healthcare setting

“…Patient characteristics, that may inform predictions of rehabilitation potential [11], were identified from medical notes and electronic hospital records by the research team. These included: age, gender, ethnicity, residential and cohabitation status, co-morbidities, medications, cognition, frailty status, pre-admission mobility, ADL abilities and reasons for admission to acute care.…”

“…A recent systematic mapping review found [11] found that concepts of rehabilitation potential in older people could encompass prognostication (a prediction of what could be achieved with rehabilitation programmes) and outcome measurement (a retrospective understanding of what had been achieved) but that assessments tend to be based upon a snapshot of older people's abilities rather than taking account of the dynamic nature of frailty and rehabilitation practice. A qualitative focus group study found that rehabilitation potential assessments in the acute setting coalesced around three clinical questions -"will it work?…”

Rehabilitation potential: A critical review of its meaning and validity

“…7 A systematic review by the same group found the phrase, rehabilitation potential, encompassed ‘two different but interrelated concepts of prognostication and outcome measurement’. 8…”