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Rehabilitation for older people in long-term care

  • Comment
  • Review
  • Intervention

Authors


Abstract

Background

Examination of demographic trends indicates that the worldwide population is progressively ageing. It is expected that such longevity will be associated with an increase in morbidity and demand for long-term residential care. This review examines whether there is evidence that physical rehabilitation benefits older people in long-term care.

Objectives

To evaluate physical rehabilitation interventions directed at improving physical function among older people in long-term care.

Search methods

We searched the trials registers of the following Cochrane entities: Stroke Group (searched March 2008), Effective Practice and Organisation of Care Group (searched August 2006) and the Rehabilitation and Related Therapies Field, (searched August 2006). In addition, we searched 17 relevant electronic databases including the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3), MEDLINE (1966 to 1 October 2007), EMBASE (1980 to 1 October 2007), CINAHL (1982 to 1 October 2007), AMED (1985 to 1 October 2007), PsycINFO (1967 to 1 October 2007) and PEDro (searched 1 October 2007). We also searched trials and research registers and conference proceedings, checked reference lists, and contacted authors and researchers in the field and other relevant Cochrane entities.

Selection criteria

Randomised studies comparing a rehabilitation intervention designed to maintain or improve physical function with either no intervention or an alternative intervention in older people aged 60 years or over who have permanent long-term care residency.

Data collection and analysis

Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information.

Main results

Forty-nine trials involving 3611 participants were included. On average, 74 (range 12 to 468) participants were randomised into trials at baseline. Of studies which reported age, the overall mean age was 82 years (range of 69 to 89). Most interventions lasted less than 20 weeks, and comprised approximately three 30 to 45-minute group sessions per week. Twelve trials conducted post-intervention follow up (maximum one year). Most often a 'usual care' control group was used, but social activity and alternative interventions also featured. The primary outcome, daily activity restriction, was reported by 36 trials. A range of secondary outcomes are also reported.

Authors' conclusions

Provision of physical rehabilitation interventions to long-term care residents is worthwhile and safe, reducing disability with few adverse events.

Most trials reported improvement in physical condition. However, there is insufficient evidence to make recommendations about the best intervention, improvement sustainability and cost-effectiveness.

Plain language summary

Rehabilitation for older people in long-term care

Rehabilitation treatments may be effective in improving the physical condition of older people in long-term care. In 1997 the number of over-65 year olds constituted 6.6% of the world's population, and this is predicted to increase to 10% by 2025.  It is expected that this will lead to a rise in demand for long-term residential care. There is therefore a demand for ways of preventing any deterioration in health and increasing independence in activities of daily living, for example walking and dressing, among residents. Physical rehabilitation (interventions based on the exercising the body) may have a role and this review examines the evidence available. Forty-nine trials are included in this review, 30 of which were conducted in the USA. In total, 3611 participants with an average age of 82 years were involved, more than two-thirds of whom were female. Most interventions in some way addressed disability in routine daily life, for example walking, eating and dressing. The trial outcomes addressed by this review are disability in daily life, strength, flexibility, balance, general physical condition, mood, cognitive status, participant drop out, session attendance, death, illness, and  unwanted effects associated with the intervention, such as injuries. Due to the wide variety of outcome measures used, the studies could not be summarised statistically, therefore a narrative review is provided. While variations between the trials means specific recommendations cannot be made, they were overwhelmingly successful, demonstrating that many different types of physical rehabilitation have benefits to physical health with few reports of unwanted events relating to the intervention.

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