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.
Goals of rehabilitation for older adults usually focus on recovery of self-care ability and mobility, while for younger persons reentering the work force or returning to school may be the goal. In general, recovery for older adults requires a longer period of time to achieve, and functional outcomes are usually worse when compared with younger adults. It is important to discuss rehabilitation goals with all patients and focus therapy toward achieving those goals. For example, older persons may have been avid golfers or fishermen, and return to this activity may be important for their quality of life. Rehabilitation efforts and goals of care may also be impacted by a person's values and beliefs about exercise and social roles. For example, if a patient has never cooked and does not believe that this is an important task to learn, taking the patient to the kitchen to learn how to prepare a meal may be viewed as a useless task. Participation by the patient and family in the development of the goals of rehabilitation is critical to achieve a successful outcome.
Disability is common in older persons and can have a significant impact on function and quality of life. In order to better understand the process of disablement, a variety of theoretical models have been explored and are presented below.
History of the Disability Framework
In an attempt to provide a framework for the discussion of the consequences of disease and injury, Nagi developed the first disablement model in the 1960s (Figure 29-1). The model uses four related yet distinct phenomena considered by Nagi to be the basis of rehabilitation and include active pathology, impairment, functional limitation, and disability. Active pathology was described as a disruption in the normal cellular function and the body's efforts to regain a normal state. Impairment, which usually ...