Introduction in the principle of geriatric rehabilitation Dr. Rehab Gwada

Objectives of the lecture Define the terminology of Gerontology, Geriatrics aging ,and elderly. Identify Categories of old age definitions &Classification of elderly Recognize the Geriatric physical therapy , its role& setting and resources Identify Essential Competencies in the Care of Older Adults List common cases & Possible indications for geriatric physical therapy referral. Recognize Geriatric Rehabilitation team and its role Dr. rehab gwada

Gerontology Gerontology• This is the study of the aging process itself. The study of physical and psychological changes which are incident to the old age is call gerontology. Geriatrics • Geriatrics is the branch of internal medicine that focuses on health care of the elderly. It aims mainly to promote health and to diagnosis , prevent and treat diseases and disabilities in older adults.

AGING Aging can be defined as a progressive and generalized impairment of function resulting in the loss of adaptive response to stress and increased risk of age related diseases. The overall effect of these alterations is an increase in the probability of declining health and dying. is the accumulation of Irreversible changes in a person over time. Ageing in humans refers to a multidimensional process of physical, psychological, and social changes.

Definition of elderly Most developed world countries ( include USA) have accepted the chronological age of 65 years as a definition of 'elderly' or older person, this definition is somewhat arbitrary. there is no United Nations standard numerical criterion, but the UN agreed cutoff is 60+ years to refer to the older population. The more traditional African definitions of an 'elderly' person correlate with the chronological ages of 50 to 65 years, depending on the region and the country.in addition many individuals in Africa do not have an official record of their birth date. Geriatric health problem may occur early at 50s and older athletes may in their 40s Dr. rehab gwada

Categories of old age definitions Chronology Change in social role how people should act as they grow older (i.e. change in work patterns, adult status of children and menopause). Change in capabilities (i.e. senility and change in physical characteristics). Dr. rehab gwada

Classification of elderly PT. is aimed at primary prevention of diseases PT is concentrated on achievement of human comfort(PM. Positioning ) Young old (60,65–75). Old (75–85) Old- old (85+) PT is directed at the improvement in function status

Geriatric physical therapy An area of specialization that requires a specific set of advanced skills and knowledge that addresses the aging process. Specialists in geriatric physical therapy understand the differences between ‘normal’ aging and pathological changes that commonly occur in the older adult. Assisting the geriatric client can be hard task because of multisystem involvement and multiple comorbidities. Special considerations such as psychosocial issues, environmental, frailty, nutritional, pharmacological and cultural factors must be accounted for in a successful rehabilitation process.

Geriatric physical therapy role Assisting the individual to return to optimal living within their capabilities. To achieve the highest level of functional mobility as possible within their environment while maintaining safety. Enabling the older adult to enjoy a longer life by living it more independently and with less pain. The primary goal of geriatric physical therapy is to prevent, maintain or rehabilitate an impairment or functional limitation, which is accomplished with the application of evidence-based scientific principles. Main goal improved function

Cont. combating and minimizing the accumulative disabling effects of physical illness in association with the aging process. reducing institutionalization. Providing education for the patient and caregivers. Contributing to the comfort and well-being of the patient.

Geriatric clinical specialists According to The world confederation for physical therapy WCPT (2005 ) and The American Board of Physical Therapy Specialties , To become a GCS, one must be:- a licensed physical therapist, spend a prescribed number of hours in direct patient care with the elderly, and pass a rigorous written examination. The world confederation for physical therapy = WCPT (

Essential Competencies in the Care Elderly of Health Promotion and Safety evaluation and assessment Care Planning and Coordination Across the Care Spectrum (Including End-of- Life Care Interdisciplinary and Team Care Caregiver Support Healthcare Systems and Benefits Essential Competencies in the Care of Older Adults according to Partnership for Health in Aging (PHA) by the American Geriatrics Society, including the APTA and Include 6 domains that clarify the skills essential for a physical therapist to provide competent physical therapy care to older adults within each domain and for each PHA competency.

Geriatric physical therapy settings Inpatient medical rehabilitation (rehabilitation units in acute care or rehabilitation hospitals, long term care, nursing-home rehabilitation) Outpatient: ( primary care, private practice, etc). Home health rehabilitation.

COMMON GERIATRIC DISORDERS PT Cases Cardiovascular disorders: hypertension, CHD, heart failure. Respiratory disorders : asthma, COPD Neurological and cognitive conditions: Stroke, Parkinson's disease, dementia, delirium, Alzheimer,depression, fear of falling Musculoskeletal: osteoporosis, OA, RA, falls, fracture, incontinence Integumentary conditions: Pressure ulcers, diabetic ulcers, venous stasis ulcers, herpes zoster, malignant tumors

Indications for geriatric PT referral Recent fall or history of falls Deficits in strength or range of motion Loss of mobility or ambulation requiring an assistive device Musculoskeletal pain Difficulty with transfers Orthotic or prosthetic needs Open wound Neurological disorder Balance deficits Decreased endurance for ADLs Bed bound status Need for adaptive equipment to enhance safety and function

Multidisciplinary Geriatric Rehabilitation team MD RN Patient& FAMILY Rehabilitation is always a multidisciplinary group. It requires a wholistic approach to the patient and includes the patient in the process. Therapists Other PT, OT, SLP, Rec. T SW, Dietary,

Geriatric Rehabilitation team

Geriatric Rehabilitation team

Geriatric Resources Professional Organizations: Journals American physical therapy Association, geriatric section http://www.apta.org American Geriatrics Society: http://www.americangeriatrics.org/ Gerontological Society of America: http://www.geron.org/ Journals Journal of American Geriatric Society(JAGS) Journal of Gerontology Journal of Geriatric physical therapy. Physical therapy.

References Guccione AA, Geriatric Physical Therapy, 3rd. Ed, Mosby 2012 Guccione AA : Geriatric Physical Therapy, Mosby, 2nd edition, 2000. Multani NK.,and Verma SK.,Principles of geriatric physical therapy. Jaypee Brothers Medical Publishers.1st ed.,2007. American physical therapy Association(APTA)2003Guide to physical therapist practice, 2nd ed. APTA,Alxandria, VA American physical therapy Association(APTA)2005 Vision Sentence for physical therapy 2020 and APTA Vision Statement for physical therapy 2020. available : http://www.apta.org