Abstract Background Older people are often admitted for rehabilitation to improve walking, yet not everyone improves. The aim of this study was to determine key factors associated with a positive response to hospital-based rehabilitation in older people. Methods This was a secondary data analysis from a multisite randomized controlled trial. Older people (n= 198, median age 80.9 years, IQR 76.6- 87.2) who were admitted to geriatric rehabilitation wards with a goal to improve walking were recruited. Participants were randomized to receive additional daily physical therapy focused on mobility (n = 99), or additional social activities (n = 99). Self-selected gait speed was measured on admission and discharge. Four participants withdrew. People who changed gait speed ≥0.1 m/s were classified as ‘responders’ (n = 130); those that changed <0.1m/s were classified as ‘non-responders’ (n = 64). Multivariable logistic regression explored the association of six pre-selected participant factors (age, baseline ambulation status, frailty, co-morbidities, cognition, depression) and two therapy factors (daily supervised upright activity time, rehabilitation days) and response. Results Responding to rehabilitation was associated with the number of days in rehabilitation (OR 1.04; 95% CI 1.00 to 1.08; p = .039) and higher Mini Mental State Examination scores (OR 1.07, 95% CI 1.00 – 1.14; p = .048). No other factors were found to have association with responding to rehabilitation. Conclusion In older people with complex health problems or multi-morbidities, better cognition and a longer stay in rehabilitation were associated with a positive improvement in walking speed. Further research to explore who best responds to hospital-based rehabilitation and what interventions improve rehabilitation outcomes is warranted. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000884707; ClinicalTrials.gov Identifier NCT01910740 .
Many nurses are involved in the management of peripheral intravenous therapy. Using scenarios of common presenting problems and evidence-based interventions, this article describes rationales for best practice. Readers are encouraged to critically appraise their own practice and to consider ways to improve the standard of intravenous therapy in their clinical area.
Abstract Background Australian guidelines advocate referral to comprehensive memory services for dementia diagnosis, but many patients may be diagnosed elsewhere. Aims To determine common settings for dementia diagnosis in Australia and to compare patient and carer experience between settings. Methods Exploratory cross‐sectional study of patients with dementia admitted to a Melbourne sub‐acute hospital. Patients who had capacity to participate were included; carers were recruited for patients without capacity. Participants completed an interviewer‐administered survey which asked them to recall the diagnostic setting, discussions about diagnosis and management (clinical care) and overall experience of diagnosis. Descriptive statistics were applied and open‐ended questions were analysed using inductive and deductive coding approaches. Results From 81 eligible participants, 74 consented to participate (one patient, 74 carers). Participants reported dementia diagnosis occurred a median of 24 months before interview, in the following settings: hospitals (31.3%), private specialist clinics (29.7%), memory clinics (14.9%), general practice (13.5%), community health services (9.5%) and residential care (1.4%). Recall of discussions about dementia‐modulating medications was higher in participants diagnosed in memory clinics and private specialist clinics (70%) compared to other settings (15%) ( P < 0.001). Discussion about living circumstances was highest in hospitals (87% vs 40%) ( P < 0.001). One third of participants reported dissatisfaction with their experience. Reported satisfaction was highest for memory clinics. Conclusion Results suggest majority of people with dementia are diagnosed outside memory services. Significant variability exists in experiences between services, with a high proportion of participants expressing dissatisfaction with their experience with dementia diagnosis. Strategies to standardise diagnosis of dementia, measure and improve quality of care across all settings are required.
Older people with a variety of health conditions are often admitted for inpatient rehabilitation to improve mobility, but it is not known how to maximize their recovery. The purpose of this single blinded, multisite randomized controlled trial was to determine whether providing increased physical activity to older people receiving inpatient rehabilitation leads to better mobility outcomes at discharge. Older people (n = 198, median age 80.9 years, IQR 76.6- 87.2) undergoing inpatient rehabilitation to improve mobility were recruited from geriatric rehabilitation units at two Australian hospitals. All participants received multidisciplinary usual care, including physical therapy. Participants were randomized to either an intervention group, which received additional daily physical therapy sessions focused on mobility activities or control group, which received social activities. Self-selected gait speed was measured using a 6-meter walk test at discharge by an assessor blinded to group. An intention- to –treat analysis was performed using a linear regression model, with baseline gait speed as a co-variate. The intervention group received a median of 20 additional minutes per day (IQR 15.0–22.5) of standing or walking activities throughout their inpatient stay; median 16.5 days (IQR 10.0–25.0). Gait speed improved in both groups, but there was no difference between groups at hospital discharge [median intervention 0.52 m/s (IQR 0.35–0.73); control 0.59 m/s (IQR 0.41–0.74); p = 0.145]. This suggests while clinically significant gains in mobility were achieved by older people receiving in-patient rehabilitation, additional physical activity sessions did not lead to better walking outcomes at discharge.
'/%3e%3c/defs%3e%3cpath fill='%23012169' d='M0 0h10080v5040H0z'/%3e%3cpath stroke='%23fff' stroke-width='.6' d='m0 0 6 3m0-3L0 3' clip-path='url(%23b)' transform='scale(840)'/%3e%3cpath stroke='%23e4002b' stroke-width='.4' d='m0 0 6 3m0-3L0 3' clip-path='url(%23c)' transform='scale(840)'/%3e%3cpath stroke='%23fff' stroke-width='840' d='M2520 0v2520M0 1260h5040'/%3e%3cpath stroke='%23e4002b' stroke-width='504' d='M2520 0v2520M0 1260h5040'/%3e%3cg fill='%23fff'%3e%3cuse xlink:href='%23d' x='2520' y='3780'/%3e%3cuse xlink:href='%23a' x='7560' y='4200'/%3e%3cuse xlink:href='%23a' x='6300' y='2205'/%3e%3cuse xlink:href='%23a' x='7560' y='840'/%3e%3cuse xlink:href='%23a' x='8680' y='1869'/%3e%3cuse xlink:href='%23e' x='8064' y='2730'/%3e%3c/g%3e%3c/svg%3e)