Overview of Principles of Geriatrics Rehabilitation
Original Editors - Tolulope ADENIJI
Top Contributors - Tolulope Adeniji, Lucinda hampton, Temitope Olowoyeye and Kim Jackson
Introduction[edit | edit source]
Ageing is characterized by decline in general physiologic function and this make chronic condition and multi-morbidity prevalent among older adults. 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.
Foundations of Rehabilitation[edit | edit source]
Rehabilitation principles can basically be discussed under 7 principles:
- Total Patient
- Individualization,
- Intensity
- Specific sequencing
- Compliance
- Timing
- avoid 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)[1]
Principles of Rehabilitation for Older adults[edit | edit source]
Three major principles to consider in geriatric rehabilitation are:
- Variation in older adults,
- Maximizing activity in older adults
- and 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.[2] 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 like contractures and bedsores and finally to restore lost functions. [2]
Experts Consensus on Geriatric Rehabilitation[edit | edit source]
One of the latest consensus on Geriatric Rehabilitation is the European consensus using a modified Delphi Procedure[3] In coming with this consensus, 33 experts that are mainly geriatrician were invited to use five point Likert scale to respond to 68 statements on geriatric rehabilitation issues. There is consensus that there is a need for a comprehensive geriatric assessment and that there is need for multidisciplinary approach to Geriatric Rehabilitation. The experts, more than half of the experts, agreed on five domains or topic of interest that should be considered in geriatric rehabilitation and this include how to select patient, need for multi-disciplinary team, having a rehabilitation plan, organization of care, and education.
In selection of patient for geriatric rehabilitation, there is agreement to use cut-point of age 70 as entry level into geriatric rehabilitation instead of 65 years of age but earlier age with frailty syndrome maybe considered. Neurocognitive impairment such as delirium and dementia are considered as part of essential cases that are fit for geriatric rehabilitation. Overall, it is noted that patient characteristics, individual rehabilitation needs, motivation, and rehabilitation potential are to be factored when selecting patients for geriatric rehabilitation. It is recommended that geriatric rehabilitation should entails multi-factorial team of experts in geriatric in geriatric rehabilitation with at least a medical doctor, physiotherapist and a nurse. This team member are charge of responsibility of evaluating their patient needs with up to date geriatric assessment tools for functioning and participation.
There is a call to redefining geriatric rehabilitation from “Diagnostic and therapeutic interventions whose purpose it is to restore functional ability or enhance residual functional capacity in older people with disabling impairments” to reflect "presence of multimorbidity, the aim for participation goals, and that it mostly follows an acute or subacute decline in function."[3]
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]
References[edit | edit source]
- ↑ Hoenig H, Kortebein PM. Overview of geriatric rehabilitation: Program components and settings for rehabilitation. UpToDate, Waltham, MA. Accessed. 2019;3(24):20.
- ↑ 2.0 2.1 da Silva MM, Curty BI, Duarte SD, Zepeda KG. Nursing safety management in onco-hematology pediatric wards. Rev Rene. 2014 Nov;15(6).
- ↑ 3.0 3.1 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.
