Physical rehabilitation for older people in long-term care

Description

Rehabilitation treatments may be effective in improving the physical health of older people in long‐term care. In 2010, 7.6% of the world's population were over 65 years old, and this is predicted to increase to 13% by 2035. It is expected that this will lead to a rise in demand for long‐term residential care. This has increased interest in ways to prevent deterioration in health and activities of daily living, for example, walking and dressing, among care home residents. Physical rehabilitation (interventions based on exercising the body) may have a role, and this review examines the evidence available.

Objectives

To evaluate the benefits and harms of rehabilitation interventions directed at maintaining, or improving, physical function for older people in long‐term care through the review of randomised and cluster randomised controlled trials.

Main results

This is an update to a review first published in 2009. This review included 67 trials, 36 of which were conducted in North America, 20 in Europe, and seven in Asia. In total, 6300 participants with an average age of 83 years were involved. Most interventions in some way addressed difficulties in activities of daily living. This review investigates the effects of physical rehabilitation on activities of daily living, strength, flexibility, balance, mood, cognition (memory and thinking), exercise tolerance, fear of falling, death, illness, and unwanted effects associated with the intervention, such as injuries. While variations between trials meant that we could not make specific recommendations, individual studies were often successful in demonstrating benefits to physical health from participating in different types of physical rehabilitation.

Authors’ conclusions

Physical rehabilitation for long‐term care residents may be effective, reducing disability with few adverse events, but effects appear quite small and may not be applicable to all residents. There is insufficient evidence to reach conclusions about improvement sustainability, cost‐effectiveness, or which interventions are most appropriate. Future large‐scale trials are justified.

An update is currently underway, with new results due in 2020.

Publications and outputs

Crocker T, Forster A, Young J, Brown L, Ozer S, Smith J, Green J, Hardy J, Burns E, Glidewell E, Greenwood DC. Physical rehabilitation for older people in long-term care. Cochrane Database of Systematic Reviews. 2013 Feb 28;(2):CD004294. doi: 10.1002/14651858.CD004294.pub3.

Crocker T, Young J, Forster A, Brown L, Ozer S, Greenwood DC. The effect of physical rehabilitation on activities of daily living in older residents of long-term care facilities: systematic review with meta-analysis. Age & Ageing 2013;42(6):682-8. doi: 10.1093/ageing/aft133.

Podcast

A short summary of the review presented by Tom Crocker in 2013: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004294.pub3/related-content/podcast/26550