Geriatric Rehabilitation

Principles & Goals - Golden Years Gains

• Primary Goal: Maximize functional independence & enhance Quality of Life (QoL).
• Core Aim: Not just ↑ lifespan, but ↑ healthspan - active, engaged years.
• Key Principles:
  • Patient-centered: Tailored goals, respecting autonomy.
  • Multidisciplinary Team (MDT): Physio, OT, speech, social work, physician.
  • Address physiological aging: Sarcopenia, osteopenia, sensory decline, cognitive changes.
  • Prevent iatrogenesis (harm from medical intervention) & deconditioning.
  • Promote activity, nutrition, social engagement.
  • Early mobilization & intervention.
• Assessment Cornerstone:

  ⭐ Comprehensive Geriatric Assessment (CGA) is the cornerstone of effective geriatric care, improving outcomes and quality of life.

  • Includes functional status (ADLs, IADLs), mobility, cognition, mood, nutrition.

Conditions & Assessment - Elderly Hurdles & Measures

• Common Conditions:
  • Orthopaedic: Osteoarthritis (OA), Osteoporosis (OP; DEXA T-score ≤ -2.5), Fractures (hip, vertebral).
  • Systemic: Sarcopenia (↓muscle mass & strength), Frailty, Falls, Polypharmacy (≥5 drugs), Malnutrition.
• 📌 Geriatric Giants (4 Is): Immobility, Instability, Incontinence, Impaired Intellect/Memory.
• Key Assessments & Thresholds:
  • Mobility:
    • Timed Up and Go (TUG): >12s indicates ↑fall risk.
    • Gait Speed: <0.8 m/s predicts ↑adverse outcomes.
  • Balance: Berg Balance Scale (BBS): <45/56 indicates ↑fall risk.
  • Frailty: Clinical Frailty Scale (CFS), Fried Frailty Phenotype.
  • Nutrition: Mini Nutritional Assessment (MNA).
  • Cognition: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA).
• Hurdles: ↓Physiological reserve, multiple comorbidities, psychosocial factors.
• Measures: Comprehensive Geriatric Assessment (CGA), multidisciplinary team approach.

⭐ Sarcopenia, the age-related loss of muscle mass and function, is a major contributor to frailty and disability in older adults.

Interventions & Strategies - Moves, Aids & Safety

• Therapeutic Exercise (Tailored & Progressive):
  • Strength: Resistance training (e.g., weights, bands); builds muscle, bone density.
  • Balance: Tai Chi, Otago exercises; reduces fall risk.
  • Endurance: Walking, swimming; improves cardiovascular fitness.
  • Flexibility: Stretching; maintains range of motion (ROM).
• Assistive Devices (Proper Fit & Training Crucial):
  • Mobility: Canes, walkers, wheelchairs for stability & ambulation.
  • ADL Aids: Grab bars, raised toilet seats, reachers to promote independence.
• Fall Prevention Strategies:
  • Comprehensive fall risk assessment (e.g., Morse Fall Scale).
  • Home environment modification (lighting, remove hazards).
  • Medication review (esp. psychotropics, polypharmacy).
  • Vitamin D supplementation if deficient.

⭐ The Otago Exercise Programme, an individually prescribed home-based program of muscle-strengthening and balance-retraining exercises, reduces falls by 30-40% in at-risk older adults.

Special Aspects & Teamwork - Holistic Geriatric Care

• Multidisciplinary Team (MDT): Essential for holistic care.
  • Core: Geriatrician, Ortho Surgeon, PT, OT, Nurse, Social Worker.
• Special Geriatric Considerations:
  • Polypharmacy: Systematic review, de-prescribing to ↓ADEs.
  • Cognitive Impairment: Assess for dementia, delirium; manage.
  • Psychosocial Support: Address mood, isolation, family involvement.
  • Nutritional Optimization: Crucial for recovery.
  • Falls Prevention: Multifactorial assessment & interventions.

⭐ Addressing polypharmacy through systematic review and de-prescribing is crucial to minimize adverse drug events and improve functional outcomes in geriatric patients.

High‑Yield Points - ⚡ Biggest Takeaways

• Geriatric rehabilitation aims for maximal functional independence and enhanced quality of life in elderly patients.
• A multidisciplinary team (MDT) is vital for comprehensive assessment, planning, and management.
• Key priorities: fall prevention strategies, sarcopenia management, and effective pain control.
• Addresses common issues: osteoporosis-related fractures, post-stroke sequelae, and arthritic limitations.
• Cognitive status (e.g., dementia) significantly impacts rehabilitation; requires adapted strategies.
• Patient-centered goals, family involvement, and polypharmacy review are critical.