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
- 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)[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
- 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, eg contractures and pressure ulcers, and finally to restore lost functions. [2]
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.
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 structure
Some points of the consensus to note are:
- There is a need for a comprehensive geriatric assessment
- There is need for multidisciplinary approach to Geriatric Rehabilitation.
- Five domains or topic of interest that should be considered in geriatric rehabilitation ie how to select patient; need for multi-disciplinary team; having a rehabilitation plan; organization of care; and education.
- Patient selection for geriatric rehabilitation should use a cut-point of age 70 as entry level instead of 65 years of age but earlier age with frailty syndrome maybe considered.
- Patient characteristics, individual rehabilitation needs, motivation, and rehabilitation potential are to be factored when selecting patients for geriatric rehabilitation.
- 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. They should be participants in the rehabilitation process. 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.
- Geriatric rehabilitation should entail a multi-factorial team of experts in geriatric in geriatric rehabilitation, with at least a medical doctor, physiotherapist and a nurse. These team members are charged with the responsibility of evaluating their patient needs with up to date geriatric assessment tools for functioning and participation.[3]
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]
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).
- ↑ 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.
