State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment.
OBJECTIVE
To increase recognition of geriatric rehabilitation and to provide recommendations for practice and future research.


METHODS
A CINAHL and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search used the Cochrane database.


METHODS
One author reviewed the reference for relevance and another for quality. A total of 336 articles were selected. Excluded articles were unrelated to geriatric rehabilitation or were anecdotal or descriptive reports.


METHODS
The following major geriatric rehabilitation subtopics were identified: frailty, comprehensive geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. Part I describes the first 5 subtopics on concepts and processes in geriatric rehabilitation. Part II focuses on the latter 5 subtopics of common clinical problems in frail older persons. A level-of-evidence framework was used to review the literature. Level 1 evidence was a randomized controlled trial (RCT) or a meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts or descriptive studies.


RESULTS
Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic. In cases in which several articles were written on the same topic and drew similar conclusions, the authors chose those articles with the strongest level of evidence, reducing the total number of references.


CONCLUSIONS
Frail elderly patients should be screened for rehabilitation potential. Standardized tools are recommended to aid diagnosis, assessment, and outcome measurement. The team approach to geriatric rehabilitation should be interdisciplinary and use a comprehensive geriatric assessment. Medication reviews and self-medication programs may be beneficial. Future research should address cost effectiveness, consensus on outcome measures, which components of geriatric rehabilitation are most effective, screening, and what outcomes are sustainable.
Wells
Jennie L
JL
Geriatric Rehabilitation Unit, Parkwood Hospital, London, ON, Canada. jennie.wells@sjhc.london.on.ca
Seabrook
Jamie A
JA
Stolee
Paul
P
Borrie
Michael J
MJ
Knoefel
Frank
F
D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006299:Health Services for the Aged; D006801:Humans