Overview of Principles of Geriatrics Rehabilitation

Original Editors - Tolulope ADENIJI

Top Contributors - Tolulope Adeniji, Lucinda hampton and Kim Jackson  

Introduction[edit | edit source]

Exercise older person.jpg

Geriatric Rehabilitation (GR) aims to restore function or enhance residual functional capability and improving the quality of life in older people ie particularly those with disabling impairments and/or frailty.[1] Current rehabilitation practice focuses on function and well-being, not exclusively on disease.[2] Rehabilitation of older adults patients can assist in preserving functional independence and improving the quality of life.[3]

After hospitalization, 11% of the older patients are referred to rehabilitation facilities.[4] The increasing geriatric population, and the apparent increases in disability related to e.g musculoskeletal disorders, depression, diabetes, and neurologic disorders, affecting mobility-related activities in particular, will increase the needs for rehabilitation[5].

Rehabilitation of the older adult should: emphasize functional activity to maintain functional mobility and capability; improvement of balance through exercise and functional activity programs (eg, weight shifting exercises, ambulation with direction and elevation changes, and reaching activities), good nutrition and good general care (including hygiene, hydration, bowel and bladder considerations, and appropriate rest and sleep), and social and emotional support.[6]

Multidisciplinary Team[edit | edit source]

  • This characteristics, among others, make recovery a challenging one among older adults, therefore, understanding principles of rehabilitation will facilitates delivery of effective therapeutic outcome to older adults.

The role of allied health professionals with specialized knowledge and skills in dealing with older people’s issues is essential, and a multidisciplinary team is required for the delivery of optimal care in response to the needs and aspirations of older people. Countries should assure the educational background of all health care providers and the specialized health and social care services required to meet the demands of a rapidly aging society.[7]

Foundations of Rehabilitation[edit | edit source]

Strengthing exercise for old people .jpg

Rehabilitation principles can basically be discussed under 7 principles:

  • Totality of Patient
  • Individualization
  • Intensity
  • Specific sequencing
  • Compliance
  • Timing
  • Avoiding aggravation

Geriatrics Rehabilitation Model[edit | edit source]

Geriatric rehabilitation models are embedded in those conceptual models for understanding disability. This will help to understand mechanisms of disability and how to achieve effective rehabilitation to improve or alleviate the disability defined. Among the notable models are: International Classification of Function, Disability, and Health (ICF); and International Classification of Impairments, Disabilities, and Handicaps (ICIDH-2) of the World Health Organization (WHO)[8]

Principles of Rehabilitation for Older adults[edit | edit source]

Three major principles to consider in geriatric rehabilitation are:

  1. Variation in older adults,
  2. Maximizing activity in older adults
  3. Concept that optimal health is directly related to optimal functional ability.

It is important to deal with an individual adult as a whole as variation in capacity of older adults of same age cadres greatly vary when compare to the variation noted within younger population cohort.[9] Rehabilitation goals should focus on improving older adults activity level because activity optimization is is key in rehabilitation of older adults and many of the changes over time are attributable to disuse among aged. In acute setting , principles of rehabilitation may be geared to first stabilizing the primary problems , preventing secondary complications, eg contractures and pressure ulcers, and finally to restore lost functions. [9]

Experts Consensus on Geriatric Rehabilitation[edit | edit source]

The aim or the consensus was to help healthcare providers with strategies to support older people who have experienced functional decline.

Of Note:

  • Definition of geriatric rehabilitation: Geriatric Rehabilitation (GR) is defined as a multidimensional approach of “diagnostic and therapeutic interventions, the purpose of which is to optimise functional…,” capacity, promote activity and preserve functional reserve and social participation “in older people with disabling impairments.”
  • Definition of geriatric rehabilitation patient: GR is recommended for patients affected by multimorbidity and geriatric syndromes, who have the potential to improve their experience and/or outcome of functional performance. Chronological age, place of residence and the presence of cognitive impairment should not be used to exclude patients from GR, but might have an impact on tailoring rehabilitation to specific patient`s needs.
  • Resources for geriatric rehabilitation: In most countries the available resources are insufficient, resulting in unmet needs. Urgent attention should be given to mapping intrinsic capacity and responding to projected GR needs across all member countries.
  • Geriatric rehabilitation team structures are very different in the individual EuGMS member states. Ideally a GR-skilled physician, eg geriatrician, nursing home physician, should lead the team. The other professionals consistently included in the multidisciplinary core team are skilled nurses, a physiotherapist, occupational therapist and social worker. In some countries this extends to include a psychologist, a pharmacist, a dietician and a speech therapist.
  • The rehabilitation process should be configured so that ambulatory and inpatient settings are linked. Inpatient GR can be located in hospitals, rehabilitation centres or nursing homes. Following an acute event or functional decline due to chronic conditions, rehabilitation should start as soon as possible.
  • GR principles should focus on minimizing activity limitation and maximizing societal participation, even in situations where body structure and function cannot be restored to premorbid levels. This may require the use of aids, appliances, technical and environmental adaptations. Rehabilitation programmes should encompass the psychosocial components of health and wellbeing.[1]

The consensus has thus provided a starting point for those wishing to further develop geriatric rehabilitation in their jurisdiction and help to develop strategic alliances with other specialties, serving as a basis for a pan-European approach to geriatric rehabilitation.

Conclusion[edit | edit source]

Principles of geriatric rehabilitation is essential in optimizing function that is essential as a fundamental of effective therapeutic outcome to older adults.

Resources[edit | edit source]

Principles and practice of geriatric rehabilitation: https://slideplayer.com/slide/9732203/

References[edit | edit source]

  1. 1.0 1.1 Van Balen R, Gordon AL, Schols JM, Drewes YM, Achterberg WP. What is geriatric rehabilitation and how should it be organized? A Delphi study aimed at reaching European consensus. European Geriatric Medicine. 2019 Dec;10(6):977-87.
  2. Khalid MT, Sarwar MF, Sarwar MH, Sarwar M. Current role of physiotherapy in response to changing healthcare needs of the society. International Journal of Education and Information Technology, 2015; 1 (3): 105. 2015;110.
  3. Silva A, Silva S, Fonseca CB, Garcia-Alonso J, Lopes M, Cardoso I, de Pinho LG. Promotion of Functional Independence in the Self-care Deficit of the Elderly Person with Orthopedic Disease and Technology. InGerontechnology III: Contributions to the Third International Workshop on Gerontechnology, IWoG 2020, October 5–6, 2020, Évora, Portugal 2021 (p. 149). Springer Nature.
  4. Tijsen LM, Derksen EW, Achterberg WP, Buijck BI. Challenging rehabilitation environment for older patients. Clinical interventions in aging. 2019;14:1451.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697645/ (accessed 11.9.2021)
  5. Hoenig H, Cary M. Overview of geriatric rehabilitation: Program components and settings for rehabilitation. UpToDate, Waltham, MA. Accessed. 2019;4:08-21.Available:https://www.uptodate.com/contents/overview-of-geriatric-rehabilitation-program-components-and-settings-for-rehabilitation (accessed 11.9.2021)
  6. Oncohemakey Principles of geriatric rehab. Available:https://oncohemakey.com/principles-and-practice-of-geriatric-rehabilitation/ (accessed 11.9.2021)
  7. Kotsani M, Kravvariti E, Avgerinou C, Panagiotakis S, Bograkou Tzanetakou K, Antoniadou E, Karamanof G, Karampeazis A, Koutsouri A, Panagiotopoulou K, Soulis G. The Relevance and Added Value of Geriatric Medicine (GM): Introducing GM to Non-Geriatricians. Journal of Clinical Medicine. 2021 Jan;10(14):3018. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8304813/(accessed 11.9.2021)
  8. Hoenig H, Kortebein PM. Overview of geriatric rehabilitation: Program components and settings for rehabilitation. UpToDate, Waltham, MA. Accessed. 2019;3(24):20.
  9. 9.0 9.1 da Silva MM, Curty BI, Duarte SD, Zepeda KG. Nursing safety management in onco-hematology pediatric wards. Rev Rene. 2014 Nov;15(6).