Rehabilitation of The Aged

Rehabilitation of the aged
Frederick Nsatimba ( Mr )
Introduction
 Rehabilitation plays an essential strategic role
to counteract impairments and disability
which characterize the elderly.
 Correct rehabilitative programmes have to be
approached on the functional limitation and
residual abilities of elders.
 The main goal of rehabilitative intervention in
the elderly is to maintain independent
mobility and activities of daily living (ADLs)
Objectives
 The role and effect of rehabilitation in elderly
people will be provided focusing on
I. role of exercise in the elderly;
II. Occupational therapy and assistive devices;
III. rehabilitation intervention in older people at
risk of falls;
IV. rehabilitation in frailty and chronic kidney
disease (CKD) in older patients;
Physical exercise in the healthy elderly
 Exercise is widely promoted to the adult

general population because of its major
benefit to health and well-being
 It contributes positively toward an individual’s
healthy weight, muscle strength, immune
system, and cardiovascular health
 The benefits of physical activity include
enhancement of the cardiovascular,
respiratory, musculoskeletal, and endocrine
function, and psychologic wellbeing
 Exercise lowers the risks of developing chronic
diseases associated with inflammation such as
coronary heart disease, hypertension, colon
cancer, and diabetes mellitus
 Physical activity can promote better brain
health with ageing and reduce the risk of
Alzheimer disease
 Older adults should perform regular moderate-
intensity aerobic activity focused on muscle-
strengthening, flexibility, and balance
 The World Health Organization promotes at least
30 minutes of moderate intensity physical
activity five days a week for older adults.
 With increasing age, there is a well-reported
decline in voluntary physical activity associated
with decreases in several measures of exercise
tolerance, including maximal aerobic capacity,
muscle strength, and fatigability, leading to an
increased risk of frailty
 Healthy older adults should take
approximately 7000-10 000 steps/day
Occupational Therapy and assistive devices
Occupational therapy and assistive
devices in elders
 The use of assistive devices is a common
intervention used to meet the goal of
maintaining independence in disabled
persons.
 In this respect, rehabilitation and occupational
therapy in particular play a key role as there
are countless assistive devices and their use
depends on impaired function and disability.
 Assistive tools are commonly recommended
for ADLs.
 They include dressing sticks, long-handled
shoe horns, long-handled sponges, button
hooks, shower seats, and three-in-one
commodes.
 These items have been revealed to be
effective in minimizing energy output and
improving function with self-care and ADLs in
patients with functional deficits because of
orthopedic and neuromuscular diseases.
 Older people can suffer from painful
polyarthritis affecting the major joints of the
limbs including shoulders, hips, and knees as
well as the small joints of the hands and feet.
In elders with limited hand use, adapting an
object’s characteristics, such as handle size,
can improve motor performance
 Increasing the diameter of handles on writing
instruments, grooming tools, feeding utensils,
and other daily tools can also improve grip
function.
 Frail older people have to rely on caregivers to
have their needs met and caregivers have to
tackle decreased psychologic and physical
health.
 Educational training and assistive strategies on
correct transfer, dressing, and toileting
techniques is an important role for
rehabilitation intervention and for
occupational therapy in particular.
 Correct techniques can save energy, increase

time efficiency, and decrease frustration.
 Simple interventions such as putting on a shirt
over the arms first then over the head and
trunk to make upper extremity dressing easier
can be taught to family or caregivers.
 Pants with elastic waists or zippers on each
side can be beneficial with clothing
management for toileting.
 Rehabilitative intervention can help to find the
best technique or equipment for a particular
situation and recommend when a caregiver
will have to provide more assistance.
 A further essential role of occupational
therapy is environmental and home-living
adaptation for elders with functional
limitation who are at risk of falls.
 In these subjects suitable programmes include
home hazard assessments by trained
individuals, removal or modification of
identified hazards, installation of safety
devices such as handrails on stairs and grab
bars on bathrooms, and improvements in
lighting.
Falls
 Falls are the leading cause of injury and
associated morbidity in the elderly
 Falls may lead to decreased mobility,
hospitalization, depression related symptoms,
functional decline, decreased social activity, and
poor quality of life .
 Falls have various causes including gait and
balance disturbance, muscle weakness, visual
deficit, dizziness, cognitive impairments,
psychoactive and multiple drug use, arthritis,
diabetes mellitus, pain, and environmental
hazards
 Among these, the most frequent factors include
impairment in balance-related physiologic systems
(impaired vision, slow reaction time, and greater
postural sway) and mobility limitation.
 Individuation of older people at risk of falls and fall
prevention is therefore an important issue in
reducing medical costs as well as promoting the
general well-being of the elderly. Indeed, quick
validated fall risk screening tools for elders are now
available for community, hospital, and nursing and
residential care settings
 Clinical practice guidelines and screening
algorithms have also been published to prevent
and reduce the risks of fall in older people
Rehabilitation in frail older people
 Generally, frailty refers to a condition
characterized by a gradual physiologic decline
in multiple body systems, by loss of function,
loss of physiologic reserve, and increased
vulnerability to disease and death
 Weakness and fatigue are central to almost all
definitions of frailty. Sarcopenia (loss of
skeletal muscle mass) is probably a key
component of these symptoms.
 As frail elder persons are mostly inclined
towards hospitalization, disability, and death,
developing interventions is a crucial step in
decreasing adverse health outcomes in frail
older adults.
 Several therapeutic strategies have been
proposed including exercises, multi-
component training and approaches, all aimed
to decrease the need for nursing home
placement, hospitalization, improving quality
of life, and reducing dependence and death.
 The interdisciplinary care team usually
includes a geriatrician or other medical
practitioner knowledgeable in the care of
older adults, a nurse, a social worker, and an
occupational or physical therapist, if available
summary
 The population of ageing is increasingly , and
for that matter, rehabilitation play an essential
role to counteract impairment and to maintain
functional independence in the elderly.
 Regular physical activity including aerobic
exercises must be recommended to healthy
older people.
 As functional decline advances, tailored and
multi-factorial rehabilitative interventions must
be planned in elder individuals with complex
disability by a comprehensive geriatric team.

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Rehabilitation of the aged

 Exercise is widely promoted to the adult

 Correct techniques can save energy, increase

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