Melody Maximos

This study examined 1) goals of older adults discharged from hospital to home in the community; 2) if goals changed during a short-term, community-based hospital-to-home program providing rehabilitation services. Adults ≥ 60 years recently discharged from hospital and participating in the program recorded goals at baseline and discharge, completing the Patient Specific Functional Scale (PSFS). Goals were mapped to the International Classification of Functioning, Disability and Health (ICF). Pre- and post-program PSFS scores were analysed for change. Thirty-eight percent of goals recorded at baseline were mapped as Body Functions, and 61.9% were mapped as Activities and Participation, with Mobility mapped goals most common (60.6%), followed by goals mapped as Domestic Life (21.2%). Of the goals mapped as Body Functions, 60.7% were mapped as Neuromusculoskeletal & Movement Functions. A statistically significant increase in PSFS scores from baseline to discharge was found for goals mapped to Activities and Participation and Body Functions domains, with the exception of those mapped to the Self-care domain. Older adult participants had a variety of goals, including goals that did not pertain to physical function. The need for continued rehabilitation services and supports was highlighted by PSFS scores at program discharge.

Background: There is international agreement that military families (MFs)—active service members, reservists, veterans, and their families—must be resilient to overcome military life adversities. Resilience is defined either as skillsets or as processes implicating multi-systems in a socio-ecological context. While research on resilience-building specific to children and families who face adversity is growing, there is a paucity of evidence on MF-centred resilience-building. Objective: This review describes the evidence on such resilience-building programming and determines if adversity is considered a barrier or facilitator to resilience-building. Methods: This scoping review yielded 4050 peer-reviewed articles from database inception until December 2023, found in 12 databases. Articles were deduplicated, leaving 1317 that were independently screened for eligibility by two reviewers. Disagreements were resolved through discussion with a third reviewer. Findings: Of these articles, 27 were included; 5 additional articles were also included from other sources. The vast majority of included studies (91%) were conducted in the United States. These 32 articles were organised into categories, including demographics, research methodologies used, resilience program descriptors, and outcomes. Conclusions: Our results reveal that programs on building MF resilience vary widely, often measuring non-resilience health and social outcomes. We provide preliminary insights for MF health and policy. Our review findings will be invaluable for further evidence-based programming that builds resilience in MFs.

Introduction: Physical activity (PA) and exercise (EX) participation rates have not been increasing among older adults, with many not meeting recommended guidelines. This qualitative descriptive study examined factors influencing engagement in PA within and outside an older adult fitness club context, using self-determination theory (SDT). Methods: Thirty-seven community-dwelling adults 65 years and older participated in focus groups or telephone interviews. Two researchers independently coded and analyzed transcript data inductively and deductively using SDT. Results: Two broad themes, The Spectrum of Motivating Factors and Facilitators and Barriers, and nine sub-themes, Physical Activity and Exercise Brings Me Joy; Meaningful Personal Impetuses; I Get Active with a Little Help from my Spouse and Others; I See Changes and Improvements (Theme 1); I Can Do This; Connections and Sense of Belonging; I Cannot Do This; Setting, Environment, and People Supports; and Pragmatics (Theme 2), emerged from the data. All participants discussed several motivating factors: enjoyment, managing health conditions, being held ‘to account’ by others, opportunities for socialization, and seeing improvements in health and well-being. A lack of supportive environments, knowledgeable staff and suitable settings and programs were cited as barriers by participants who were not older adult fitness club members. Discussion: Factors along the extrinsic to intrinsic regulation continuum facilitated or hindered community-dwelling older adults to engage in and sustain PA within and outside an older adult fitness club context. The findings underscore the need for programs, settings, environments, and related components to be expressly older-adult-tailored to enhance motivation through competence, autonomy, and relatedness support for maximal engagement and participation in PA or EX.

Introduction: Shortened hospital stays have shifted the burden of care for older adults to community, informal (ie, family, caregiver) and formal post-acute care and services, highlighting the need for effective post-hospital stay services and programs. As there is a dearth of information related to community-based, slow-stream rehabilitation program models for older adults transitioning from hospital to home in the Canadian context, the paper describes a mixed methods evaluation of such a program. Materials and Methods: A mixed methods program evaluation, with process- and outcome-related elements, included 1) review and analysis of program documents; 2) observations to examine fidelity. Observation data were coded and summarized using descriptive statistics. Coded information and data were compared to document review data; 3) quantitative assessment of pre-post changes in physical, social, and psychological outcome measure and instrument scores using descriptive statistics, paired t-tests and confidence intervals (p = 0.05); and 4) exploration of acceptability through interviews and focus groups with 41 of the older adult participants and 17 family caregivers. Thematic analysis was used to examine focus group and interview transcripts. Results: Observational data indicated alignment with the program document information overall. Statistically and clinically significant positive trends in improvement for physical outcome measure scores were observed (6-minute Walk Test, Life Space Assessment, Short Physical Performance Battery, Rapid Assessment of Physical Activity). Participants and family caregivers identified several positives and benefits of the program, ie, improvement in physical, social and mental well-being, decreased caregiver burden; and areas for improvement ie, need for more information about the program prior to enrollment and individualization, several of which aligned with the observation and quantitative data. Discussion/Conclusion: This mixed methods program evaluation provided a detailed description of a community-based, slow-stream rehabilitation program for older adults who are transitioning to home post-hospital stay and its participants. Evidence of program fidelity, acceptability, and positive trends in improvement in physical outcome measure scores were found. Information about program strengths and areas for improvement can be used by stakeholders to inform program refinement and enhancement.

The purpose of this study was to examine the perspectives of support staff, health care professionals, and care coordinators working in or referring to a community-based, slow-stream rehabilitation, hospital-to-home transition program regarding gaps in services, and barriers and facilitators related to implementation and functioning of the program. This was a qualitative descriptive study. Recruitment was conducted through purposive sampling, and 23 individuals participated in a focus groups or individual semi-structured interview. Transcripts were analyzed by six researchers using inductive thematic analysis. Themes that emerged were organized based on a socio-ecological framework. Themes were categorized as: (1) macro level, meaning gaps while waiting for program, limited program capacity, and gaps in service post-program completion; (2) meso level, meaning lack of knowledge and awareness of the program, lack of specific referral process and procedures, lack of specific eligibility criteria, and need for enhanced communication among care settings; or (3) micro level, meaning services provided, program participant benefits, person-centred communication, program structure constraints, need for use of outcome measures, and follow-up or lack of follow-up. Implementation of seamless patient information sharing, documentation, use of specific referral criteria, and use of standardized outcome measures may reduce the number of unsuitable referrals and provide useful information for referral and program staff.

This prospective cohort study described cardiovascular and resistance exercises completed by older adults in a community-based, slow-stream rehabilitation, hospital-to-home transition program; compared exercises completed to the American College of Sports Medicine (ACSM) exercise guidelines; and, assessed differences in Late Life Function and Disability Index (LLFDI)-Function Component (FC) between older adults who met and did not meet the ACSM guidelines. Descriptive statistics and Factorial ANCOVA were conducted. For cardiovascular exercise 59.3% of participants met frequency, 73.4% met intensity, and 35.9% met time. For resistance exercise, 67.2% of participants met frequency, 42.2% met intensity, and 76.6% number of repetitions. Participants who met both frequency and time for cardiovascular exercise had higher LLFDI-FC scores, as did those who met intensity and/or number of repetitions for resistance exercise. The findings provide support that older adults engaged in a slow-stream rehabilitation program can meet the ACSM exercise guidelines for community-dwelling older adults, and that meeting the guidelines improves function.

RÉSUMÉ: Au Canada, les personnes âgées présentant des problèmes de santé complexes sont souvent considérées comme inadmissibles aux programmes de réadaptation traditionnels, mais peuvent toutefois bénéficier de soins en réadaptation lente (SRL). Cet examen de la portée apporte une vue d’ensemble sur les publications traitant des SRL offerts aux personnes âgées dans les systèmes de soins de santé à payeur unique. Méthodes : Les articles publiés sur les personnes âgées en SRL par des revues avec comités de pairs et dans la littérature grise ont été analysés de manière systématique. Résultats : Un total de 1 445 documents ont été examinés de manière indépendante par deux évaluateurs [valeur Kappa de Cohen de 0,78 (IC = 0,73, 0,83)], et 18 documents ont été retenus. Les programmes de RSS pouvaient être caractérisés comme multidisciplinaires et leur durée moyenne variait de 30 à 141,2 jours. Les participants ayant reçu des SRL étaient majoritairement de sexe féminin, et leurs moyennes d’âge variaient entre 72 et 82 ans. Ils présentaient de multiples comorbidités et des troubles cognitifs légers ou modérés. Leurs mesures physiques et fonctionnelles se sont améliorées après les SRL. Discussion : Les programmes de SRL présentent un potentiel intéressant et leur intégration au continuum de soins devrait être considérée pour les personnes âgées ayant des antécédents médicaux complexes.