COVID-19 restrictions increased perceptions of social isolation for older people discharged home after rehabilitation: A mixed-methods study.

OBJECTIVE: To explore older persons' perceptions of the impact of COVID-19 restrictions on participating in community activities after discharge from inpatient rehabilitation. METHODS: Mixed-methods study design. Participants were older adults who were discharged home following inpatient rehabilitation. Interviews were conducted with 70 participants, with a variety of diagnoses, 8 weeks after discharge from inpatient rehabilitation. Frequency of participation in domestic, leisure/work and outdoor activities was measured using the Frenchay Activities Index (FAI). Qualitative analysis was completed using qualitative content analysis and triangulated with FAI scores. RESULTS: In all, 70 older adults (mean age: 73.0 years, SD: 9.9; 59% female) participated in the study. The overarching theme was that participants felt socially isolated following discharge from rehabilitation, with COVID-19 restrictions increasing perceptions of social isolation and complicating their return to participating in community activities. The four categories informing the overarching theme were as follows: physical health was the primary limitation to participation in community activities; COVID-19 restrictions limited participation in social activities and centre-based physical rehabilitation; low uptake of videoconferencing to facilitate socialisation and rehabilitation; and reduced incidental physical activity. Mean FAI score was 21.2 (SD 7.8), indicating that participants were moderately active. Participants most commonly performed domestic activities (mean: 10.0, SD: 4.1), followed by outdoor activities (mean: 6.6, SD: 3.5) and leisure/work activities (mean: 4.5, SD: 2.5). CONCLUSIONS: COVID-19 restrictions exacerbated perceptions of social isolation and the limitations already imposed by poor physical health after discharge from rehabilitation. The findings highlight the need for rehabilitation that addresses the psychological and social dimensions of community reintegration.

Meeting community ambulation criteria and confidence with walking on discharge from inpatient rehabilitation were positively associated with performance of outdoor community activities 8 weeks after discharge.

PURPOSE: To assess whether meeting criteria for community ambulation and ambulatory self-confidence on discharge from inpatient rehabilitation are associated with participation in community activities. METHODS: Prospective longitudinal observational study design. Participants were assessed within 48-hours of discharge on ability to complete tasks reflective of community ambulation (walking 315 m, ascending/descending three stairs, a ramp, and a street curb and walking at 0.44 m/s) and ambulatory self-confidence. At 8 weeks post-discharge frequency of participation in domestic, leisure/work and outdoor activities was measured using the Frenchay Activities Index (FAI). Multivariable regression analysis determined factors associated with total and outdoor FAI score. RESULTS: Seventy-four of 79 participants were followed up at 8 weeks post-discharge. Meeting all ambulation criteria was positively associated with FAI outdoor score (ß = 1.85, 95%CI 0.01-3.69, p = 0.049). Ambulatory self-confidence was positively associated with FAI outdoor score (ß = 0.03, 95%CI 0-0.05, p = 0.032) and FAI total score (ß = 0.05, 95%CI 0-0.1, p = 0.040). Age (ß= -0.22, 95%CI -0.36 to -0.08, p = 0.003) and living alone (ß = 3.36, 95%CI 0.10-6.61, p = 0.044) were associated with FAI total score. CONCLUSIONS: Capacity to meet ambulation criteria and ambulatory self-confidence are modifiable factors that could be targeted during rehabilitation to improve participation in community activities.Implications for rehabilitationMeeting community ambulation criteria and confidence with walking on discharge from inpatient rehabilitation are positively associated with performance of outdoor community activities 8 weeks after discharge.Capacity to meet community ambulation criteria and ambulatory confidence may be useful measures for rehabilitation teams to consider when discharging patients home.Meeting ambulation criteria and ambulatory confidence are modifiable factors that could be addressed through targeted therapy to improve community integration following hospitalisation.