Views from health professionals on accessing rehabilitation for people with dementia following a hip fracture

Abstract

The literature reports that rehabilitation for elderly patients with mild-to-moderate dementia who have a hip fracture improves functional outcomes. However, access to rehabilitation may be difficult due to misconceptions about the ability of these patients to engage in and benefit from rehabilitation. Additionally, people who are admitted from residential care may not have the same options for rehabilitation as those admitted from home. This study sought to understand from expert clinicians how and why decisions are made to accept a person with dementia post-fracture for rehabilitation. In this Australian-based qualitative study, 12 health professionals across a state and territory were interviewed. These clinicians were the primary decision makers in accepting or rejecting elderly patients with dementia post-fracture into rehabilitation. Three key themes emerged from the data: criteria for accessing rehabilitation, what works well and challenges to rehabilitation. The participants were unanimous in the view that access to rehabilitation should be based on the ability of the patient to engage in a rehabilitation programme and not assessed solely on cognition. In terms of clinical care, a coherent rehabilitation pathway with integration of geriatric and ortho-geriatric services was reported as ideal. Challenges remain, importantly, the perception of some health care staff that people with dementia have limited capability to benefit from rehabilitation. Rehabilitation for this growing group of patients requires multiple resources, including skilled practitioners, integrated clinical systems and staff education regarding the capabilities of people with dementia. Future research in this area with patients with moderate-to-severe dementia in residential care is warranted.

Equipping staff with the skills to maximise recovery of people with dementia after an injurious fall

“…Despite unprecedented attention to dementia in the UK through the Prime Minister's Challenge on Dementia (Department of Health, 2015) and the National Dementia Strategy (Department of Health, 2009), there was still considerable evidence of negative attitudes towards, and a lack of understanding of, dementia among professionals who were not specifically trained in dementia. As with previous studies of hip fracture in dementia, the majority of the professional participants had not received any formal training in dementia care (Gill, et al, 2017;Isbel & Jamieson, 2016;Patel et al, 2016). Our findings demonstrate the diversity of staff knowledge and skills regarding working with people with dementia.…”

“…Similarly, while the principles of personcentred care have long been established in occupational therapy and physiotherapy (Bright, Boland, Rutherford, Kayes, & McPherson, 2012;Gzil et al, 2007;Mudge, Stretton, & Kayes, 2014), staff may nevertheless find working with people with dementia challenging, particularly those whose communication skills are impaired or who are perceived as 'disengaged' or 'non-compliant' (Bright, Kayes, Worrall, & McPherson, 2015). This reflects a lack of specific training in dementia (Gill et al, 2017;Isbel & Jamieson, 2016), and may result in inexperienced therapists 'writing off' people with dementia (Hall, Watkins, Lang, Endacott, & Goodwin, 2017). A focus on biomedical (rather than more holistic) assessments and targets, as well as a lack of space, equipment and time all contribute to negative attitudes towards people with dementia and therapeutic nihilism among staff (Hall, et al, 2017;Staples & Killian, 2012).…”

Health Professional Perspectives on Rehabilitation for People With Dementia

“…This is in contrast to post-diagnosis care following other degenerative neurological conditions (like multiple sclerosis) or acquired brain injuries (like stroke), for which rehabilitation is more accepted in the clinical pathway (Khan, Turner-Stokes, Ng, Kilpatrick, & Amatya, 2007). Additionally, people with dementia are sometimes excluded from rehabilitation programs for acute conditions including fracture (Isbel & Jamieson, 2016;Mitchell, Harvey, Brodaty, Draper, & Close, 2016) despite evidence that they benefit similarly to people without dementia (Cameron, Schaafsma, Wilson, Baker, & Buckley, 2012;McGilton et al, 2013;Resnick et al, 2016;Seitz et al, 2016).…”

An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study

“…82,83 Few health and social care professionals had received formal dementia training, a finding reported by several previous studies of staff delivering care following hip fracture. [84][85][86] We identified a need for staff delivering the intervention to have both theoretical and practical understandings of dementia. In particular, practical skills in communication, observation, engaging PWD and tailoring and embedding interventions are required.…”