Additional treatment for caregiver exhaustion include; therapy [ 13, 19, 21], hospitalization [ 31], temporary respite or temporary admission to nursing home [ 23, 24, 38- 40] and institutionalization [ 19, 21, 34].
Age has been found to be a strong and consistent predictor of admission to a nursing home [ 8- 15], as has the need for care, with lower physical and mental health status associated with an increased risk of institutionalization [ 7, 9, 10, 14, 16, 17].
Studies of these rehabilitation programmes for older people in general-, orthopedic- and stroke rehabilitation report higher long-term levels of independence [ 8, 29, 33- 35] and lower long-term levels of institutionalization [ 8, 33, 35] and mortality [ 8, 29, 35, 36].
The general approach to studying older people's health has been to look at relationships among measures of chronic conditions, cognition, frailty and steps along the disablement pathway [ 1- 4]; the goals have been to identify determinants and rates of decline and recovery [ 5- 14], and predict mortality [ 15], institutionalization [ 16, 13], and service utilization [ 17- 21].
Interventions showed increased caregivers' sense of competence [ 19, 20], stabilized caregivers' well-being [ 21, 22] to sustained benefit in reducing depressive symptoms [ 23], changed caregiver's appraisals of patient behavioral problems [ 24], and, lastly, postponement of patients' institutionalization [ 19, 20, 25- 28], although there is lack of strong findings in general [ 18, 29, 30].
Hip fractures are associated with functional impairment [ 3], poor health-related quality of life [ 4], institutionalization [ 5, 6] and mortality [ 6- 8].
We tested intra class coefficients to control for team level variance; for Routinization, ICC =.05, F 62,38) = 1.08; and for Institutionalization, ICC =.20, F 62,38) = 1.41 (both n.s.; variables were based on the long version).
This importance is mainly due to the large evidence that physical function measures are not only associated with clinical and subclinical age-related modifications[ 2, 3], but are also able to predict future health-related events, including disability[ 4, 5], institutionalization [ 6- 8], and mortality[ 6, 9].
Some studies have reported positive effects of home care services including reductions in functional decline [ 6- 10], mortality rates [ 11- 15], institutionalization rates [ 8, 10, 12, 16- 18] and costs of care [ 19].
Inadequate social or caregiver networks predict mortality and contribute to other poor healthcare outcomes [ 13, 14], including institutionalization [ 15, 16].
6 In addition to fatal and severe injuries such as hip fractures and head injuries, the consequences of falls are broad and contribute to immobility and premature institutionalization. 1, 7, 8 Prospective cohort studies indicate that falls seem to be an independent determinant for functional decline and dependency in activities of daily living (ADL) in a general elderly population.
