Geriatric Rehabilitation

CGA & Principles - Rehab Foundations

• CGA (Comprehensive Geriatric Assessment): A holistic, multidimensional, interdisciplinary diagnostic process. Evaluates medical, functional (ADLs, IADLs, mobility, falls), psychosocial (cognition, mood, social support, environment) status in frail older adults to formulate a coordinated, integrated care plan.
• Rehab Foundations & Goals:
  • Maximize functional independence & QoL.
  • Patient-centered goal setting.
  • Prevent complications (e.g., deconditioning, delirium).
  • Promote safe community reintegration.
• Multidisciplinary Team (MDT) essential: Geriatrician, Physiotherapist, Occupational Therapist, Nurse, Social Worker, Dietitian, Speech Therapist.
• CGA Process Overview:

⭐ Comprehensive Geriatric Assessment (CGA) is proven to improve outcomes like survival and functional ability in hospitalized older adults.

Key Conditions - Targeted Rehab

Geriatric Giants - Syndrome Strategies

• Core Syndromes: Immobility, Instability (Falls), Incontinence, Intellectual Impairment (Delirium/Dementia), Iatrogenesis.
• Falls (Instability):
  • Assessment: Gait/balance (TUG >12s ↑risk), Morse Fall Scale.
  • Risk Factors: 📌 FALLS RISK (polypharmacy, weakness, prior fall).
  • Intervention: Multifactorial - exercise, medication review, environment mod.
• Delirium:
  • Acute confusion, fluctuating. Screen: CAM (Confusion Assessment Method).
  • Causes: 📌 I WATCH DEATH (infection, drugs, metabolic).
  • Management: Treat cause, reorient, hydration, avoid restraints.
• Incontinence: Identify type (Stress, Urge, Overflow, Functional); targeted therapy (pelvic floor exercises, bladder training).
• Iatrogenesis: Polypharmacy (≥5 drugs); review with Beers criteria, STOPP/START.

⭐ Multicomponent exercise programs (strength, balance, endurance, flexibility) are most effective in preventing falls and managing frailty.

Rehab Tools & Goals - Smooth Discharge

• Rehab Tools:
  • Assistive Devices: Enhance safety & functional independence.
    • Mobility aids: Walkers, canes, wheelchairs.
    • ADL aids: Grab bars, raised toilet seats, dressing aids, reachers.
  • 
• Goals & Outcome Measures:
  • Aim: Maximize functional independence, improve Quality of Life (QoL).
  • Track progress using standardized scales:

    Scale	Focus	Scoring (Higher = More Independent)
    Barthel Index	10 ADLs (feeding, toilet use, mobility)	0-20 (Total Dep.) to 100 (Indep.)
    FIM™ (Functional Independence Measure)	18 items (motor & cognitive tasks)	18 (Total Dep.) to 126 (Total Indep.)
    Katz ADL	6 basic ADLs (bathing, dressing)	6 (Full function) to 0 (Severe impairment)

• Smooth Discharge Planning:
  • Involves: Multidisciplinary team, home environment assessment & modifications.

  • ⭐ Patient and family education on safe transfers, medication management, and use of assistive devices is critical for successful discharge and preventing readmission.

  • Essential: Caregiver training, scheduled follow-ups, community support linkage.

High‑Yield Points - ⚡ Biggest Takeaways

• Comprehensive Geriatric Assessment (CGA) is foundational for tailored rehabilitation.
• Aim for maximal functional independence and enhanced Quality of Life (QoL).
• Prioritize rehabilitation for stroke, hip fractures, and Parkinson's disease.
• A multidisciplinary team (MDT) approach is crucial for effective care.
• Early mobilization prevents deconditioning and complications like pressure sores.
• Manage polypharmacy and cognitive deficits impacting rehabilitation progress.