Overview of Principles of Geriatrics Rehabilitation: Difference between revisions

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Geriatric Rehabilitation (GR) aims to restore function or enhance residual functional capacity and improve the [[Quality of Life|quality of life]] in older people, particularly those with disabling impairments and/or [[Introduction to Frailty|frailty]].<ref name=":1" /> Current rehabilitation practice focuses on function and well-being, not exclusively on disease.<ref>Khalid MT, Sarwar MF, Sarwar MH, Sarwar M. [https://www.researchgate.net/profile/Muhammad-Taimoor-Khalid/publication/350754364_Current_Role_of_Physiotherapy_in_Response_to_Changing_Healthcare_Needs_of_the_Society/links/607001e9299bf1c911ba3532/Current-Role-of-Physiotherapy-in-Response-to-Changing-Healthcare-Needs-of-the-Society.pdf 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.</ref> Rehabilitation of older adults assists in preserving functional independence and improving the quality of life.<ref>Silva A, Silva S, Fonseca CB, Garcia-Alonso J, Lopes M, Cardoso I, de Pinho LG. [https://www.researchgate.net/profile/Jaime-Galan-Jimenez/publication/350912003_A_Self-sustainable_DTN_Solution_for_Isolation_Monitoring_in_Remote_Areas/links/6172ca70eef53e51e1c9499e/A-Self-sustainable-DTN-Solution-for-Isolation-Monitoring-in-Remote-Areas.pdf#page=157 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.</ref>   
Geriatric Rehabilitation (GR) aims to restore function or enhance residual functional capacity and improve the [[Quality of Life|quality of life]] in older people, particularly those with disabling impairments and/or [[Introduction to Frailty|frailty]].<ref name=":1" /> Current rehabilitation practice focuses on function and well-being, not exclusively on disease.<ref>Khalid MT, Sarwar MF, Sarwar MH, Sarwar M. [https://www.researchgate.net/profile/Muhammad-Taimoor-Khalid/publication/350754364_Current_Role_of_Physiotherapy_in_Response_to_Changing_Healthcare_Needs_of_the_Society/links/607001e9299bf1c911ba3532/Current-Role-of-Physiotherapy-in-Response-to-Changing-Healthcare-Needs-of-the-Society.pdf 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.</ref> Rehabilitation of older adults assists in preserving functional independence and improving the quality of life.<ref>Silva A, Silva S, Fonseca CB, Garcia-Alonso J, Lopes M, Cardoso I, de Pinho LG. [https://www.researchgate.net/profile/Jaime-Galan-Jimenez/publication/350912003_A_Self-sustainable_DTN_Solution_for_Isolation_Monitoring_in_Remote_Areas/links/6172ca70eef53e51e1c9499e/A-Self-sustainable-DTN-Solution-for-Isolation-Monitoring-in-Remote-Areas.pdf#page=157 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.</ref>   


{{#ev:youtube|PJuolVqizo|300}}<ref>Southampton Hospitals Charity. The importance of rehabilitation for the elderly. Available from: http://www.youtube.com/watch?v=PJuolVqizo [last accessed 22/3/2023]</ref>
{{#ev:youtube|PJuolVqizo|300}}<ref name=":2">Southampton Hospitals Charity. The importance of rehabilitation for the elderly. Available from: http://www.youtube.com/watch?v=PJuolVqizo [last accessed 22/3/2023]</ref>


After hospitalization, 11% of older patients are referred to rehabilitation facilities.<ref>Tijsen LM, Derksen EW, Achterberg WP, Buijck BI. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697645/ 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)</ref> The increasing geriatric population, and the apparent increases in disability related to musculoskeletal disorders, [[depression]], [[diabetes]], and [[Neurological Disorders|neurologic disorders]], affecting mobility-related activities in particular, will increase the need for rehabilitation<ref>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)</ref>.     
After hospitalization, 11% of older patients are referred to rehabilitation facilities.<ref>Tijsen LM, Derksen EW, Achterberg WP, Buijck BI. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697645/ 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)</ref> The increasing geriatric population, and the apparent increases in disability related to musculoskeletal disorders, [[depression]], [[diabetes]], and [[Neurological Disorders|neurologic disorders]], affecting mobility-related activities in particular, will increase the need for rehabilitation<ref>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)</ref>.     


Rehabilitation of the older adult should: emphasize functional activity to maintain functional mobility and capability; improvement of [[balance]] through [[Balance Training|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.<ref>Oncohemakey [https://oncohemakey.com/principles-and-practice-of-geriatric-rehabilitation/ Principles of geriatric rehab]. Available:https://oncohemakey.com/principles-and-practice-of-geriatric-rehabilitation/ (accessed 11.9.2021)</ref>     
Rehabilitation of the older adult should: emphasize functional activity to maintain functional mobility and capability<ref name=":2" />; improvement of [[balance]] through [[Balance Training|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.<ref>Oncohemakey [https://oncohemakey.com/principles-and-practice-of-geriatric-rehabilitation/ Principles of geriatric rehab]. Available:https://oncohemakey.com/principles-and-practice-of-geriatric-rehabilitation/ (accessed 11.9.2021)</ref>     


== Multidisciplinary Team ==
== Multidisciplinary Team ==


* Aging is characterized by a decline in general physiologic function and this makes [[Chronic Disease|chronic condition]] and [[Multimorbidity|multi-morbidity]] prevalent among older adults.
* Aging is characterized by a decline in general physiologic function and this makes [[Chronic Disease|chronic conditions]] and [[Multimorbidity|multi-morbidity]] prevalent among older adults.


* These characteristics, among others, make recovery a challenging one among [[Older People - An Introduction|older adults]], therefore, understanding the principles of rehabilitation will facilitate the delivery of effective therapeutic outcomes to older adults.
* These characteristics, among others, make recovery a challenging one among [[Older People - An Introduction|older adults]], therefore, understanding the principles of rehabilitation will facilitate the delivery of effective therapeutic outcomes to older adults.
A study carried out by Romke van Balen ''et al'' confirmed that geriatric rehabilitation should start with Comprehensive Geriatric Assessment and should use a multi/interdisciplinary<ref name=":1" /> and should include a doctor trained in geriatric rehabilitation, a physiotherapist, a nurse, an occupational therapist, a speech and language therapist, a dietician, a psychologist, and a social worker.  
A study carried out by Romke van Balen ''et al'' confirmed that geriatric rehabilitation should start with Comprehensive Geriatric Assessment and should use a multi/interdisciplinary<ref name=":1" /> and should include a doctor trained in geriatric rehabilitation, a physiotherapist, a nurse, an occupational therapist, a speech and language therapist, a dietician, a psychologist, and a social worker.  


Countries should assure the educational background of all healthcare providers and the specialized health and social care services required to meet the demands of a rapidly aging society.<ref>Kotsani M, Kravvariti E, Avgerinou C, Panagiotakis S, Bograkou Tzanetakou K, Antoniadou E, Karamanof G, Karampeazis A, Koutsouri A, Panagiotopoulou K, Soulis G. T[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8304813/ he 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/<nowiki/>(accessed 11.9.2021)</ref>
Countries should assure the educational background of all healthcare providers and the specialized health and social care services required to meet the demands of a rapidly aging society.<ref>Kotsani M, Kravvariti E, Avgerinou C, Panagiotakis S, Bograkou Tzanetakou K, Antoniadou E, Karamanof G, Karampeazis A, Koutsouri A, Panagiotopoulou K, Soulis G. T[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8304813/ he 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/<nowiki/>(accessed 11.9.2021)</ref>  


== Foundations of Rehabilitation ==
== Foundations of Rehabilitation ==
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== Geriatrics Rehabilitation Model ==
== Geriatrics Rehabilitation Model ==
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 Functioning, Disability and Health (ICF)|International Classification of Function, Disability, and Health (ICF)]]; and International Classification of Impairments, Disabilities, and Handicaps (ICIDH-2) of the World Health Organization (WHO)<ref>Hoenig H, Kortebein PM. Overview of geriatric rehabilitation: Program components and settings for rehabilitation. UpToDate, Waltham, MA. Accessed. 2019;3(24):20.</ref>  
Geriatric rehabilitation models are embedded in those conceptual models for understanding disability. This will help to understand the mechanisms of disability and how to achieve effective rehabilitation to improve or alleviate the disability defined. Among the notable models are: [[International Classification of Functioning, Disability and Health (ICF)|International Classification of Function, Disability, and Health (ICF)]]; and the International Classification of Impairments, Disabilities, and Handicaps (ICIDH-2) of the World Health Organization (WHO)<ref>Hoenig H, Kortebein PM. [https://www.louisianahealthconnect.com/content/dam/centene/louisiana-health-connect/policies/clinical-policies/CP.MP.71.pdf Overview of geriatric rehabilitation: Program components and settings for rehabilitation.] UpToDate, Waltham, MA. Accessed. 2019;3(24):20.</ref>  


== Principles of Rehabilitation for Older adults ==
== Principles of Rehabilitation for Older adults ==
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# Variation in older adults,
# Variation in older adults,
# Maximizing activity in older adults  
# Maximizing activity in older adults  
# Concept that optimal health is directly related to optimal functional ability.
# The concept is 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.<ref name=":0">da Silva MM, Curty BI, Duarte SD, Zepeda KG. Nursing safety management in onco-hematology pediatric wards. Rev Rene. 2014 Nov;15(6).</ref>  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|pressure ulcers]], and finally to restore lost functions. <ref name=":0" />
It is important to deal with an individual adult as a whole as variation in the capacity of older adults of same age cadres greatly varies when compared to the variation noted within the younger population cohort.<ref name=":0">da Silva MM, Curty BI, Duarte SD, Zepeda KG. [http://www.periodicos.ufc.br/rene/article/view/3279/2520 Nursing safety management in onco-hematology pediatric wards.] Rev Rene. 2014 Nov;15(6).</ref>  Rehabilitation goals should focus on improving older adults' activity levels because activity optimization is key in the rehabilitation of older adults and many of the changes over time are attributable to disuse among the aged.  


=== Experts Consensus on Geriatric Rehabilitation ===
In the acute setting, principles of rehabilitation may be geared to first stabilizing the primary problems, preventing secondary complications, eg contractures and [[Pressure Ulcers|pressure ulcers]], and finally restoring lost functions. <ref name=":0" />
The aim or the consensus was to help healthcare providers with strategies to support older people who have experienced functional decline.
 
=== Experts' Consensus on Geriatric Rehabilitation ===
The aim of the consensus was to help healthcare providers with strategies to support older people who have experienced functional decline.


Of Note:
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: Geriatric Rehabilitation (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.”
* 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.
* 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 patients' 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.
* 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.
* Geriatric rehabilitation team structures are very different in the individual EuGMS member states. Ideally, a GR-skilled physician, eg geriatrician, or nursing home physician, should lead the team. The other professionals consistently included in the multidisciplinary core team are skilled nurses, a physiotherapist, an occupational therapist, and a 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.  
* The rehabilitation process should be configured so that ambulatory and inpatient settings are linked. Inpatient GR can be located in hospitals, rehabilitation centers, 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.<ref name=":1">Van Balen R, Gordon AL, Schols JM, Drewes YM, Achterberg WP. [https://link.springer.com/article/10.1007/s41999-019-00244-7 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.</ref>
* 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, and technical and environmental adaptations. Rehabilitation programs should encompass the psychosocial components of health and well-being.<ref name=":1">Van Balen R, Gordon AL, Schols JM, Drewes YM, Achterberg WP. [https://link.springer.com/article/10.1007/s41999-019-00244-7 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.</ref>


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.  
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 ==
== Conclusion ==
Principles of geriatric rehabilitation is essential in optimizing function that is essential as a fundamental of effective therapeutic outcome to older adults.
The principles of geriatric rehabilitation are essential in optimizing a function that is essential as fundamental to effective therapeutic outcomes for older adults.


== Resources  ==
== Resources  ==

Latest revision as of 15:36, 22 March 2023

Original Editors - Tolulope ADENIJI

Top Contributors - Tolulope Adeniji, Lucinda hampton, Temitope Olowoyeye and Kim Jackson  

Introduction[edit | edit source]

Exercise older person.jpg

Geriatric Rehabilitation (GR) aims to restore function or enhance residual functional capacity and improve the quality of life in older people, 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 assists in preserving functional independence and improving the quality of life.[3]

[4]

After hospitalization, 11% of older patients are referred to rehabilitation facilities.[5] The increasing geriatric population, and the apparent increases in disability related to musculoskeletal disorders, depression, diabetes, and neurologic disorders, affecting mobility-related activities in particular, will increase the need for rehabilitation[6].

Rehabilitation of the older adult should: emphasize functional activity to maintain functional mobility and capability[4]; 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.[7]

Multidisciplinary Team[edit | edit source]

  • These characteristics, among others, make recovery a challenging one among older adults, therefore, understanding the principles of rehabilitation will facilitate the delivery of effective therapeutic outcomes to older adults.

A study carried out by Romke van Balen et al confirmed that geriatric rehabilitation should start with Comprehensive Geriatric Assessment and should use a multi/interdisciplinary[1] and should include a doctor trained in geriatric rehabilitation, a physiotherapist, a nurse, an occupational therapist, a speech and language therapist, a dietician, a psychologist, and a social worker.

Countries should assure the educational background of all healthcare providers and the specialized health and social care services required to meet the demands of a rapidly aging society.[8]

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 the 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 the International Classification of Impairments, Disabilities, and Handicaps (ICIDH-2) of the World Health Organization (WHO)[9]

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. The concept is 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 the capacity of older adults of same age cadres greatly varies when compared to the variation noted within the younger population cohort.[10] Rehabilitation goals should focus on improving older adults' activity levels because activity optimization is key in the rehabilitation of older adults and many of the changes over time are attributable to disuse among the aged.

In the acute setting, principles of rehabilitation may be geared to first stabilizing the primary problems, preventing secondary complications, eg contractures and pressure ulcers, and finally restoring lost functions. [10]

Experts' Consensus on Geriatric Rehabilitation[edit | edit source]

The aim of 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 optimize 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 patients' 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, or nursing home physician, should lead the team. The other professionals consistently included in the multidisciplinary core team are skilled nurses, a physiotherapist, an occupational therapist, and a 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 centers, 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, and technical and environmental adaptations. Rehabilitation programs should encompass the psychosocial components of health and well-being.[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]

The principles of geriatric rehabilitation are essential in optimizing a function that is essential as fundamental to effective therapeutic outcomes for 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 1.2 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. ↑ 4.0 4.1 Southampton Hospitals Charity. The importance of rehabilitation for the elderly. Available from: http://www.youtube.com/watch?v=PJuolVqizo [last accessed 22/3/2023]
  5. ↑ 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)
  6. ↑ 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)
  7. ↑ Oncohemakey Principles of geriatric rehab. Available:https://oncohemakey.com/principles-and-practice-of-geriatric-rehabilitation/ (accessed 11.9.2021)
  8. ↑ 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)
  9. ↑ Hoenig H, Kortebein PM. Overview of geriatric rehabilitation: Program components and settings for rehabilitation. UpToDate, Waltham, MA. Accessed. 2019;3(24):20.
  10. ↑ 10.0 10.1 da Silva MM, Curty BI, Duarte SD, Zepeda KG. Nursing safety management in onco-hematology pediatric wards. Rev Rene. 2014 Nov;15(6).
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