Geriatric Rehabilitation

In: New Horizons in Geriatric Medicine. Volume 2 ISBN: 978-1-62808-976-9 Editors: A. T. Isik, M. R. Mas, M. A. Karan et al. © 2014 Nova Science Publishers, Inc. No part of this digital document may be reproduced, stored in a retrieval system or transmitted commercially in any form or by any means. The publisher has taken reasonable care in the preparation of this digital document, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in rendering legal, medical or any other professional services. Chapter 15 Geriatric Rehabilitation H. Serap İnal and Feryal Subaşı Yeditepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey Abstract Geriatric rehabilitation aims to improve or restore the motor function, sensorial and cognitive status of elderly having a loss or disability due to a disease, which may be an acute or chronic condition. However, elderly people living independently in the community or in the institutions may gain the benefits of geriatric rehabilitation in the concept of preventive measures and social rehabilitation. Thus, we may briefly define the geriatric rehabilitation as an approach of multidisciplinary interventions to upgrade the functional level and the overall quality of life as well as the life satisfaction of elderly. In this concept, we aimed to present physical therapy and rehabilitation approaches for elderly having neuromusculoskelatal problems; the importance of the assessment, evaluation and the treatment planning from the physiotherapist point of view. Exercise regimes and fall preventions with balance, flexibility and strengthening exercises; physical therapy approaches for the patients with cognitive deficiencies and how to embed these approaches into the regular physical therapy programs are the subjects discussed. Additionally, some information about the assistive devices and assistive technology in improving the physical and mental status of the elderly, in providing a safe, comfortable and functional gait pattern and activities of daily living were also conveyed. Introduction As the developments in civilizations are increasing, the improvements in science and technology give rise to lengthen the life span; in this context, nowadays, the health prevention and quality of life issues are started to be considered among the basic needs of elderly population. Thus, physical, sensorial, psychological and cognitive changes that are eventually happening as aging occurs are needed to be delayed or supported by means of rehabilitative interventions. We may convey that rehabilitation of elderly is a complex process of 288 H. Serap İnal and Feryal Subaşı multidisciplinary and interdisciplinary approaches, simply to improve the function and the quality of life of the elderly in any condition. However, the rehabilitation processes are not only to give services to the elderly but also to support the family members and the caregivers, and to increase their knowledge regarding to the issues of elderly home care. The involvement of elderly, their family and the caregivers to the process of rehabilitation is essential and profitable to achieve the most possible wellness of the elderly physically, cognitively, psychologically and socially as suggested by [1]. The optimal functional level in home, in an institution or in the community is the fundamental aim of the geriatric rehabilitation. For instance, the aim may be simply to relieve the pain in knee joints due to osteoarthritis via physiotherapeutic approaches; however, the activity level of the elderly in home or in the institution is also important. Thus, while searching pain, it is important to question whether, the elderly is spending her/his time sitting and preferring mostly staying indoors or being eager to have an active life style. In other words, the activity level and the motivations of the elderly person should be searched and her/his expectations should be well understood. Besides the personal circumstances, the environment of the elderly is important in order to improve the functional level of the elderly and to urge them to have a much more active life style. For instance, a house or a nursing home with well lightened corridors, nonslippery bathrooms, wide passages, ramps, handrails by the stairs and so on, may ease the life of the elderly in daily living but they are also important for a safe environment. Furthermore, outdoor environment should also be considered for the elderly to interact with society and continue to have an active life style as a part of the society with vocational, recreational and leisure activities. Hence, the aim of the geriatric rehabilitation is to maximize of the functional level, mobility, and independence of elderly, in order to increase their quality of life (QoL) [2, 3] not only from a medical point of view but also from the social aspect [4-6]. 1. Social Rehabilitation The more traditional description of rehabilitation in terms of disease, impairment, disability, and handicap has been changed due to the recent The World Health Organization‘s (WHO) International Classification of Functioning, Disability and Health (ICF) model providing a helpful framework for understanding of health, disease or trauma, impairment, restriction in activity and limitation in participation to activity [5]. Figure 1 illustrates a model of the sorts of interventions that could be employed to improve health, either by reducing impairments, helping performance of activities even in the face of limited capacity, or promoting participation even in the face of activity limitation. Disease is an intrinsic pathology or disorder that may affect the systems for instance, osteoarthritis, stroke, and amyotrophic lateral sclerosis. Impairment is a decline or loss in anatomic structure or function at the organ level usually as a result of the disease process. For example, decreased mobility due to osteoarthritis of the back, hips, or knees or decreased hand function due to stroke impairment predispose to disability that refer to functional limitations, that is, restrictions in the ability to carry out basic physical and mental activities for example limitations in the ability to carry out activities such as dressing or bathing. However, disability occurs due to the cumulative effects of internal factors (comorbidity, disease severity, cognition, education, Geriatric Rehabilitation 289 culture) and external factors (treatment facilities, environment, support services, finance). The limitation in participation, which is preferred by ICF instead of the term handicap, refers to the interaction of an impairment or disability with external factors (e.g., architectural barriers) that limit or prevent the fulfillment of a normal social role of the elderly in the society, for example having a walk in the street for shopping [3]. From this point of view, we may consider geriatric rehabilitation involving with therapeutic interventions but not only treating the elderly person or elderly patients, but also improving their overall functional capacity, preparing them to return to their active life and achieve the sustainability of the gained activities as much as possible. Environment Body functions and Capacity Activity Participation structures Personal factors Figure 1. ICF Model of Health (Adapted from Gladman, 2008). 2. Success in Rehabilitation Elderly who need rehabilitation interventions may have a disease or a disability from their childhood or adult life that are usually in tendency of deterioration due to the consequences of the eventual effects of aging of the systems. Thus, by years their dependency will be changed according to their needs and mostly will be increased. For instance, as a post- polio patient while walking with a long leg brace and a cane, working professionally and involved in social activities with her family and friends; towards the retirement age may have sudden symptoms of post-polio syndrome that may refrain her from having this active life and she may become more depended to home due to weakness, tiredness and pain. This situation may eventually decrease her quality of life and of course, her life satisfaction. On the other hand, the elderly may have a healthy life without serious health problems, however, during the later life they may have a disease or a trauma that refrain them from having a healthy, active aging. Although, the degree and the duration of dependency are related with the pathology, the previous functional capacity is also an important criterion for the health promotion. Hence, the achieved personal features and the environmental facilities provided for the elderly will have a governing effect on the success of the rehabilitation. In this context, rehabilitation may be viewed as the combination of two models of health and illness—the biomedical and the biopsychosocial model. The biomedical model refers to the effects of biology, physiology, anatomy, and their clinical outcomes and focuses on function and well-being of the elderly. This model is most useful for the cause-and-effect analysis; for 290 H. Serap İnal and Feryal Subaşı example, a left middle cerebral artery stroke may cause right-sided weakness. However, the biopsychosocial model emphasizes the importance of understanding

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