Overview of geriatric rehabilitation: Patient assessment and common indications for rehabilitation
- Helen Hoenig, MD, MPH
Helen Hoenig, MD, MPH
- Professor of Medicine/Geriatrics
- Duke University School of Medicine
- Chief - Physical Medicine and Rehabilitation Service
- Durham VA Medical Center
- Cathleen Colon-Emeric, MD
Cathleen Colon-Emeric, MD
- Associate Professor of Medicine
- Duke University Medical Center
Disability, or limitation in the ability to carry out basic functional activities, becomes increasingly common with advancing age; nearly one in four United States Medicare beneficiaries report at least one health-related disability . Crude rates of disability are rising around the globe with over 700 million years lived with disability (YLDs) in 2010 compared with 583 million in 1990; however, after adjusting for population growth rates of YLDs per 100,000, people have remained largely constant over time, but rise steadily with age . While there is considerable heterogeneity across countries in the dominant causes of disability, in general, the global disease burden has shifted from communicable to noncommunicable diseases, with many countries experiencing increases in age-related conditions and YLDs . The most common contributors to YLDs in 2010 included low back pain, major depressive disorder, iron deficiency anemia, neck pain, chronic obstructive pulmonary disease (COPD), anxiety disorders, migraine, diabetes, and falls .
The primary purpose of rehabilitation is to enable people to function at the highest possible level despite physical impairment. While rehabilitation may be provided to all age groups, the fastest growing population of persons requiring rehabilitation services is adults over 65 years of age.
This topic will discuss assessing patients for rehabilitation services and indications for rehabilitation. Issues regarding comprehensive geriatric assessment, disability assessment, and components and settings for rehabilitation are discussed separately. (See "Comprehensive geriatric assessment" and "Disability assessment and determination in the United States" and "Overview of geriatric rehabilitation: Program components and settings for rehabilitation".)
EPIDEMIOLOGY OF DISABILITY
Functional disabilities are commonly categorized as activities of daily living (ADL) (table 1) or instrumental activities of daily living (IADL) (table 2). ADLs include bathing, dressing, toileting, transferring, eating, and continence. IADLs include cooking, cleaning, shopping, transportation, finances, and medication management.
Disability has a tremendous impact on the quality of life of individuals and their caregivers . Disability also impacts health care utilization; increasing the number of ADL disabilities from zero to six results in a sevenfold increase in health care costs . Multiple chronic conditions are associated with increasing levels of disability, and the proportion of older adults in the United States reporting multiple chronic conditions is increasing over time, with 17.4 percent reporting four or more chronic conditions in 2008 compared with 11.7 percent in 1998, although, the proportion reporting an ADL or IADL disability has remained stable at approximately 25 percent over this period .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- EPIDEMIOLOGY OF DISABILITY
- APPROACH TO ASSESSING LATE-LIFE DISABILITY
- Characterize the disability
- Identify impairments
- Identify health conditions
- Identify contextual factors
- APPROACH TO THE MANAGEMENT OF LATE-LIFE DISABILITY
- Strategies to improve capacity
- Strategies to reduce demand
- Role of the interprofessional team
- REHABILITATION FOR SPECIFIC CONDITIONS
- - Stroke
- - Other neurologic conditions
- Spinal cord injury
- Musculoskeletal conditions
- - Hip fracture
- - Elective joint replacement
- - Knee arthritis
- PREVENTION OF LATE-LIFE DISABILITY
- Optimizing functional reserve
- Prevent common disability precipitants
- Early intervention
- SUMMARY AND RECOMMENDATIONS