- Open Access
Rehabilitation potential in older people living with frailty: a systematic mapping review
BMC Geriatrics volume 21, Article number: 533 (2021)
Following periods of acute ill-health and injury, older people are frequently assessed and provided with rehabilitation services. Healthcare practitioners are required to make nuanced decisions about which patients are likely to benefit from and respond to rehabilitation. The clinical currency in which these decisions are transacted is through the term “rehabilitation potential”. The aim of this study was to explore information about rehabilitation potential in older people to inform the development of an evidence-based assessment tool.
A systematic mapping review was completed to describe the extent of research and the concepts underpinning rehabilitation potential. We searched Medline, CINHAL, EMBASE, AMED, PsycINFO, PEDro, Cochrane Library, Web of Science, ProQuest, Trip and EThOS from inception to December 2020. We included studies which focused on rehabilitation potential and/or assessing for rehabilitation interventions for older people with comorbidities in the hospital and community setting. Reviewer pairs independently screened articles and extracted data against the inclusion criteria. A descriptive narrative approach to analysis was taken.
13,484 papers were identified and 49 included in the review. Rehabilitation potential was found to encompass two different but interrelated concepts of prognostication and outcome measurement. 1. Rehabilitation potential for prognostication involved the prediction of what could be achieved in programmes of rehabilitation. 2. Rehabilitation potential as an outcome measure retrospectively considered what had been achieved as a result of rehabilitation interventions. Assessments of rehabilitation potential included key domains which were largely assessed by members of the multi-disciplinary team at single time points. Limited evidence was identified which specifically considered rehabilitation potential amongst older people living with frailty.
Current approaches to rehabilitation potential provide a snapshot of an individual’s abilities and conditions which fail to capture the dynamic nature and fluctuations associated with frailty and rehabilitation. New approaches to measures and abilities over time are required which allow for the prognostication of outcomes and potential benefits of rehabilitation interventions for older people living with frailty.
Older people living with frailty often do not have discrete illnesses that they recover from. Rather they have an array of long-term conditions, which can both progressively worsen and have acute exacerbations resulting in hospitalisation. This can have a devastating impact on their function, well-being and social interactions.
Rehabilitation interventions are key in supporting patients’ recovery after periods of acute ill health [1, 2]. Healthcare practitioners are required to make nuanced decisions about patient’s rehabilitation requirements and which patients are likely to benefit from and respond to rehabilitation. The clinical currency in which these decisions are transacted is through the term “rehabilitation potential”.
Rehabilitation potential has been described in a number of different ways. It has been used to describe how well a patient’s function improves in response to rehabilitation, [3, 4] restoration of activities of daily living [5, 6] and patients’ psychological abilities to take part in rehabilitation . Being deemed to have rehabilitation potential or not is critical to the amount and type of rehabilitation a patient will receive and can result in individuals being denied access to services which may be beneficial [8, 9]. How rehabilitation potential is conceptualised, assessed and operationalised, and which factors influence clinical decision-making, in routine clinical practice is highly variable.
The aim of our study was to identify and map literature on rehabilitation potential to inform the development of a tool to support consistent decisions [10, 11]. It sought to identify how the term rehabilitation potential or similar descriptors were used, what was understood by the term, how rehabilitation potential had been assessed, the use of clinical tools and decision-making frameworks, by whom they were used, and the timing of the assessment.
We conducted a systematic mapping review. These are designed to describe the extent of research into a field and the concepts underpinning the research [12, 13]. They are widely used in developing complex interventions .
An electronic, three-step search strategy was used. An initial search was carried out in all databases using the keyword “rehabilitation potential”. A second search was carried out using MeSH combined with the key word “rehabilitation potential” across all included databases from inception to December 2020. Thirdly, a citation search was completed across the reference lists of all identified studies to enhance the rigour of the study . Studies published in the English language were included. Databases searched were: Medline (Ovid 1946-present), CINAHL Plus with full text (EBSCO), EMBASE (Ovid), AMED (Allied and Complementary Medicine, Ovid), PsycINFO (Ovid), PEDro, Cochrane Library and Web of Science. The search for grey literature included: ProQuest Dissertations and Theses, Trip (Turning Research into Practice) and EThOS. Justification for the inclusion of each database can be found in supplementary data file one.
Searches, title and abstract screening were conducted by a single researcher (AC). Full text screening and data extraction were independently completed by two reviewers selected from AC, PL, SG and ALG. Disagreements were resolved through discussions with the study team. Data were recorded on a standardised data extraction form (supplementary data file two) which collected details about the study design, interventions, participants, context and outcomes alongside definitions of rehabilitation potential, methods of assessment and theoretical underpinnings. The form was piloted with a member of the study team on a sample of five papers to ensure that it was fit for purpose, unambiguous and clear.
Studies were included if they focused on rehabilitation interventions delivered in hospitals or community settings for adults aged over 65 with frailty or multiple comorbidities, where recovery trajectories are particularly uncertain. Studies that included assessments of rehabilitation potential and clinical decision-making during assessments for rehabilitation programmes were included. Studies which presented primary research, including randomized controlled trials, non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case-control studies, analytical cross-sectional studies, case series, individual case reports, descriptive cross-sectional studies, phenomenology, grounded theory, ethnography and action research were included.
Studies focussing on specialist stroke rehabilitation, fracture care, end of life care or with a terminal diagnosis were excluded. Opinion pieces, editorials and books were excluded.
Types of outcome
Outcomes of interest included measures of function or activities of daily living (ADL), instrumental activities of daily living (IADL), and access to and provision of services as a consequence of rehabilitation potential assessments.
Data were analysed by publication rate by year, country of publication, study type, participant type and study settings. Results were displayed in descriptive tables taking into account a priori themes based on the World Health Organization International Classification of Functioning, Disability and Health (WHO ICF)  and emergent themes. This enabled the theoretical underpinnings and components of rehabilitation potential assessments relating to health conditions, body functions and structures, activities and participation personal and environmental factors to be identified and to inform the development of a rehabilitation potential assessment tool . Categories were added into the analytical framework based upon important insights from included articles that were not adequately captured by a priori themes.
13,484 papers were identified through bibliographic searches with an additional 48 found through citation searching. After duplicates were removed, 12,566 records titles and abstracts were screened and 12,452 were excluded. 114 articles underwent full paper screening, at which point a further 65 articles were excluded. 49 articles were included in the final review. A PRISMA diagram is shown in Fig. 1.
The majority of studies were conducted in North America (n = 21) and Europe (n = 14). Five were completed in Australasia, three in Asia and six as part of international collaborations. Publication dates ranged from 1959 to 2017 with the greatest number of articles published in 2012 and 2016 (Fig. 2).
The review included a wide range of study designs: 25 observational studies, four clinical assessment protocols, three narrative reviews, two descriptive studies, two comparisons of clinical data against machine learning algorithms, two qualitative interview studies, two cohort studies and one of each of the following: randomized controlled trial, case report, comparison of inter-rater reliability, expert consensus, quantitative survey data, chart reviews, tool validation, literature review and a systematic review. Experimental studies included in the review are described by setting and number of participants in Table 1.
The studies identified in this review included a wide range of participants, patient groups and diagnoses. In studies which considered how healthcare practitioners assessed rehabilitation potential, assessments were carried out by a single profession or as part of a multidisciplinary team (MDT) (Table 2).
The majority of studies included patients with diverse diagnoses and characteristics who were in receipt of rehabilitation assessments or interventions. Study populations were described in different ways with variables including: frailty, multimorbidity, cognitive status, functional abilities and activities of daily living. Diagnoses commonly identified included: Alzheimer’s diseases and other dementias, orthopaedic diagnoses (osteoarthritis and falls), cardiac and respiratory conditions, stroke and hip fractures. Where reported, mean ages ranged from 65 to 88.1 years (Supplementary data file three). Fourteen articles did not report on specific patient populations or conditions [18, 19, 22,23,24,25,26,27,28,29,30,31,32,33].
Findings coalesced around specific themes which are presented in Table 3:
Definitions of rehabilitation potential
Definitions demonstrated considerable heterogeneity and a lack of consensus. The term was used prognostically to describe an individual’s potential for restoration of function [28, 34, 35] or predicted benefit from MDT rehabilitation . Cunningham, Mosqueda and New [17, 27, 29] adopted the definition provided by Rentz:
“The prognostic indicator of how the patient will perform within a standard inpatient rehabilitation program … involving an estimation of the patient’s personal strengths (i.e., level of motivation/cooperation, cognitive status and personality constellation), medical complications and familial support as they interface with therapies and rehabilitation environment … estimates the individual’s capability of cooperating with a rehabilitation program and making measured functional gains in ambulation and self- care … appraising whether the patient’s current quality of life can be improved upon despite chronic or multiple disabilities.” .
A number of authors [18, 26, 37,38,39,40,41,42] adopted a functionally-orientated approach to definitions where individuals had rehabilitation potential if they were likely to achieve restoration of function after an acute event. Hoenig et al.  considered that rehabilitation potential was better expressed by gaining improvements in quality of life rather than by functional gain alone. Gray et al.  and Hartley et al.  used place of residence as a proxy for functional ability whereby individuals had rehabilitation potential if they were predicted to be likely to be discharged back to their usual place of residence after an acute episode of ill health.
In contrast, rehabilitation potential was defined as being present if the individual undergoing rehabilitation and/or a member of the continuing care team thought the individual was capable of increased independence in some objectively measured functional areas [3, 43,44,45,46]. This definition was further refined by Zhu et al. [4, 47] whereby true rehabilitation potential was said to be present if an individual demonstrated measurable improvements in ADL functioning (measured using the interRAI ADL long form) over a period of one year or if they remained at home at the end of the rehabilitation intervention.
In three studies by Johansen et al. [48,49,50] a working definition developed by the Norwegian Government, was adopted which described rehabilitation potential as the “physiological and psychological possibilities of a disabled person to restore, improve on maintain an optimal level of function and quality of life” . Whilst this definition emphasises the relationship between physical and psychological health and well-being, it was not specific to older people living with frailty.
Three studies were identified which stated that they selected patients for rehabilitation on the basis that they had rehabilitation potential [52,53,54] but robust operational definitions were not given. Badriah et al. , designed a retrospective measurement of rehabilitation potential based on the Functional Independence Measure (FIM), where rehabilitation potential was calculated by dividing the change in FIM total score at the beginning of rehabilitation therapy and hospital discharge by the FIM total score target (total maximum FIM minus FIM score at the start of rehabilitation). Rehabilitation potential was assumed to represent an improvement in functional abilities.
Who was involved in the assessment of rehabilitation potential
Rehabilitation potential assessments were completed by: physicians [27, 34, 40], rehabilitation nurses , untrained home care staff [3, 38], disability or medical assessors [24, 25, 28, 32, 33] or an MDT [17, 29]. It was unclear from all studies how assessments guided decision-making and who made the final decision about rehabilitation potential. Patients or clients and carers were included in rehabilitation assessments [24, 25, 30, 37, 44] but the extent of their involvement or influence on decision-making was unclear. Chang et al.  assessed the differences between self-perceived and carer-evaluated rehabilitation potential among care home residents in Taiwan. The study reported that 63.2% (n = 367) of residents believed that their physical function would improve, but just 9.8% (n = 57) of their caregivers deemed them to have rehabilitation potential.
Where rehabilitation potential was assessed
Assessments took place in outpatient geriatric clinics [28, 55], intermediate care units [48, 52], acute or subacute geriatric inpatient wards [32, 33, 41, 56, 57], inpatient rehabilitation units [17, 20, 28, 29, 36, 37, 53, 58,59,60,61], care homes [3, 28, 34, 35, 38, 40, 43, 44, 62], rehabilitation situated in care homes  and day hospitals [42, 54]. Some studies included multiple sites where rehabilitation took place in either the patient’s own home, inpatient setting or nursing homes [46, 48, 49]. In some studies it was unclear where the assessment of, or decision about, an individual’s rehabilitation potential took place [4, 18, 26, 27, 45, 47, 63].
When assessments of rehabilitation potential were completed
In studies which specifically explored rehabilitation potential, the decision that an individual did or did not have rehabilitation potential was predominantly made at a single time point. Assessments occurred at the time of deciding on patient suitability for admission to a rehabilitation unit , to guide care planning after a hospital admission [3, 17, 29], as a snapshot for a study  or during application for state benefits . Some studies used multiple time point assessments: at admission and discharge from rehabilitation services  and at baseline and one-year follow up . In other studies it was unclear when the assessment and decision was made [4, 27, 38, 47]. Some tools sought to assess individuals’ pre-morbid abilities in the hours or days leading up to a hospital admission [24, 25].
The use of formal decision-making frameworks
The identification of an individual’s rehabilitation potential was said to involve clinical judgement and reasoning [17, 21, 41], but there was limited evidence for the use of formal decision-making frameworks. In one study a Pre-Admission Screening checklist  was developed from a sample of 549 referrals over a six month period with medical charts reviewed for risk factors for readmission to acute care from a rehabilitation unit. A type of safety checklist was developed to guide decision making but was found to be largely subjective and unsubstantiated. Clinicians were asked to use a simple binary rating of yes, no or not applicable on absolute and relative contraindications to rehabilitation and on patients’ levels of motivation, and ability to tolerate and participate in rehabilitation.
Jupp et al.  developed a tool to aid clinicians in predicting outcomes after acute hospitalization and guide rehabilitation assessments. It was based on factors linked to discharges to residential or nursing home placements. The tool incorporated assessments of gait, eyesight, mental state and sedation (GEMS). In the validation study, patients admitted to care homes were found more likely to have abnormal vision, impaired cognitive abilities, gait abnormalities and taking sedative medications.
The interRAI ADL and IADL Clinical Assessment Protocols (CAP), developed for acute and community-dwelling populations [24, 25, 32, 33], provided decision-making frameworks for use in older and vulnerable populations. An overall score indicated whether the individual ‘triggered’ to prevent decline, facilitate improvement or triggered no action. A series of clinical prompts and care plans were then recommended to guide care planning. Two studies by Zhu et al. [4, 47] compared the use of CAPs with a computer algorithm to guide rehabilitation potential decision making in the Canadian home care setting. Findings indicated that both the K-nearest neighbour algorithm  and Support Vector Machine  had superior predictive powers for calculating rehabilitation potential and subsequent rehabilitation outcomes when compared to the ADLCAP. Further work to refine and operationalise these tools is required to understand the practical implications of applying big data to clinical decision-making.
Components of a rehabilitation potential assessment
Two studies recommended that holistic assessments were required which addressed biopsychosocial needs and abilities of patients [29, 45]. However, there was a lack of detail about the composition of these assessments. Key areas that were identified included: diagnoses and medication, functional abilities, mental health, social and environmental factors.
Diagnoses and medication
The evidence suggested a pertinent role for assessing co-morbidities and diagnoses [4, 18, 19, 21, 23, 28,29,30,31,32,33, 39,40,41, 46,47,48,49,50, 52, 54, 55, 58,59,60,61,62] which were likely to affect rehabilitation participation or outcome. These were typically measured by counting the type and number of underlying diseases [26, 39] or using the Charlson Co-morbidity Index . Medical stability was frequently seen as a prerequisite for an individual being able to take part in or tolerate rehabilitation . Common features of assessments included the identification of medications which may affect rehabilitation outcome or participation [24, 25, 32, 33, 39], nutritional status [24, 25, 32, 33, 39, 60], pain [21, 24, 25, 30, 32, 33, 61], continence [17, 25, 26, 39, 61], tissue viability  and communication including vision and hearing [24, 25, 30, 32, 33, 39, 46]. There was a lack of evidence to support the exact composition of medical components of rehabilitation potential assessments.
Assessing and identifying functional abilities was strongly represented in the data. They were largely assessed and understood through assessing ADLs [4, 19,20,21, 23,24,25, 27, 30, 32, 33, 35,36,37,38,39, 41, 42, 44, 46, 48,49,50, 53, 54, 59,60,61, 63, 64]. Some studies were more specific with their definitions of function such as mobility [4, 21, 47, 56, 61], transfers , or occupational abilities . Specific issues such as muscle strength neurological deficits or sensation [26, 34, 39] were included. Assessment of IADLs describing key life tasks such as managing finances, cleaning, shopping and meal preparation were identified [24, 25, 33, 61]. Impairments in IADL can often be present in those with mild cognitive deficits and the early stages of dementias  so may be an important indicator of cognitive abilities and function.
Mental health and psychological abilities
Establishing an individual’s psychological abilities or deficits was frequently included in rehabilitation potential assessments [20, 30, 31, 41, 49, 50, 60]. Studies cited that they specifically considered individuals cognitive abilities [4, 18, 20, 21, 23,24,25, 32, 33, 39, 42, 44, 46, 49, 50, 53, 60]. Gray et al.  stated that assessing cognitive skills for decision-making was essential, specifically short term memory recall, procedural and situational memory. An assessment of motivation , mood [24, 25, 32, 37, 39, 46], disruptive behaviours [21, 24, 25, 29, 30, 39, 40, 46] and depression [23, 24, 30, 39, 46] were also found to be included. Motivation was described as being present if the patient was eager to participate in therapy and took responsibility for being actively involved in their self-care . The Kemp model of motivation  was proposed, taking into account patient wants, beliefs and rewards, offset by the costs of participating in the rehabilitation programme.
An assessment of rehabilitation potential was found to require an understanding of an individual’s social circumstances [18, 21, 22, 35, 37, 39, 46, 52]. Understanding social status and conditions were important factors in determining the recovery of older community dwelling adults who received intermediate care rehabilitation following an acute hospital admission  where the ability to live at home was reported to be a “good and practical measure of recovery”. Social situation, where an individual lives and the type of support they received were found to be strong predictors of rehabilitation outcome . Mosqueda  outlined that understanding the reliability and number of existing social support mechanisms were essential components of rehabilitation potential assessments. Caradoc-Davies et al.  explored the perceived benefits of rehabilitation between health professionals and clients, finding that those with strong social support mechanisms were more positive about the potential benefits of rehabilitation.
The literature highlighted the need to assess an individual’s environment [27,28,29,30, 54]. Mosqueda  suggested that environmental assessments should include understanding the environment of the usual place of residence and the current or proposed rehabilitation venue. This view was supported by Nagi , who stated that the environment should be considered in terms of the individuals’ level of functioning within that specific environment, suggesting that assessments were context-specific.
How rehabilitation potential was measured
A number of measures were identified in studies specific to rehabilitation potential. Chang et al.  found significant disagreement between residents and caregivers on whether they thought rehabilitation would improve a residents ADL’s. Myers et al.  found a significant relationship between nurses assessment of rehabilitation potential at admission and functional status as measured through ADLs at discharge (r = 0.20, R2 = 0.04, P < 0.001). Cunningham et al.  proposed a binary response where members of the MDT were asked to rate the rehabilitation potential of 27 consecutive patients admitted onto a geriatric rehabilitation ward as either good or poor. They found that agreement between professionals was poor (kappa = 0.21).
Other studies adopted retrospective measures, comparing outcome measures before and after rehabilitation programmes. Measures adopted included changes in individuals ADL functioning [4, 47] where gains were seen as a positive affirmation of rehabilitation potential.
New  developed a traffic light system to classify a patient’s appropriateness for rehabilitation and by proxy their rehabilitation potential. This model, developed by expert opinion, proposed that ‘green light’ patients were always appropriate for rehabilitation, those with conversion and personality disorders, obesity or specialist nursing needs were classified as ‘orange’ (proceed with caution) and for patients with limited life expectancy, lack of capacity and severe dementia as red and not appropriate for rehabilitation. This system was not however designed specifically for older people, rather for a heterogeneous inpatient population.
Most aspects of medical interventions were not measured or categorized in a way that could be easily reported. Those that were quantifiable were largely measures of frailty or symptom scores.
Morghen et al.  was the only study which sought to measure and evaluate the impact that patient participation had on predicting rehabilitation gains or outcomes. They found that participation was independently associated with functional gain in an older people’s inpatient rehabilitation setting. Participation was assessed using the Pittsburgh Rehabilitation Participation Scale (PRPS) , and functional gain was measured using the Montebello Rehabilitation Factor Score . The PRPS measures participation during therapy sessions, where clients were rated using a Likert Scale of 1–6 (1 = refusal to participate in a session and 6 = excellent participation in all exercises, taking an active interest in exercise and/or future therapy sessions). Moseley et al.  and Wells et al.  proposed the Goal Attainment Scale to measure rehabilitation outcomes, whereby patient-centred goals are set and percentage attainment was measured.
External factors influencing the assessment of rehabilitation potential
Staff skills, training and experience were found to affect the transaction of rehabilitation potential assessments [26, 29, 38, 64]. Two separate concepts emerged from the literature: the skills of staff to assess rehabilitation potential and skills for providing rehabilitation interventions. Fortinsky  proposed that training and clinical judgement were key factors, stating that older adults with complex needs may never reach the ideal of maximised function due to clinical judgements and policy guidelines that carry vague and conflicting messages about rehabilitation potential. Moseley  and Mofina and Guthrie  suggested that staff needed a thorough understanding of referral criteria to rehabilitation services in order to decide on the suitability of individuals to rehabilitation.
Funding and availability of resources were considered in rehabilitation potential assessments. Mosqueda  stated that economic reality influenced rehabilitation potential, whereby resources are limited or rationed through government commissioning or insurance. Although an individual may demonstrate gains from rehabilitation during their inpatient stay, if resources are not available to continue programmes of rehabilitation, gains may not be maintained and benefit may therefore not be realised. In this context, Gordon  found that staff over-estimated an individual’s rehabilitation potential for fear of omission; in other words, they offered rehabilitation even if they were unsure of the benefit. This ethical dilemma is further supported by New  who highlighted the tensions clinicians faced in allocating resources including the potential for injustice and bias, utility and beneficence and how these factors may influence the decision that an individual does or does not have rehabilitation potential.
Markers of success
The majority of studies identified in this review included patients who had been deemed to have rehabilitation potential, rather than studies which explored or tested the assessment of rehabilitation potential. As a consequence, a successful outcome of rehabilitation potential was frequently linked to rehabilitation outcomes specific to the study design, aims and objectives.
Frequently, improvement was identified as the optimum outcome associated with rehabilitation or rehabilitation potential amongst older people. Improvement was described as a return to premorbid abilities or an improvement in function [3, 4, 17, 18, 24,25,26, 32,33,34, 37, 40, 41, 45,46,47,48,49,50, 52, 53, 58, 60, 64]. However, some studies recognised that improvement may not always be feasible in this population. Muller et al., Gray et al. and Fusco et al. [24, 35, 39] stated that maintaining an individual’s current status and abilities was also a successful outcome. Poulos et al.  further embraced this notion, proposing that reablement programmes in dementia should go beyond improvement and consider maintenance and managing or delaying declining abilities. Assessments should identify and address causes of functional decline discrete from the natural progression of the underlying dementia diagnosis, such as medication management, acute or comorbid medical conditions, deconditioning or lack of activity.
This study found considerable variations in definitions of rehabilitation potential and in some cases, an absence of definition. Rehabilitation potential was found to encompass two different, but inter-related, concepts of prognostication and outcome measurement. Prognostic rehabilitation potential described the prediction of what could be achieved through rehabilitation, whereas outcome-based rehabilitation potential considered what had been achieved. The locations of rehabilitation potential assessments were highly contextualized by the study designs and aims.
Prognosis involves the prediction of the future course and outcome of disease processes concerning either their natural course or outcome after treatment . Prognostic methods in medical and rehabilitation decision-making allow for wider contextual factors to be taken into account . These factors are commonly affected by frailty, old age and multi-morbidity. Single conditions and diagnoses are more predictable in terms of their trajectories and response to treatment, however, multi-morbidity, frailty and acute ill health make for a very unpredictable rehabilitation context . In contemporary clinical practice, older people living with frailty frequently present with acute illnesses superimposed on underlying conditions and physiological decline. This presents clinicians with particular challenges in understanding and predicting recovery [72, 73] and challenges researchers in establishing the effectiveness of rehabilitation interventions.
Rehabilitation potential was also found to be used as a proxy for entry criteria into rehabilitation studies. In that patients deemed not to have rehabilitation potential were excluded from studies based on the belief that they would not benefit or respond to rehabilitation interventions. This frequently included those with moderate to severe levels of cognitive impairment [19, 52, 64] who are regular recipients of in-patient hospital care. If the evidence base for frailty rehabilitation is to progress, patients with cognitive impairment must be recruited to studies so that their true rehabilitation potential can be understood. There have been suggestions that the term rehabilitation potential may lead to rationing of services particularly in older adults with cognitive impairments . Age based rationing of services presents significant practical and ethical challenges in terms of allocation of services and resources and the term rehabilitation potential may further reinforce outdated notions of rehabilitation benefit .
Rehabilitation potential was used as a measure of rehabilitation outcome, in that individuals ‘had rehabilitation potential’ if they achieved favourable outcomes. Based on retrospective analysis, these variables help inform clinicians’ predictions of what an individual may be capable of, but in isolation they do not capture the complexity of human behaviour and nuances of frailty and multimorbidity. However, Enderby et al.  warn that variables which are strong predictors may hide the subtleties associated with an individual’s recovery and clinical decision-making.
Unsurprisingly, domains relevant to the World Health Organization’s International Classification of Functioning, Disability, and Health (WHO ICF)  featured prominently in the findings of this mapping review. This may be explained by the use of the ICF in the a priori analytical framework but is also indicative of the impact that the ICF has had on contemporary clinical practice. This study has demonstrated that knowledge of physical attributes and underlying diseases and conditions are integral to assessments of rehabilitation potential. Findings from this study draw many parallels with Comprehensive Geriatric Assessment (CGA) models of care which seek to provide an iterative approach of assessment and case management focus on medical, mental health, functional capacity, environmental and social circumstances [74, 75]. CGA aims to place patient and carers needs at the centre of the relationship through the use of targeted goal setting which enables interventions, such as rehabilitation to be identified, delivered and revewied. This review identified evidence to support the assessment of medical, mental health and functional abilities in terms of rehabilitation potential but limited evidence to focus on environment and social circumstances. Recent literature has suggested that spirituality and economic status should also be considered for a truly holistic assessment , but no supporting evidence for the inclusion of these domains in an assessment of rehabilitation potential was identified in this review.
Personal and participatory factors are part of the ICF  and this study found that motivation and participation played a key role in assessments of rehabilitation potential. Motivation is a complex construct that has been widely explored in relation to rehabilitation in traumatic brain injury, stroke and sports medicine but less frequently amongst older people living with frailty. Siegert et al.  propose that exploring an individual’s motivation, emotions and goals allows for an understanding of how they will react with rehabilitation programmes, whereas prognosis or prediction considers variables and outcomes. Rehabilitation potential assessments should consider prognostic, performance and participatory approaches for maximal rehabilitation outcomes to be achieved. Commonly cited ‘barriers’ to rehabilitation such as poor cognition and low mood  can all have a profound impact on an individuals’ ability to be motivated to take part in and achieve beneficial outcomes from rehabilitation interventions. It remains unclear which items within these tools best correlate to or predict rehabilitation potential in older people living with frailty.
It is clear that solely focusing on the physical effects of frailty will not address the complex, highly individualised and fluctuating needs of older people living with frailty. Clinicians need to consider the wider social implications of ageing and the impact these have on continued quality of life and control over individuals lives. The inclusion of environmental and social domains of assessment identified during this review may go some way to remedy this medical and physical bias, but further evidence is needed to understand how these domains relate to rehabilitation potential. Rehabilitation potential was largely assessed at singular time points, with subsequent reviews of outcome measures completed retrospectively.
Strengths and limitations
Due to the heterogeneous nature of frailty presentations and rehabilitation interventions a mapping review was ideally suited to map this complex field. This enabled the context and mechanism of frailty rehabilitation to be explored, essential in understanding complex interventions .
Of the 49 studies included in this review, 24 were from either Anglophone countries (UK, USA, Canada or America) or from European countries which have a tradition in publishing in English language journals. The predominance of studies from Anglophone countries may represent selection bias by limiting selection criteria to the English language. Asian countries have been found to publish less frequently , but this study included three publications from Asian countries and a total of six international collaborations.
This study excluded evidence from books and hence the most commonly cited definition of rehabilitation potential by Rentz . Whilst academic books are subject to editorial review, they do not always undergo the same scrutiny as articles in peer-reviewed journals. These sources, commonly classified as grey literature, are frequently excluded from evidence appraisal methods, but can provide new insights and help contextualise research evidence .
It proved challenging to identify studies which solely explored rehabilitation potential in relation to frailty. This may represent a limitation in search terms or engines used, but more likely represents the lack of evidence in rehabilitation decision-making and the emerging field of frailty rehabilitation. The studies included in this review comprised a broad range of clinical conditions and patient groups. This study sought to exclude articles which included patient participants in receipt of specialist stroke, palliative and fracture services. However, many of the studies identified included patients with these diagnoses.
This review identified considerable heterogeneity in definitions and use of the term rehabilitation potential and in some cases an absence of definition despite it being used as an entry criterion into a study. It was found to be poorly understood and judged differently by different people at different times. Rehabilitation potential was found to encompass two different but interrelated concepts of prognostication and outcome measurement. Limited evidence was identified which specifically considered rehabilitation potential amongst older people living with frailty. Current tools and approaches provide a snapshot of an individual’s abilities and conditions which failed to capture the dynamic nature and fluctuations associated with frailty and rehabilitation. Snapshot approaches further enhance the risk of age-based rationing of services where those who might benefit from rehabilitation are denied access to interventions. New aggregative approaches to measures and abilities over time are required which allow for the prognostication of outcomes and potential benefits of rehabilitation interventions for older people living with frailty.
Availability of data and materials
The datasets used and analysed during the current study are available from the corresponding author on reasonable request.
Activities of Daily Living
Clinical Assessment Protocol
Comprehensive Geriatric Assessment
Functional Independence Measure
Instrumental Activities of Daily Living
- WHO ICF:
World Health Organization International Classification of Functioning, Disability and Health
Oliver D, Foot C, Humphries R. Making our health care systems fit for an ageing population. London: The Kings Fund; 2014.
NHS RightCare. NHS RightCare: frailty toolkit: NHS England; 2019 [https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2019/07/frailty-toolkit-june%2D%2Dv1.pdf].
Chang YY, Peng LN, Lin MH, Lai HY, Chen LK, Hwang SJ, et al. Who determines the rehabilitation needs of care home residents? An observational survey. Arch Gerontol Geriatr. 2011;52(2):138–41. https://doi.org/10.1016/j.archger.2010.03.002.
Zhu M, Chen W, Hirdes JP, Stolee P. The K-nearest neighbor algorithm predicted rehabilitation potential better than current clinical assessment protocol. J Clin Epidemiol. 2007;60(10):1015–21. https://doi.org/10.1016/j.jclinepi.2007.06.001.
Poynter L, Kwan J, Sayer AA, Vassallo M. Does cognitive impairment affect rehabilitation outcome? J Am Geriatr Soc. 2011;59(11):2108–11. https://doi.org/10.1111/j.1532-5415.2011.03658.x.
Rentz D. The assessment of rehabilitation potential: cognitive factors. In: Hartk R, editor. Psychological aspects of geriatric rehabilitation. Aspen: Gaithersburg; 1991.
Poduri RK, Cushman AL, Gibson JC. Inpatient rehabilitation: the correlation between functional gains and appropriateness of admissions. Int J Rehabil Res. 1996;19(4):327–32. https://doi.org/10.1097/00004356-199612000-00005.
Enderby P, Pandyan A, Bowen A, Hearnden D, Ashburn A, Conroy P, et al. Accessing rehabilitation after stroke – a guessing game? Disabil Rehabil. 2017;39(7):709–13. https://doi.org/10.3109/09638288.2016.1160448.
Goodwin VA, Allan LM. 'Mrs Smith has no rehab potential': does rehabilitation have a role in the management of people with dementia? Age Ageing. 2019;48(1):5–7. https://doi.org/10.1093/ageing/afy152.
Cowley A. Assessment of Rehabilitation Potential in Frail Older People in the Acute Healthcare Setting: A Mixed Methods Study. Online: https://eprints.nottingham.ac.uk/etheses/: University of Nottingham; 2020.
Cowley A, Goldberg SE, Gordon AL, Kerr M, Logan P. Exploring rehabilitation potential in older people living with frailty: a qualitative focus group study. BMC Geriatr. 2021;21(1):165. https://doi.org/10.1186/s12877-021-02107-y.
Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal. 2009;26(2):91–108. https://doi.org/10.1111/j.1471-1842.2009.00848.x.
Maike-Lye IM, Hempel S, Shanman R, Shekelle PG. What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products. Systematic Reviews. 2016;10(5):28. https://doi.org/10.1186/s13643-016-0204-x.
Mays N, Roberts E, Popay J. Synthesising research evidence. In: Fulop N, Allen P, Clarke A, Black N, editors. Studying the organisation and delivery of health services: research methods. London: Routledge; 2001. p. 188–220.
Vom Brocke J, Simons A, Niehaves B, Riemer K, Plattfaut R, Cleven A. Reconstructing the giant: on the importance of rigour in documenting the literature search process. ECIS Proceedings. 2009;161:2206–17.
World Health Organisation. Towards a Common Language for Functioning, Disability and Health - ICF [Online] http://who.int/classifications/icf/training/icfbeginnersguide.pdf: World Health Organisation; 2002.
Cunningham C, Horgan F, Neill D. Clinical assessment of rehabilitation potential of the older patient: a pilot study. Clin Rehabil. 2000;14(2):205–7. https://doi.org/10.1191/026921500668895760.
Hoenig H, Mayer-Oakes SA, Siebens H, Fink A, Brummel-Smith K, Rubenstein LV. Geriatric rehabilitation: what do physicians know about it and how should they use it? J Am Geriatr Soc. 1994;42(3):341–7. https://doi.org/10.1111/j.1532-5415.1994.tb01762.x.
Jette DU, Grover L, Keck CP. A qualitative study of clinical decision making in recommending discharge placement from the acute care setting. Phys Ther. 2003;83(3):224–36. https://doi.org/10.1093/ptj/83.3.224.
McPhail SM, Nalder E, Hill AM, Haines TP. Physiotherapists have accurate expectations of their patients' future health-related quality of life after first assessment in a subacute rehabilitation setting. Biomed Res Int. 2013;2013:340371–8. https://doi.org/10.1155/2013/340371.
Myers JS, Grigsby J, Teel CS, Kramer AM. Nurses' assessment of rehabilitation potential and prediction of functional status at discharge from inpatient rehabilitation. Int J Rehabil Res. 2009;32(3):264–6. https://doi.org/10.1097/MRR.0b013e32832a62c2.
Aspinal F, Glasby J, Rostgaard T, Tuntland H, Westendorp RG. New horizons: Reablement - supporting older people towards independence. Age Ageing. 2016;45(5):572–6. https://doi.org/10.1093/ageing/afw094.
Everink I, van Haastregt J, van Hoof S, Schols J, Kempen G. Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review. BMC Geriatrics. 2016;16(6).
Gray L, Arino-Blasco S, Berg K, Bernabei R, Carpenter I, Finne-Soveri H, et al. interRAI Acute Care (AC) Assessment Form and User's Manual. Version 9.1.: interRAI Publications; 2016.
Gray L, Arino-Blasco S, Berg K, C. B, Gambassi G, Heckman G, et al. interRAI Clinical and Management Applications Manual. Scales, Screeners, Problems, Clinical Action Points and Quality Indicators. Version 9.1. https://catalog.interrai.org/content/interrai-clinical-and-management-applications-manual-use-interrai-acute-care-assessment ed: interRAI; 2016.
Moseley C. A functional outcome-based approach to evaluate the quality of geriatric rehabilitation. Physical & Occupational Therapy in Geriatrics. 1994;12(3):51–64. https://doi.org/10.1080/J148V12N03_04.
Mosqueda LA. Assessment of rehabilitation potential. Clin Geriatr Med. 1993;9(4):689–703. https://doi.org/10.1016/S0749-0690(18)30371-9.
Nagi SZ. A study in the evaluation of disability and rehabilitation potential: concepts, methods, and procedures. American Journal of Public Health & the Nation's Health. 1964;54(9):1568–79. https://doi.org/10.2105/AJPH.54.9.1568.
New P. The assessment and selection of potential rehabilitation patients in acute hospitals: a literature review and commentary. The Open Rehabilitation Journal. 2009;2(1):24–34. https://doi.org/10.2174/1874943700902010024.
Poulos CJ, Bayer A, Beaupre L, Clare L, Poulos RG, Wang RH, et al. A comprehensive approach to reablement in dementia. Alzheimer's & Dementia: Translational Research & Clinical Interventions. 2017;3(3):450–8. https://doi.org/10.1016/j.trci.2017.06.005.
Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment. Archives of Physical Medicine & Rehabilitation. 2003;84(6):890–7. https://doi.org/10.1016/S0003-9993(02)04929-8.
Morris J, Berg K, Bjorkgren M, Finne-Soveri H, Fries B, Fritjers D, et al. interRAI Clinical Assessment Protocols (CAPS) 9.2.1 ADL. Ontario: interRAI Publications; 2010.
Morris J, Berg K, Bjorkgren M, Finne-Soveri H, Fries B, Fritjers D, et al. interRAI Clinical Assessment Protocols (CAPS) 9.2.1 IADL. Ontario: interRAI Publications; 2010.
Reynolds F, Abramson M, Young A. The rehabilitation potential of patients in chronic disease institutions. Journal of Chronic Disease. 1959;10(2):152–9. https://doi.org/10.1016/0021-9681(59)90029-3.
Muller JN, Tobis JS, Kelman HR. The rehabilitation potential of nursing home residents. American Journal of Public Health & the Nation's Health. 1963;53(2):243–7. https://doi.org/10.2105/AJPH.53.2.243.
Cameron ID, Schaafsma FG, Wilson S, Baker W, Buckley S. Outcomes of rehabilitation in older people--functioning and cognition are the most important predictors: an inception cohort study. J Rehabil Med. 2012;44(1):24–30. https://doi.org/10.2340/16501977-0901.
Caradoc-Davies TH, Dixon GS, Campbell AJ. Benefit from admission to a geriatric assessment and rehabilitation unit. Discrepancy between health professional and client perception of improvement. J Am Geriatr Soc. 1989;37(1):25–8. https://doi.org/10.1111/j.1532-5415.1989.tb01564.x.
Fortinsky R. How much rehabilitation potential is in long-term care? Using data for informed practice. Topics in Geriatric Rehabilitation. 1993;9(1):1–10. https://doi.org/10.1097/00013614-199309000-00003.
Fusco D, Bochicchio GB, Onder G, Barillaro C, Bernabei R, Landi F, et al. Predictors of rehabilitation outcome among frail elderly patients living in the community. J Am Med Dir Assoc. 2009;10(5):335–41. https://doi.org/10.1016/j.jamda.2009.02.004.
Gordon E. A study of rehabilitation potential in nursing home patients over 65 years. Journal of Chronic Disease. 1962;15(3):311–26. https://doi.org/10.1016/0021-9681(62)90014-0.
Hartley P, Alexander K, Adamson J, Cunningham C, Embleton G, Romero-Ortuno R. Association of cognition with functional trajectories in patients admitted to geriatric wards: a retrospective observational study. Geriatr Gerontol Int. 2017;17(10):1438–43. https://doi.org/10.1111/ggi.12884.
Hershkovitz A, Brill S. The association between patients' cognitive status and rehabilitation outcome in a geriatric day hospital. Disability & Rehabilitation. 2007;29(4):333–7. https://doi.org/10.1080/09638280600787096.
Arling G, Williams AR, Kopp D. Therapy use and discharge outcomes for elderly nursing home residents. Gerontologist. 2000;40(5):587–95. https://doi.org/10.1093/geront/40.5.587.
Chou K-L, Chi I. Leung AC-t, Wu YM, Liu C-P. validation of minimum data set for nursing home in Hong Kong Chinese elders. Clin Gerontol. 2001;23(1–2):43–54. https://doi.org/10.1300/J018v23n01_05.
Mofina AM, Guthrie DM. A comparison of home care quality indicator rates in two Canadian provinces. BMC Health Serv Res. 2014;14(1):37. https://doi.org/10.1186/1472-6963-14-37.
Sinn CL, Tran J, Pauley T, Hirdes J. Predicting Adverse Outcomes After Discharge From Complex Continuing Care Hospital Settings to the Community. Professional Case Management. 2016;21(3):127–36;.
Zhu M, Zhang Z, Hirdes JP, Stolee P. Using machine learning algorithms to guide rehabilitation planning for home care clients. BMC Medical Informatics & Decision Making. 2007;7(1):41. https://doi.org/10.1186/1472-6947-7-41.
Johansen I, Lindbaek M, Stanghelle JK, Brekke M. Structured community-based inpatient rehabilitation of older patients is better than standard primary health care rehabilitation: an open comparative study. Disability & Rehabilitation. 2012;34(24):2039–46. https://doi.org/10.3109/09638288.2012.667193.
Johansen I, Lindbaek M, Stanghelle JK, Brekke M. Effective rehabilitation of older people in a district rehabilitation Centre. J Rehabil Med. 2011;43(5):461–4. https://doi.org/10.2340/16501977-0792.
Johansen I, Lindbak M, Stanghelle JK, Brekke M. Independence, institutionalization, death and treatment costs 18 months after rehabilitation of older people in two different primary health care settings. BMC Health Serv Res. 2012;12(1):400. https://doi.org/10.1186/1472-6963-12-400.
Norwegian Government. Responsibility and empowerment. Norway. 1998.
Abrahamsen JF, Haugland C, Nilsen RM, Ranhoff AH. Three different outcomes in older community-dwelling patients receiving intermediate Care in Nursing Home after acute hospitalization. Journal of Nutrition, Health & Aging. 2016;20(4):446–52. https://doi.org/10.1007/s12603-015-0592-y.
Badriah F, Abe T, Miyamoto H, Moriya M, Babazono A, Hagihara A. Interaction effects between rehabilitation and discharge destination on inpatients' functional abilities. Journal of Rehabilitation Research & Development. 2013;50(6):821–34. https://doi.org/10.1682/JRRD.2012.08.0153.
Eagle DJ, Guyatt GH, Patterson C, Turpie I, Sackett B, Singer J. Effectiveness of a geriatric day hospital. CMAJ Canadian Medical Association Journal. 1991;144(6):699–704.
Aberg AC, Lindmark B, Lithell H. Evaluation and application of the general motor function assessment scale in geriatric rehabilitation. Disability & Rehabilitation. 2003;25(7):360–8. https://doi.org/10.1080/0963828031000093468.
Haley MN, Wells YD, Holland AE. Relationship between frailty and discharge outcomes in subacute care. Aust Health Rev. 2014;38(1):25–9. https://doi.org/10.1071/AH13067.
Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM. Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ. 2010;340(7758).
Alekseyev K, Fallon Z, Cristian A, Ross M. Development of a pre-admission screening checklist to minimize acute discharges from an inpatient rehabilitation facility: a quality improvement initiative. Patient Safety & Quality Improvement Journal. 2016;5(1):488–92.
Jupp BJ, Mallela SK, Kwan J, Allen S, Sharma JC, Vassallo M. Development and evaluation of the GEMS (gait, eyesight, mental state, sedation) tool as an aid to predict outcome after hospitalization. Geriatr Gerontol Int. 2011;11(1):8–15. https://doi.org/10.1111/j.1447-0594.2010.00626.x.
Morghen S, Morandi A, Guccione AA, Bozzini M, Guerini F, Gatti R, et al. The association between patient participation and functional gain following inpatient rehabilitation. Aging-Clinical & Experimental Research. 2017;29(4):729–36. https://doi.org/10.1007/s40520-016-0625-3.
Stolee P, Stadnyk K, Myers AM, Rockwood K. An individualized approach to outcome measurement in geriatric rehabilitation. Journals of Gerontology Series A-Biological Sciences & Medical Sciences. 1999;54(12):M641–7. https://doi.org/10.1093/gerona/54.12.M641.
Arling G, Nordquist RH, Brant BA, Capitman JA. Nursing home case mix. Patient classification by nursing resource use. Med Care. 1987;25(1):9–19. https://doi.org/10.1097/00005650-198701000-00002.
Seematter-Bagnoud L, Lecureux E, Rochat S, Monod S, Lenoble-Hoskovec C, Bula CJ. Predictors of functional recovery in patients admitted to geriatric postacute rehabilitation. Arch Phys Med Rehabil. 2013;94(12):2373–80. https://doi.org/10.1016/j.apmr.2013.06.024.
Singh I, Gallacher J, Davis K, Johansen A, Eeles E, Hubbard RE. Predictors of adverse outcomes on an acute geriatric rehabilitation ward. Age Ageing. 2012;41(2):242–6. https://doi.org/10.1093/ageing/afr179.
Farias ST, Lau K, Harvey D, Denny KG, Barba C, Mefford AN. Early functional limitations in cognitively Normal older adults predict diagnostic conversion to mild cognitive impairment. J Am Geriatr Soc. 2017;65(6):1152–8. https://doi.org/10.1111/jgs.14835.
Kemp JB. Motivation, rehabilitation, and aging: a conceptual model. Topics in Geriatric Rehabilitation. 1988;3(3):41–51. https://doi.org/10.1097/00013614-198804000-00008.
Lenze EJ, Munin MC, Quear T, Dew MA, Rogers JC, Begley AE, et al. The Pittsburgh rehabilitation participation scale: reliability and validity of a clinician-rated measure of participation in acute rehabilitation. Arch Phys Med Rehabil. 2004;85(3):380–4. https://doi.org/10.1016/j.apmr.2003.06.001.
Drubach D, Kelly M, Taragano F. The Montebello rehabilitation factor score. Journal of Neurorehabilitation. 1994;8:92–6.
Lucas PJF, Abu-Hanna A. Prognostic methods in medicine. Artif Intell Med. 1999;15(2):105–19. https://doi.org/10.1016/S0933-3657(98)00047-5.
Croft P, Altman DG, Deeks JJ, Dunn KM, Hay AD, Hemingway H, et al. The science of clinical practice: disease diagnosis or patient prognosis? Evidence about “what is likely to happen” should shape clinical practice. BMC Medicine. 2015;13(20).
Bone AE, Morgan M, Maddocks M, Sleeman KE, Wright J, Taherzadeh S, et al. Developing a model of short-term integrated palliative and supportive care for frail older people in community settings: perspectives of older people, carers and other key stakeholders. Age Ageing. 2016;45(6):863–73. https://doi.org/10.1093/ageing/afw124.
Zisberg A, Sinoff G, Agmon M, Tonkikh O, Gur-Yaish N, Shadmi E. Even a small change can make a big difference: the case of in-hospital cognitive decline and new IADL dependency. Age Ageing. 2016;45(4):500–4. https://doi.org/10.1093/ageing/afw063.
Hatheway OL, Mitnitski A, Rockwood K. Frailty affects the initial treatment response and time to recovery of mobility in acutely ill older adults admitted to hospital. Age Ageing. 2017;46(6):920–5. https://doi.org/10.1093/ageing/afw257.
Stuck AE, Iliffe S. Comprehensive geriatric assessment for older adults. BMJ. 2011;343(oct27 1):d6799. https://doi.org/10.1136/bmj.d6799.
Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood R, et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2017;9(9). https://doi.org/10.1002/14651858.CD006211.pub3.
Volpato S, Guralnik J. The different domains of the comprehensive geriatric assessment. In: Pilotto A, Martin F, editors. Comprehensive geriatric assessment (practical issues in geriatrics). Switzerland: Springer International Publishing; 2018. p. 11–25. https://doi.org/10.1007/978-3-319-62503-4_2.
Siegert RJ, Taylor WJ. Theoretical aspects of goal-setting and motivation in rehabilitation. Disabil Rehabil. 2004;26(1):1–8. https://doi.org/10.1080/09638280410001644932.
Lord S, Rochester L. Role of the physiotherapist in the management of dementia. In: Ames D, O'Brien JT, Burns A, editors. Dementia. 5th edition. 5th edition ed. Boca Raton, FL: CRC Press; 2017. p. 220–228.
Sermeus W. Modelling process and outcomes in complex interventions. In: Richards D, Rahm Hallberg I, editors. Complex interventions in health: an overview of research methods. London: Routledge; 2015. p. 111–20.
Man J, Weinkauf J, Tsang M, Sin J. Why do some countries publish more than others? An international comparison of research funding, English proficiency and publication output in highly ranked general medical journals. Eur J Epidemiol. 2004;19(8):811–7. https://doi.org/10.1023/b:ejep.0000036571.00320.b8.
Adams RJ, Smart P, Huff AS. Shades of Grey: guidelines for working with the Grey literature in systematic reviews for management and organizational studies. Int J Manag Rev. 2017;19(4):432–54. https://doi.org/10.1111/ijmr.12102.
This report is independent research arising from a Clinical Doctoral Research Fellowship (Integrated Clinical Academic Programme) held by Alison Cowley ICA-CDRF-2016-02-015 which was supported by the National Institute for Health Research (NIHR) and Health Education England (HEE). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, HEE or the Department of Health and Social Care.
Ethics and consent to participate
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Cowley, A., Goldberg, S.E., Gordon, A.L. et al. Rehabilitation potential in older people living with frailty: a systematic mapping review. BMC Geriatr 21, 533 (2021). https://doi.org/10.1186/s12877-021-02498-y
- Frail elderly
- Geriatric assessment