ASPECTS OF AGING AND REHABILITATION OF OLDER ADULTS
Robert S. Stall, MD
Last updated December 27, 1995
- What are the Important Elements of Geriatric Functional Assessment?
- How is Rehabilitation Potential Determined?
- Videotape & Critique
- "Functional Assessment" (UNC Program on Aging)--starring
- Currently, 12% of population >65 years old, compared to
4% in 1900.
- By 2030, >20% of population will be >65 years old.
- The old-old (>75 years old): 29% in 1900, 38% in 1970,
44% by 2000.
- For each active year added to life, approximately 3.5 compromised
years are added.
- Approximately 30% of NH admissions are for convalescence/rehab
(2o 1983 PPS); all NH admissions are for some kind of functional
- Why are "frail" elderly frail? How do you
- Physiology of Aging
- Concept of Functional Reserve and Disease Threshold
- Holistic approach essential to maximize "Total Body"
- Mind (Cognitive Ability, Mood)
- Body (Physical Ability, Pain)
- Spirit (Hope, Love, Connectedness, Goals, Sense of Purpose)
- Impairment, Disability and Handicap
- Functional Assessment
- Listen and Observe! Take a Good History and Focus on Change.
- Cognitive Status: Mini-Mental Status Exam (MMSE)--Folstein
- Psychological Status: Geriatric Depression Scale (GDS)--Yesavage
- Physical Status: FIM, Barthel, Katz ADL, Lawton IADL, Tinetti
Balance and Gait Scale, Dartmouth COOP Function and Health Status
Measures for Adults, Medication Review, Pulmonary Function Tests,
Echocardiography, Stress Testing
- Environmental Status: Home Safety Assessment, Medication Review
- Quality of Life Status: Life History, Functional History,
Joys/Fears/Frustrations, Favorite Music
- Rehab Goals for Older Adults
- Maximize Function/Maintain Function
- Promote Independence
- Provide Needed Help
- Treatment Approaches
- Ask yourself, "What one thing can I do to improve this
patient's quality of life?"
- Prevention--may delay onset of morbidity (i.e., crossing disease
threshold) (e.g., periodic screening & counseling of patient
and family (home safety, caregiver stress, medication use,
- Cure--many problems can be well-defined and treated definitively
(e.g., hypothyroidism, obstructive uropathy, restorative rehab)
- Palliation--attempt to maximize functional ability & quality
of life (e.g., maintenance rehab, pain control, emotional support)
- Choosing a Treatment Setting--The Continuum of Care
- Hospitalization/Acute Inpatient Rehabilitation
- Short-Stay Nursing Home Rehabilitation/Subacute Care
- Outpatient Rehabilitation/Home Health Care
- Adult Day Care/Hospice Care/Long-term Nursing Home Care
- The Team Approach--Key to Success
- Activities Staff/Administrator/Children/Dietary Staff
- Family/Friends/Hairdresser/Housekeeping Staff/Inservice Staff
- Maintenance Staff/Medical Records Staff/Nurses & Nursing
- Other Patients or Residents/Occupational Therapy Staff/Pets
- Pharmacist/Physical Therapy Staff
- Primary Care Practitioner (Physician, Nurse Practitioner or
- Public Relations Staff/Receptionist/Social Work Staff/Speech
- Others? ________________________________________________
- Ageist Attitudes/Behavioral
- Depression & Anxiety/Frustration/Futility/Multiple Medical
- Multiple Medications/Pain
- Regulatory Compliance (especially with regard to catheters,
contractures, pressure sores, psychotropics, restraints)
- Special Issues: Driving, Drug Abuse (Alcohol, Medications)
- Meeting the Challenge--Teamwork, Creativity and Positive
- Good Baseline Assessment to Find Opportunities for Improvement.
- Define clearly previous and current functional status.
- Ask "Has a catastrophic event occurred?" (e.g. amputation,
- Organize your team.
- Clarify/Understand the Main Problems and Possible Side Issues.
- Set specific goals/Select Appropriate Interventions.
- Reassess Response to Treatment/Try New Interventions/Go Back
- What is your "Quality Zone"?
- Merck Manual of Geriatrics
- Working With Your Older Patient: A Clinician's Handbook (available
free from the National Institute on Aging--800 222-2225)
- Clinics in Geriatric Medicine, November 1993 (Geriatric Rehabilitation)
- Clinics in Geriatric Medicine, May 1993 (Medical Considerations
in the Older Driver)
- University of North Carolina Program on Aging Videotape Series
- On-Line Resources: Internet/World Wide Web (WWW)
- Disability Resources on the WWW (e.g. http://mac10a.shrs-uparc.pitt.edu/RST/DisabilityLinks.html)
- Dr. Stall's WWW home page http://www.acsu.buffalo.edu/~drstall/index.html
- Administration on Aging home page http://www.aoa.dhhs.gov/aoa/index.html
Comments and questions
This page Copyright 1995 Robert S. Stall, MD--may be used
freely with acknowledgment