from Hospital to Home World Confederation for Physical Therapy - - PowerPoint PPT Presentation

Short-Term Benefits of a Community- Based Slow-Stream Rehabilitation Program for Older Adults Transitioning from Hospital to Home

World Confederation for Physical Therapy Congress

July 2-4, 2017 Cape Town, South Africa

Team Members

Vanina Dal Bello-Haas, PT, PhD Principal Investigator Associate Professor Assistant Dean, Physiotherapy Program School of Rehabilitation Science McMaster University Sharon Kaasalainen, RN, PhD Co-Principal Investigator Associate Professor School of Nursing McMaster University Olivia Virag Project Coordinator School of Rehabilitation Science, McMaster University

July 2017

Sirirat Seng-iad, PhD Candidate Student Research Assistant School of Rehabilitation Science, McMaster University Melody Maximos, MSc Candidate Student Research Assistant School of Rehabilitation Science, McMaster University

This research is possible through funding by the LaBarge Optimal Aging Initiative at McMaster University and the Saskatchewan Health Research Foundation

July 2017

Ethics approval from the Hamilton Integrated Research Ethics Board (HiREB # 15-089)

Background

 Limited health care and system resources and a focus

• n moving care to the community
• much shorter hospital stays for older adults and

discharge to home prior to full recovery (Kripalani 2014)

 Shortened hospital admissions for older adults and a

corresponding increase in the use of post-acute services

• community-based programs and adult day services

have become important components in the older adult health care continuum.

July 2017

Purpose

➢ The purpose of this mixed-methods study was to

examine short-term physical function related effects and benefits of participating in Goldies2Home (G2H, Shalom Village, Hamilton, Ontario), a community- based, slow-stream rehabilitation program.

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Methods

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➢ Prospective, cohort study ➢ 64 participants

• 62.5% females, mean age = 78.5 years (SD = 9.7)

➢ Participants completed a variety of tests and outcome

measures at admission and discharge from G2H:

• PHYSICAL: 6-minute Walk Test (6-MWT

, endurance), Mini-BesTest (balance), Rapid Assessment of Physical Activity (RAPA), Short Performance Physical Battery (SPPB, function), Life Space Assessment (LSA, mobility)

• PSYCHOLOGICAL: Geriatric Anxiety Inventory (GAI), Geriatric

Depression Scale (GDS), Montreal Cognitive Assessment (MoCA)

Analysis

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 Descriptive statistics to describe the sample, one-sided paired t-

test, confidence interval = 99%

➢ Evaluated change in outcome measures at discharge ➢ Parametric and non-parametric statistics  Focus groups conducted at discharge

➢ Transcripts coded individually by two research team members and

compared

• Adjustments made to avoid personal bias and to reach consensus.
• Disagreements were resolved via discussion with a 3rd team member
• Codes were grouped, themes were developed and discussed with the

team, and shared for additional triangulation

Results

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➢ MOCA: mean score = 21.4 (5.5) ➢ 95.7% of participants were living with chronic conditions ➢ 47.8% lived alone ➢ 89.1% lived in a house, 10.9% lived in an assisted-living

facility

➢ Average number of days in G2H program = 21.2 (SD = 3.6)

➢ Absence of clinically significant anxiety (GAI) and depression

(GDS) scores at baseline and discharge

Results

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Outcome Measure Admission Mean (SD) Discharge Mean (SD) Change p-value SPPB 3.9 (2.6) 5.0 (2.6) 1.1*

p ≤ 0.001

6-MWT 128.9 m (84.4) 173.8 m (96.32) 44.9 m

p ≤ 0.001

Mini- BesTest 7.3 (4.6) 8.9 (5.4) 1.6

p ≤ 0.001

LSA 29.8 (15.9) 41.6 (21.3) 11.8*

p ≤ 0.001

*clinically meaningful

Results

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 Significantly more participants engaged in physical activities at

discharge, change in RAPA scores (p = 0.001)

 Several positive aspects of the program were identified by

participants related to services provided and outcomes

 Challenges that could be rectified to enhance participant

experiences were also identified.

“What we started not being able to do nothing, then ending up to be better at walking a little bit better, and have a little bit more strength” (I16) “The only thing I want to say is that it is too short … I’m a little bit disappointed in the follow up …” (PFG 3) “The staff was most accommodating” (I17) “Less stress for the family, not so worried about him falling. He is more able to move around and he is stronger … He can now go for walks with his wife again without anyone fearing for him” (CID018a)

Conclusions

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➢ Mobility (LSA) and physical activity (RAPA) increased ➢ SPPB, Mini-BesTest scores were low and 6-MWT distances were limited both at baseline and discharge

• Although SPPB scores were clinically and statistically significant,

scores ≤ 6 are indicative of severe disability (Cruz-Jentoft 2010)

• Mini-BesTest scores in Canadian older adults (O’Hoski 2013):
• 70 to 79 years = 21; 80 to 89 years = 19.6
• ≤ 19 have identified recurrent fallers
• Mean 6-MWT scores in community-dwelling older adults (Steffan 2002)
• 70 to 79 years: males = 527 m, females = 471 m
• 80 to 89 years: males = 417 m, females = 392 m

Implications

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➢ Continued poor physical function following hospitalization

places older adults at significant risk for adverse events:

• rehospitalization; increased disability;

institutionalization

➢ To what extent physical improvements are sufficient and

can be sustained to maintain safe independent living post G2H discharge has yet to be determined

➢ Room for further improvement

➢ Despite short-term benefits and positive aspects of the

G2H program, responding to challenges to enhance the model of care is warranted.

Acknowledgements

We would like to thank and acknowledge our community partner, Shalom Village (Hamilton, Ontario) for their continued support and commitment to evaluating the Goldies2Home Program, and to all who have participated to date.

July 2017

May 2016