Post-discharge home-based rehabilitation for frail older adults a scoping review of environmental support strategies for functional recovery and aging-in-place

Abstract

Frail older adults commonly experience functional decline following hospitalization, increasing the risks of disability, hospital readmission, institutionalization, and loss of independence. Although post-discharge home-based rehabilitation has been widely implemented to support recovery, the environmental support strategies incorporated into these programs have not been comprehensively synthesized. This scoping review aimed to map the current evidence on post-discharge home-based rehabilitation and environmental support strategies for frail older adults and to identify knowledge gaps for future research. This scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported following the PRISMA-ScR guidelines. PubMed, Ovid MEDLINE, and CINAHL were systematically searched from database inception to 23 June 2026. Eligible studies included frail older adults receiving post-discharge home-based rehabilitation incorporating one or more environmental support strategies. Data were extracted using a standardized charting form and synthesized descriptively and narratively. As recommended for scoping reviews, no formal critical appraisal of study quality was undertaken. Ten studies published between 2008 and 2026 met the eligibility criteria. The included studies represented diverse healthcare systems across Europe, Asia, Australia, and North America and employed randomized controlled, qualitative, observational, pilot, feasibility, and service evaluation designs. Six intervention and support components were mapped across the included studies. Home-based rehabilitation was identified as the core rehabilitation component, alongside five environmental support domains: home assessment, home modification, assistive devices, caregiver support, and service coordination. Home rehabilitation was the most consistently reported component, followed by caregiver support and service coordination. Home assessment, assistive devices, and home modification were reported less frequently. The combination of environmental support components varied across studies according to participant characteristics, clinical needs, discharge pathways, and models of care, without a consistent temporal progression toward increasingly integrated approaches. Home-based rehabilitation represents the foundation of post-discharge care for frail older adults, while environmental support strategies are incorporated in varying combinations according to clinical needs, discharge pathways, and models of care. However, the individual contributions of specific environmental support components remain unclear because they are typically delivered as multicomponent interventions. Future research should standardize frailty definitions and outcome measures, evaluate the effectiveness of individual environmental support strategies, and investigate long-term patient, caregiver, and implementation outcomes to strengthen the evidence base for integrated post-discharge rehabilitation. Open Science Framework (OSF), https://osf.io/rkues/ . Registered prospectively.