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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #14, #15, #16, #30, #53

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LEARNING OBJECTIVES

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Learning Objectives

  • Name and describe the conceptual models used as the framework for rehabilitation.

  • Explain the advantages and disadvantages of each site of care for rehabilitation.

  • List providers who are commonly members of the interprofessional rehabilitation team.

  • Identify common rehabilitation interventions, in addition to exercise.

  • Name at least two types of adaptive aids and how they are used.

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Key Clinical Points

  1. In addition to the history and physical examination, an evaluation should include assessments of cognition, motivation, depression, social support, and financial resources, as these factors can have a significant impact on rehabilitation outcomes.

  2. It is important for the provider to understand the range of available rehabilitation settings, both inpatient and community based, and the advantages and disadvantages of each setting.

  3. An interdisciplinary team is often required to meet the complex rehabilitation needs of older patients and while team members have defined roles and functions, there is considerable overlap in the services provided.

  4. Exercise is the cornerstone of physical rehabilitation, with each prescribed exercise being related to achievement of a goal and ultimately to an improvement in function.

  5. Adaptive aids include devices that allow persons with physical limitations to participate in activities, such as basic and instrumental activities of daily living, with greater ease and/or less pain. Categories of adaptive aids include mobility aids to assist people to move around within their home and community, bathroom aids to assist with bathing and toileting, and self-care aids that assist with dressing, personal hygiene, cooking, and other activities.

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DEFINING REHABILITATION

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The purpose of rehabilitation is to restore some or all of a person’s physical and mental capabilities that have been lost as a result of disease, injury, or illness and to help achieve the highest possible level of function, independence, and quality of life. The techniques and modalities used to achieve these goals are numerous and typically do not differ for younger versus older persons. However, rehabilitation outcomes and approaches are frequently different for the older adult. For example, most young adults experience a single acute event that results in disability. Older adults are more likely to have multiple comorbid conditions that, over time, result in disability. Even if the older persons have acute events, like a hip fracture or a stroke, their underlying comorbid conditions may impact on the outcomes of rehabilitation. Older patients may also have subclinical physical or cognitive comorbidities, which become evident when challenged by a new disability. For example, mild cognitive impairment may be first recognized during rehabilitation after a hip fracture, when the patient has difficulty learning how to use a new assistive device.

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Goals of rehabilitation for older adults usually focus on recovery of self-care ability and mobility, while for younger persons reentering the workforce or returning to school may be the ...

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