Geriatric RehabilitationRHPT 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

Malnutrition

Knee arthritis

Depression

Weakness

Pain

Immobility

Apathy

Difficulty

walking

Difficulty

shopping

Social Isolatio

n

Loss of ability to live independent

ly

Physical Environment (multi-

story house)

Social Environme

nt(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 problemsVulnerability 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 diseases2. Negative effects of acute hospitalization3. 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.