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Geriatric Rehabilitation
RHPT 483
Course instructor:
Ahmad Osailan
Course description
• This course aims to provide students with fundamental
skills and knowledge in the care of the elderly. Aging
concept and selected theories are discussed, along
with the physiologic and psychosocial changes. Physical
and mental health problems associated with the aging
process and evidence-based physical therapy practice
in geriatrics are addressed. The course schedule is
divided into three units: basics of geriatric physical
therapy, principles of healthcare for older adults, and
physical therapy for the most common pathological
conditions among older adults
Objectives
• Upon completion of this course students will be
able to:
• Define the role of physical therapy in geriatric.
• Identify the most common physical and mental
health problems affecting older population.
• Develop basic evidence-based practice skills
relevant to geriatric physical therapy.
• List and describe the most common outcome
measures used in geriatric rehabilitation.
Definition
• “Geriatric rehabilitation is an important
emerging field in rehabilitation.”
• It may be defined as “evaluative, diagnostic,
and therapeutic interventions whose purpose
is to restore functional ability or enhance
residual functional capability in elderly people
with disabling impairments.”
Definition
• Disability make it harder to take part in
normal daily activities. They may limit what
you can do physically or mentally, or they can
affect your senses.
• Disability doesn't mean unable, and it isn't a
sickness. Most people with disabilities can and do - work, play, learn, and enjoy full
healthy lives
definition
• Handicapped refer to people having physical
or mental disabilities, those described by the
word tend to prefer the expressions disabled
or people with disabilities
Disease Impairment Disability Handicap
Difficulty
shopping
Malnutrition
Weakness
Physical
Environment
(multi-story
house)
Immobility
Knee
arthritis
Pain
Difficulty
walking
Loss of ability to
live
independently
Apathy
Depression
Social
Isolation
Social
Environment
(loss of
spouse)
Prin. Geriat. Med, 5th edition,
p. 289
Aims of Geriatric Rehab
1. Minimize the negative impact of the primary
disorder
2. Maximize (physical, psychological and social)
functional activities
3. Based on good assessment of where the
elderly person is now (in terms of
functioning), where they wish to be, and how
team members and agencies can contribute
to achieve the goals and meet the needs
Special consideration
• To restore functional abilities few things need
to be considered:
Acute or chronic problems
Vulnerability to complications (low reserve)
Interacting factors (drugs / co-morbidity /
cognitive and physical impairments etc)
Frailty
Vulnerability
• Elderly persons are vulnerable to functional
decline by –
1. Cumulative functional sequel of diseases
2. Negative effects of acute hospitalization
3. Deconditioning
Deconditioning
Consequences to deconditioning
Medicines and rehabilitation
• During hospitalization patients are exposed to:
• Postural hypotension –alpha-blockers,
antiarrhythmics, antipsychotics, nitrates,
antidepressants.
• Beta-blockers –effect on HR and BP.
• Anticoagulants –injury caution.
• Insulin requires rotation of injection sites away
from exercise body parts.
• Scheduling may help, e.g. patients on
parkinsonism drugs / pain medications /
antipsychotics/ diuretics.
Excessive use of medications
• Age and cumulative use
• Co-morbidities
• Failure to discontinue drugs with minimal
therapeutic effect
• Multiple prescribing physicians
• Multiple filling pharmacies
• Self-medication
Frailty
• “Frailty is the clinical state that makes the
medical management and rehabilitation of the
elderly complex.”
• Its definition has evolved over the years from
description of dependence on others, to a
dynamic model with multidimensional construct.
• Frailty may also seen as the loss of functional
homeostasis –e.g. elderly patients faring poorly in
hospitalization
Disuse
• With disuse, decline in strength is easily
evident; with chronic disuse, there is
cardiovascular endurance decline
• Usual daily activities does help to maintain
strength, though it does not have training
effect in cardiovascular endurance.
Immobilization –an extreme cause of
deconditioning
• Rapid loss of muscle strength at 2-3% per day
(i.e. 25-30% in 2 weeks)
• Contractures caused by flexor muscles
collagenous adhesions and poor positioning
• Dependent oedema
• Increased risk of DVT
• Decreased lung volumes
• Situational incontinence
History of studies in population aging
Demography
• Demography is the statistical study of human
populations and sub-populations.
• It encompasses the study of the size,
structure, and distribution of these
populations, and spatial and/or temporal
changes in them in response to birth,
migration, aging and death
History
• Emerged in France at End of 19th century
 -Proportion of aged population raised from 5% to
8%. Sweden also experienced the same.
• Sundbarg was the 1st to emphasize on relative
proportions of aged people in society.
• He was also the 1st demographer to note
systematic differences in age composition among
countries.
 He hypothesized that there would be a
demographic shift over time toward an aging
population in all countries
History
• Western countries like USA Identified Aging
population in 20th century.
• 1930s the concern was expressed after decline
in fertility which led demographers to project
rapid changes in the age structure of USA.
• Population aging now is a worldwide
phenomenon that requires immediate
attention.
Demographic process and age
structure
• It starts with identifying Mean or median age
of population,
• Size and proportion of various age categories
of population.
• Ratios between different age categories
Demographic process and age
structure
• Factors that change the size of population:
• Rate persons join the population through birth
or immigration.
• Rate they leave the population through death
or immigration.
Demographic process and age
structure
• Demographers Identified 65yrs as old age.
• This was helpful to:
• Standardize analysis in social practice.
• Born Males are more slightly than females,
therefore, Sex of persons have to be
distinguished when constructing models of
population change.
Demographic process and age
structure
• Q:What is the most determinant of population
growth ?
• A: Fertility
• When fertility rate is high, the age population
has more members than the previous one.
Effect of mortality rates on aging
population
• The effect of decline in mortality rates from
high to moderate in late 19th century in US
was due to the control of infectious diseases.
• This caused population to become younger.
• The reason for this relationship between
mortality rates and age structure is that the
most improvements in survivorship during this
period occurred in age group of infants and
children.
Effect of mortality rates on aging
population
• Q: So, did they find a factor to improve the survivorship
in older persons?
• A: improvements in prevention and treatment of
cardiovascular diseases.
• The growth of total population is particularly sensitive
to declining mortality rates.
• The growth of older population to the total population
occurs when fertility rates declines.
• Q: what is reason for current population’s aging?
• A: the sustained decrease in mortality that extends into
older ages.
Mortality patterns
• Mortality rate: Measurement of number of
Deaths.
• In 1983, 2 millions deaths reported in US
• Do you think that since 1983, number will be
less ?
• In the next centuries death rates are expected
to be higher, Why?
• Because we already have established that the
population is getting older.
morbidities
• Def: Morbidity is an incidence of ill health.
• Most common morbidities:
• hypertension, arthritis, and diabetes mellitus.
• In women, osteoporosis and arthritis were the
second and third most prevalent diseases,
respectively.
• Morbidity was significantly associated with
gender, employment, household income.
• kyung Woo et al, 2007.