47 Rehabilitants and informal caregivers’ perspectives of a Challenging Rehabilitation Environment Introduction The demand for Geriatric Rehabilitation (GR) in Europe increases with the ageing of the population.1 After hospitalization, 11% of those aged ≥ 75 years are referred to a post-acute geriatric rehabilitation unit.2 Common reasons for hospitalization of older persons are cardiac events, infections, fall-related injuries, stroke, cancer, or medical/surgical interventions.3 In 2019, 53.320 rehabilitants in the Netherlands were referred for GR.4 GR is defined as ‘a multidimensional approach of diagnostic and therapeutic interventions, the purpose of which is to optimize functional capacity, promote activity and preserve functional reserve and social participation in older people with disabling impairments’.5 Persons who are rehabilitating are trying to adapt and self-manage their current condition. In line with the ideas on positive health of Huber et al., we have chosen not to label persons during their rehabilitation as patients, but to use the term “rehabilitants” when referring to them.6 A Challenging Rehabilitation Environment (CRE) is a relatively new concept which involves the comprehensive organization of care and support by the rehabilitation team, as well as the environment in which the rehabilitation takes place.7,8 Knowledge about this concept may improve the rehabilitation outcomes of rehabilitants, e.g. in terms of functional recovery, length of stay, (health-related) quality of life and lower caregiver burden.8 In a review, seven main components for modelling CRE were identified: 1) therapy time, 2) group training, 3) patient-regulated exercise, 4) family participation, 5) task-oriented training, 6) enriched environment, and 7) team dynamics.8 Because there is no official definition of CRE, there are considerable differences between wards in the interpretation and execution of CRE. Therefore, it is not certain that the beforementioned components cover all aspects of CRE. In addition, it is unknown which components rehabilitants and their informal caregivers consider relevant for a CRE. The aim of rehabilitation is to optimize the level of 3
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