Community-Based, Slow-Stream Rehabilitation, Hospital-To-Home Transition Program for Older Adults

Abstract

Current models of hospital-to-home transitions for older adults do not typically include a rehabilitation perspective, which led to the endeavor of this thesis. Chapter 2 (Paper 1) is a scoping review that summarized current literature related to slow-stream rehabilitation (SSR) for older adults. Chapter 3 (Paper 2) was a descriptive prospective cohort study that examined frequency, intensity, type and time (FITT) parameters for cardiovascular and resistance exercises completed by older adult participants in a community-based, SSR, hospital-to-home transition program; and to compare FITT parameters of completed exercises to established guidelines. Chapter 4 (Paper 3) was a qualitative study that examined perspectives of those working in or referring to the community-based, SSR, hospital-to-home transition program to identify factors that act as barriers or facilitators to successful implementation and function of an enhanced, community-based, SSR, hospital-to-home transition program. The scoping review found that SSR programs in single payer healthcare systems improved physical and functional outcomes, decreased hospital readmission and institutionalization for older adults with complex healthcare needs. SSR programs were multidisciplinary, ranged in program and session length, and only took place in institutional settings. The prospective cohort study found that older adults with complex healthcare needs participating in a community-based, SSR, hospital-to-home transition program were able to meet many of the cardiovascular and resistance frequency, intensity, and time (FIT) guideline parameters for community-dwelling older adults. Exercise interventions should be tailored to older adult needs and preferences, at the appropriate FIT to allow for functional gains. The qualitative study found the current program’s services e.g., rehabilitation, education, and nursing care were of benefit. Most of the stated barriers were at a macro or meso level and were out of the study participants’ control, while all the facilitators were at a micro level. Community-based, SSR, hospital-to-home transition programs can serve as a holistic model of care that address identified gaps in the literature.