The purpose of this study was to compare the discharge outcomes of two client groups who were admitted to geriatric rehabilitation units (GRUs). The Emergency Department or ED Group were clients seen by WRHA Geriatric Program Assessment Team (GPAT) geriatric clinicians in EDs and admitted directly to geriatric rehabilitation units and the Acute Group were clients admitted from inpatient acute care units to geriatric rehabilitation units. The study design was a retrospective study using administrative data to examine two groups for the following discharge outcomes: discharged home, discharged to personal care home, and poor outcomes of either medical instability or mortality. The study results found that 70% of clients assessed by GPAT clinicians and admitted from the ED directly to a GRU were discharged home. Similarly, 68% of the clients admitted from acute inpatient units to a GRU were discharged home. The discharge home outcomes indicate that geriatric clinicians in consultation with team Geriatricians were able to select geriatric rehabilitation clients in a busy ED despite the need for an abbreviated evaluation period requiring rapid decision-making. Results of the study indicate that clinicians in this unique GPAT program utilizing collaboration between the ED team and clear GRU admission criteria selected ED clients with potential to benefit from the rehabilitation process and return to their homes in the community. Furthermore, 6% of the ED Group cases had poor outcomes of medical instability or mortality and 10% of the Acute Group had poor outcomes following GRU admission (see Table2).

The purpose of this study was to compare the discharge outcomes of two client groups who were admitted to geriatric rehabilitation units (GRUs). The Emergency Department or ED Group were clients seen by WRHA Geriatric Program Assessment Team (GPAT) geriatric clinicians in EDs and admitted directly to geriatric rehabilitation units and the Acute Group were clients admitted from inpatient acute care units to geriatric rehabilitation units. The study design was a retrospective study using administrative data to examine two groups for the following discharge outcomes: discharged home, discharged to personal care home, and poor outcomes of either medical instability or mortality. The study results found that 70% of clients assessed by GPAT clinicians and admitted from the ED directly to a GRU were discharged home. Similarly, 68% of the clients admitted from acute inpatient units to a GRU were discharged home. The discharge home outcomes indicate that geriatric clinicians in consultation with team Geriatricians were able to select geriatric rehabilitation clients in a busy ED despite the need for an abbreviated evaluation period requiring rapid decision-making. Results of the study indicate that clinicians in this unique GPAT program utilizing collaboration between the ED team and clear GRU admission criteria selected ED clients with potential to benefit from the rehabilitation process and return to their homes in the community. Furthermore, 6% of the ED Group cases had poor outcomes of medical instability or mortality and 10% of the Acute Group had poor outcomes following GRU admission (see Table2).

Despite considerable debate surrounding an age associated cognitive decline in non-demented elders, recent studies indicate that changes attributable to normal aging affect cognitive processes and fluid abilities. Additionally, studies indicate that factors such as physical illness, depression, neurological damage, medication side effects, drug interactions, and the effects of surgery and anesthesia may also cause varying degrees of cognitive impairment. Impairment of cognitive function is known to affect treatment and rehabilitation outcomes for older persons, and increase their likelihood of institutionalization. Although proper screening and identification of cognitive deficits in geriatric patients are crucial in developing treatment plans, there is evidence in the medical and nursing literature that cognitive decline in older non-demented patients is often not identified. Proper screening in this case, refers not only to whether or not clinicians engage in assessment behavior, but that they adhere to evidence-based practices and utilize standardized instruments which can identify the type, extent, and implications of the cognitive deficits. This study used an exploratory, non-experimental design and the population of interest consisted of occupational therapists providing physical rehabilitation to patients >65 years of age in the United States. The Ecological Systems Model was chosen as the theoretical framework, because it depicts human behavior as the product of the interaction between the individual's personal attributes and the physical and social environment in which the individual functions. Given the changes in health care, and the limits imposed by third party payers, it would seem important to inquire as to the effect of personal and practice contexts on therapists' assessment practices in geriatric rehabilitation. Although results of the study indicate that factors in the practice context are stronger predictors of therapists' use of standardized cognitive screening and assessment instruments, the study supports principles of Ecological Systems Models in that both practice and personal contexts contribute to therapists' assessment practices.

La réadaptation gériatrique reconnaît le loisir comme un indicateur clé des résultats de la réadaptation. Cependant, les connaissances théoriques sur le loisir sont peu développées. L’objectif de ce mémoire est de décrire et critiquer des modèles en lien avec le loisir et publiés dans les écrits scientifiques afin d’en dégager les aspects les plus pertinents pour la réadaptation gériatrique. Dix modèles ont été sélectionnés à partir d’une stratégie de recherche bibliographique. Ils ont été analysés sur la base de six critères : 1) le processus de développement du modèle, 2) les concepts, 3) les interactions entre les concepts, 4) l’aspect pratique, 5) la littérature générée et 6) la compatibilité avec les concepts-clés de la réadaptation gériatrique. Les résultats révèlent quatre modèles particulièrement intéressants pour la réadaptation gériatrique, sans pouvoir en dégager un en particulier, chacun présentant des forces et des limites qui sont discutées. De plus, les concepts rattachés au loisir les plus pertinents à retenir selon l’ensemble des modèles concernent: 1) la participation dans les loisirs, 2) la perception de soi face aux loisirs, 3) la motivation dans les loisirs, 4) la satisfaction dans les loisir, 5) les capacités en lien avec les loisirs et 6) l’environnement physique et social. Les résultats de la présente étude se traduiront par une meilleure connaissance des déterminants, caractéristiques et effets du loisir auprès des personnes âgées en processus de réadaptation. / Leisure is a key indicator of successful geriatric rehabilitation. However, there is a need for further development of theoretical knowledge of the role of leisure. The goal of this study was to describe and analyze scientific publications addressing leisure models and to extract the most relevant aspects for the rehabilitation of the elderly. A structured bibliographical search was conducted to select the most pertinent models (n=10). These models were analyzed regarding six criteria: 1) the development process of the model, 2) concepts put forward, 3) the interactions between the various concepts, 4) there practical aspects, 5) the subsequent literature generated and 6) the compatibility with key concepts of rehabilitation. It was concluded that four of the ten models were more pertinent for geriatric rehabilitation. Each model strengths and weaknesses are examined. The most relevant concepts that emerged from all the models are: 1) leisure participation, 2) leisure and self-perception, 3) leisure motivation, 4) leisure satisfaction, 5) leisure capacities and 6) physical and social environment. It is hoped that this study will be a first step in the comprehension of the determinants, characteristics and effects of leisure in the context of geriatric rehabilitation.

<p>Two main goals of geriatric rehabilitation are to re-establish ability for physical function in order to facilitate independence in activities of daily living (ADL), and to promote an optimal degree of well-being, i.e. life satisfaction, in the individual. In this research a new scale, the General Motor Function assessment scale (GMF), was developed and evaluated. Subsequently, factors perceived as important for the life satisfaction of people undergoing geriatric rehabilitation were investigated. </p><p>The GMF includes both mobility and upper limb functions and comprises three subscales covering different aspects of functioning, namely performance-related Dependence, Pain and Insecurity. The clinical practicality of the GMF was evaluated by a field test. Its psychometric properties were analysed in both hospital and community-based settings of geriatric rehabilitation, using non-parametric statistical methods. The results indicated that the GMF is clinically adequate, possesses good reliability and is sensitive enough to demonstrate changes from pre- to post-intervention in different forms of geriatric rehabilitation. </p><p>For investigation of perceptions of life satisfaction, individual qualitative interviews were conducted with old (80+) care recipients and with their significant others, who had a helping relationship with them. The results revealed that habitual activity, independence and adaptation were generally considered to be important for the life satisfaction of the care recipients. Recalling of pleasant past memories in an effort to achieve current life satisfaction was a commonly used adaptive strategy among the care recipients. This strategy created a temporary sense of life satisfaction, with a potential for concealing dissatisfaction with conditions that might otherwise be correctable. From the perspective of the significant others, protection of the continuity of the care recipients’ self was seen as vital for the latter's life satisfaction, and was thus an underlying general purpose of the informal caregiving. </p>

Two main goals of geriatric rehabilitation are to re-establish ability for physical function in order to facilitate independence in activities of daily living (ADL), and to promote an optimal degree of well-being, i.e. life satisfaction, in the individual. In this research a new scale, the General Motor Function assessment scale (GMF), was developed and evaluated. Subsequently, factors perceived as important for the life satisfaction of people undergoing geriatric rehabilitation were investigated. The GMF includes both mobility and upper limb functions and comprises three subscales covering different aspects of functioning, namely performance-related Dependence, Pain and Insecurity. The clinical practicality of the GMF was evaluated by a field test. Its psychometric properties were analysed in both hospital and community-based settings of geriatric rehabilitation, using non-parametric statistical methods. The results indicated that the GMF is clinically adequate, possesses good reliability and is sensitive enough to demonstrate changes from pre- to post-intervention in different forms of geriatric rehabilitation. For investigation of perceptions of life satisfaction, individual qualitative interviews were conducted with old (80+) care recipients and with their significant others, who had a helping relationship with them. The results revealed that habitual activity, independence and adaptation were generally considered to be important for the life satisfaction of the care recipients. Recalling of pleasant past memories in an effort to achieve current life satisfaction was a commonly used adaptive strategy among the care recipients. This strategy created a temporary sense of life satisfaction, with a potential for concealing dissatisfaction with conditions that might otherwise be correctable. From the perspective of the significant others, protection of the continuity of the care recipients’ self was seen as vital for the latter's life satisfaction, and was thus an underlying general purpose of the informal caregiving.

La réadaptation gériatrique reconnaît le loisir comme un indicateur clé des résultats de la réadaptation. Cependant, les connaissances théoriques sur le loisir sont peu développées. L’objectif de ce mémoire est de décrire et critiquer des modèles en lien avec le loisir et publiés dans les écrits scientifiques afin d’en dégager les aspects les plus pertinents pour la réadaptation gériatrique. Dix modèles ont été sélectionnés à partir d’une stratégie de recherche bibliographique. Ils ont été analysés sur la base de six critères : 1) le processus de développement du modèle, 2) les concepts, 3) les interactions entre les concepts, 4) l’aspect pratique, 5) la littérature générée et 6) la compatibilité avec les concepts-clés de la réadaptation gériatrique. Les résultats révèlent quatre modèles particulièrement intéressants pour la réadaptation gériatrique, sans pouvoir en dégager un en particulier, chacun présentant des forces et des limites qui sont discutées. De plus, les concepts rattachés au loisir les plus pertinents à retenir selon l’ensemble des modèles concernent: 1) la participation dans les loisirs, 2) la perception de soi face aux loisirs, 3) la motivation dans les loisirs, 4) la satisfaction dans les loisir, 5) les capacités en lien avec les loisirs et 6) l’environnement physique et social. Les résultats de la présente étude se traduiront par une meilleure connaissance des déterminants, caractéristiques et effets du loisir auprès des personnes âgées en processus de réadaptation. / Leisure is a key indicator of successful geriatric rehabilitation. However, there is a need for further development of theoretical knowledge of the role of leisure. The goal of this study was to describe and analyze scientific publications addressing leisure models and to extract the most relevant aspects for the rehabilitation of the elderly. A structured bibliographical search was conducted to select the most pertinent models (n=10). These models were analyzed regarding six criteria: 1) the development process of the model, 2) concepts put forward, 3) the interactions between the various concepts, 4) there practical aspects, 5) the subsequent literature generated and 6) the compatibility with key concepts of rehabilitation. It was concluded that four of the ten models were more pertinent for geriatric rehabilitation. Each model strengths and weaknesses are examined. The most relevant concepts that emerged from all the models are: 1) leisure participation, 2) leisure and self-perception, 3) leisure motivation, 4) leisure satisfaction, 5) leisure capacities and 6) physical and social environment. It is hoped that this study will be a first step in the comprehension of the determinants, characteristics and effects of leisure in the context of geriatric rehabilitation.