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      Geriatrische Rehabilitation – Aktueller Stand und zukünftige Entwicklung

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          Zusammenfassung

          Aufgrund des demographischen Wandels steigt die Zahl hochbetagter, multimorbider Menschen mit Rehabilitationsbedarf und -potenzial. Dieser Entwicklung wurde bereits in den 90er Jahren durch die Unterstützung der geriatrischen Rehabilitation begegnet. Mit ihren diversen Ausgestaltungen hilft diese, die rehabilitativen Bedarfe älterer Menschen in den verschiedenen Versorgungssektoren abzudecken. Dabei erfolgt die gut etablierte und wissenschaftlich fundierte stationäre geriatrische Rehabilitation häufig nach einem akutstationären Aufenthalt. Demgegenüber unterstützt die ambulante und mobile geriatrische Rehabilitation die Versorgung im prä- und poststationären Sektor. Aktuelle Zahlen belegen die Entwicklungsdynamik in diesem Bereich. Der derzeitige Entwicklungsfokus liegt auf der Optimierung präventiver und rehabilitativer Maßnahmen im ambulanten Bereich sowie im stationären Pflegebereich. Unterstützt wird dies durch zahlreiche Innovationsfonds-Projekte des G-BA und durch eine europaweite Zusammenarbeit. Zudem gilt es Gesetze zur Stärkung der Teilhabe älterer Menschen besser umzusetzen.

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          Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies

          Abstract Background frailty impacts older adults’ ability to recover from an acute illness, injuries and other stresses. Currently, a systematic synthesis of available interventions to prevent or reduce frailty does not exist. Therefore, we conducted a scoping review of interventions and international policies designed to prevent or reduce the level of frailty in community-dwelling older adults. Methods and analysis we conducted a scoping review using the framework of Arksey and O'Malley. We systematically searched articles and grey literature to identify interventions and policies that aimed to prevent or reduce the level of frailty. Results fourteen studies were included: 12 randomised controlled trials and 2 cohort studies (mean number of participants 260 (range 51–610)), with most research conducted in USA and Japan. The study quality was moderate to good. The interventions included physical activity; physical activity combined with nutrition; physical activity plus nutrition plus memory training; home modifications; prehabilitation (physical therapy plus exercise plus home modifications) and comprehensive geriatric assessment (CGA). Our review showed that the interventions that significantly reduced the number of frailty markers present or the prevalence of frailty included the physical activity interventions (all types and combinations), and prehabilitation. The CGA studies had mixed findings. Conclusion nine of the 14 studies reported that the intervention reduced the level of frailty. The results need to be interpreted with caution, as only 14 studies using 6 different definitions of frailty were retained. Future research could combine interventions targeting more frailty markers including cognitive or psychosocial well-being.
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            A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial

            Background Frailty is a well known and accepted term to clinicians working with older people. The study aim was to determine whether an intervention could reduce frailty and improve mobility. Methods We conducted a single center, randomized, controlled trial among older people who were frail in Sydney, Australia. One group received an intervention targeting the identified characteristics of frailty, whereas the comparison group received the usual health care and support services. Outcomes were assessed by raters masked to treatment allocation at 3 and 12 months after study entry. The primary outcomes were frailty as assessed by the Cardiovascular Health Study criteria, and mobility as assessed by the Short Physical Performance Battery. Secondary outcome measures included disability, depressive symptoms and health-related quality of life. Results A total of 216 participants (90%) completed the study. Overall, 68% of participants were women and the mean age was 83.3 years (standard deviation, 5.9). In the intention-to-treat analysis, the between-group difference in frailty was 14.7% at 12 months (95% confidence interval: 2.4%, 27.0%; P = 0.02). The score on the Short Physical Performance Battery, in which higher scores indicate better physical status, was stable in the intervention group and had declined in the control group; with the mean difference between groups being 1.44 (95% confidence interval, 0.80, 2.07; P <0.001) at 12 months. There were no major differences between the groups with respect to secondary outcomes. The few adverse events that occurred were exercise-associated musculoskeletal symptoms. Conclusions Frailty and mobility disability can be successfully treated using an interdisciplinary multifaceted treatment program. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12608000250336
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              European consensus on core principles and future priorities for geriatric rehabilitation: consensus statement.

              In response to the growing recognition of geriatric rehabilitation and to support healthcare providers which need strategies to support older people with frailty who have experienced functional decline, we developed a consensus statement about core principles and future priorities for geriatric rehabilitation.
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                Author and book information

                Book Chapter
                2020
                September 02 2020
                : 135-148
                10.1007/978-3-662-61362-7_9
                0af3291b-624d-475a-aa1f-a8b5eb243480
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