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Transitioning from Hospital to Home: What do Older Adults Think Would Prevent Re-

Hospitalization?Vanina Dal Bello-Haas, PT, PhD

Briana Virag, Melody Maximos, Olivia Virag

Canadian Physiotherapy Association Forum 2019June 27-29, 2019

Charlottetown, PEI

• ~ 2/3’s of older people have functional decline when hospitalized

• 1 of 12 older adults have an unplanned hospital readmission within the first month of discharge

• < 50% older adults return to their pre-illness level of function and mobility ….

…. leads to high rates of re-hospitalization and LTC placement

OBJECTIVES

1. perspectives of older adults and family members/caregivers re: hospitalization, the discharge process, the hospital-to-home experience

2. needs and priorities related to discharge and transitioning from hospital-to-home

3. potential solutions from the point of view of older adults and family members

METHODOLOGY

Purposeful sampling - hospitalized older adult patients; recently discharged older adults; family members/caregivers.

Six semi-structured interviews - 6 older adults, 5 family members.

Thematic Analysis – 2 independent researchers

What did we find ….

ACKNOWLEDGEMENTWe would like to thank the participants for partaking in our study, the continued support from Shalom Village. Funding: McMaster Institute for Research on Aging Summer Student Fellowship program.

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School of Rehabilitation ScienceReaching Further

Background and Rationale

• Heart failure (HF): structural/functional impairment Ventricular filling Ejection of blood (Yancy et al., 2013).

• Primary symptoms of HF (Yancy et al., 2013).

Fatigue Shortness of breadth Fluid retention

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School of Rehabilitation ScienceReaching Further

Objectives/Research Questions

1. What is the effect of exercise on lower extremity function (LEF) including: balance, walking speed, endurance & muscle strength) in older adults with HF?

2. What is the effect of multimodal vs. unimodal exercise on LEF in older adults with HF?

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Methods• Data sources: MEDLINE, EMBASE, CINAHL, AMED & Web of

Science (inception to August 1st, 2018); hand searching.

• Search terms: exercise, physical function, walking speed, heart failure, aged.

• Meta-analysis: DerSimonian & Laird random effects in RevManversion 5.3 (The Cochrane Collaboration, 2014).

• Risk of bias: The Cochrane Collaboration’s tool (The Cochrane Collaboration, 2011).

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Results

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• Six Minute Walk Test (6MWT) distance• Strength/endurance plantar flexors • Isokinetic & isometric knee extension strength

• Multimodal exercise (e.g. Tai chi + endurance training) improved 6MWT distance more than unimodal exercise (e.g. endurance training).

School of Rehabilitation ScienceReaching Further

Relevance/Implications• Our findings show that exercise can improve LEF in older

adults with HF.

• Longitudinal studies: LEF predicts onset of mobility-related disability and ADL disability in older adults (Guralnik et al., 1995, Fried et al., 2000 & Onder et al., 2005).

• Physiotherapists can play a role in improving LEF & reducing disability in older adults with HF through exercise training. 12

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Dominique Cardinal, M.A, Ed. B. Sc. PhtGestionnaire du volet formation

CNFS – Volet Université d’Ottawa

La technologie pour réduire les facteurs de risque de chutes chez les

aînés en situation minoritaire francophone

Forum 2019 - 29 juin

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Pertinence

(ICIS, 2010)

Population de 65 ans et plus, par région en 2011 et projection pour 2036 (en pourcentage)

PertinenceMarche vers le futur

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But/Objectif de l’étude

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Évaluer l’efficacité du programme Marche vers le futur ( 2014-2016)

Réduction des facteurs de risque de chute?

Méthode / AnalyseÉLÉMENTS MESURÉS OUTILS

Données comparatives pré-postForce musculaire des membres inférieurs Sit-to-stand 10 réps.Équilibre statique et dynamique Test de Berg et appui unipodal 30 secondesConnaissances sur les facteurs de risque de chutes

Test de connaissances

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ÉLÉMENTS MESURÉS OUTILS

Données auto-rapportées en post Perception d’avoir un meilleur équilibre Échelle de 1 à 10

Satisfaction du programme Grille d’évaluation écrite

Comportement et environnement à risque Entrevue téléphonique (4 - 6 mois)

Résultats

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• Équilibre statique et dynamique

• Force musculaire des membres inférieurs

• Connaissances

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The effects of physical exercise on executive function in community dwelling

older adults living with Alzheimer’s-type dementia: A systematic review

Nicole A. GuitarPhD/MPT Candidate

The University of Western Ontario CPA Forum 2019 Maximizing Potential: Promoting Health Aging

• Functions involved in complex cognition• Solving novel problems• Modifying behaviour in light of new information• Purposive, goal-directed behaviours (Elliot, 2003; Luria, 1966)

• Accounts for 47% of the variance in scores on Instrumental Activities of Daily Living scales (IADLs) (Wattmo et al., 2016)

• Deficits in executive functioning can be detected a decade before a clinical dementia diagnosis (Pérès et al., 2008)

• Clock-Drawing Test

What is “Executive Function”?Why should I care?

Alzheimer’s-type Dementia• Alzheimer’s-type dementia is a common form of dementia (Laver et al., 2016)

• The number of Canadians living with AD is expected to double over the next 15 years (Alzheimer’s Society of Canada, 2017)

• Nonpharmacological approaches have been recommended as the first step (National Institute of Health and Clinical Excellence, 2011)

• Physical exercise improves IADL scores and functional ability (Cahn-Weiner et al., 2002)• 28% lower chance of developing dementia• 45% lower chance of developing Alzheimer’s-type (Deslades et al., 2009)

Do physical exercise interventions improve scores on measures of executive functioning in community-dwelling older adults living with Alzheimer’s-type

Dementia?

Come to the Pope Ballroom at 10:15am to find out!

Our Question:

A survey of physiotherapists’ knowledge and use of executive functioning assessments in clinical practice

Three ways to access the survey:

Participants Needed!

1Copy this survey

link to access more information:

bit.ly/2GoOLPo

2See your CPA

National Rounds Newsletter

(February 2019) to access the survey

link

3Visit my poster and scan our QR Code

Thank you!

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1.Department of Health, Dalhousie University, Halifax, Canada (corresponding author: adriaquigley@dal.ca)2. Community member, Halifax, Canada

3. Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada 4. Department of Physiotherapy and Medicine, Dalhousie University, Canada

USING THE THEORETICAL DOMAINS FRAMEWORK TO IDENTIFY BARRIERS AND

FACILITATORS TO EXERCISE AMONG OLDER ADULTS LIVING WITH HIV

Adria Quigley1, Larry Baxter2, Laura Keeler3, Marilyn Mackay-Lyons4

STUDY BACKGROUND•PLWH (People Living with HIV) experience significant disability •Exercise interventions are recommended but many are not meeting guidelines•The Theoretical Domains Framework (TDF) identifies behaviour change factors

Purpose:• Use the TDF to investigate

the physical activity barriers and facilitators of older PLWH

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METHODS, DATA COLLECTION, AND ANALYSIS

• Qualitative, in-depth, key-informant, semi-structured interviews with 12 PLWH

• Inclusion criteria: aged 45 and older, HIV+, self-identified cognitive difficulties

• Demographic questionnaire• Interview guide was developed

using a committee of PLWH

• Interviews were audio-recorded, transcribed verbatim.

• De-identified transcripts were uploaded onto Nvivo

• Data coded using deductive content analysis.

• Two independent investigators coded each transcript by paragraph

0

50

100

150

200

250

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350 320

249 249208 192 174

Number of Codes

Facilitators: HIV diagnosis reinforces positive health behaviours, prioritizing exercise, physical and mental benefits, encouragement, technologyBarriers: Negative health care experiences, stigma, HIV medications, side effects, comorbidities, weather, injuries, lack of motivation, lack of self-efficacy unfamiliarity with yoga, lack of knowledge of exercise guidelines, lack of exercise prescription

RESULTS• 12 participants• 9 males, 3 females• Mean age: 56.6 • 20.0 years living with HIV• All taking antiretrovirals• All had undetectable viral

loads• Mean CD4 count: 835.5

DISCUSSION AND KEY MESSAGES•Mental and physical benefits facilitate physical activity.•Positive relationships between perceived health status and physical activity participation.•Psychological attributes (such as self-efficacy) may be more influential mediators of adherence than physical characteristics.•Lack of exercise parameters from health care providers.

Key Messages:•PLWH experience barriers to physical

activity but also identify many facilitators. •Researchers and clinicians should identify

barriers to participation and incorporate strategies to address these obstacles.

• Clinicians should offer basic exercise information, particularly weight-bearing and balance exercises.

References: https://docs.google.com/document/d/1yPDnqCOMdXJZC1T5GBAQOZxkX52eFHYplcES_mKEK4Y/edit?usp=sharing

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