GERIATRIC REHABILITATION

Definition: Geriatric rehabilitation can

can be
be defined
defined
as a multidisciplinary set of evaluations, diagnostic
and therapeutic interventions whose purpose is to
restore functional ability or enhance residual
functional capacity in elderly people with disabling
impairments.
 Biology and physiology of aging:
1. Body composition.
2. Postural changes.
3. Cardiopulmonary changes.
4. Skin changes.
5. Hydration.
6. Skeletal muscle changes.
7. Intersystem homeostasis.
8. Sensory changes.
9. Gastrointestinal changes.
10.Renal,
10.Renal, urogenital & hepatic changes.
11.Endocrine
11.Endocrine changes.
 1. Body composition:
There is a gradual loss of lean tissue and an
increase in fat.
The loss of lean tissue reflects: loss of muscle
mass, total body muscle mass, limb muscle
volume, muscle cross section area, muscle fiber
numbers and area.
Body fat increases to 30% of body weight at the
age 80 years as compared to 15% at age 30,
which should be taken into account while
prescribing fat soluble drugs.
Bone mineral is lost, peak bone density occurs
in the 30s & 40s & thereafter gradually declines.
 2. Postural changes:
Progressive anterior thrust of the head &
extension of the cervical spine.
Accentuated thoracic kyphosis.
Straightening of the lumbar spine.
Increased extension of the arms.
Scapular protraction at shoulders is associated
with flexion of the elbows, ulnar deviation at wrist
& finger flexion.
Increased postural sway occurs with aging.
Ability to balance on one leg either with eyes
open or closed decreases.
Righting reflexes decreases and reaction time
increases.
 3. Cardiopulmonary changes:
Cardiac changes that occur with aging
include:
Decrease cardiac reserve.
Decreased contractile function.
Decreased heart rate.
Decreased response to exercise.
Blood pressure tends to rise with aging.
 4. Skin changes:
Aging changes that occurs in skin include:
Decreased moisture content.
Decreased epidermal renewal.
Decreased elasticity & blood supply.
Decreased sensitivity to touch, pain &
temperature.
More susceptible to pressure sores and
infection.
Alopecia.
Increased wrinkles.
 5. Hydration:
Elderly have approximately 25% decrease in
thrust perception as compared to young.
Medication (diuretics and laxatives) might
increase the elderly persons need for water to
maintain adequate hydration.
Many drugs used by elderly (antidepressants,
analgesics, cancer chemotherapy agents) can
cause the syndrome of inappropriate antidiuretic
hormone secretion and lead to water retention
and hyponatremia.
6. Changes in skeletal muscles:
Reduction in muscle mass.
Reduction in muscle fiber number.
Changes in muscle fiber size (individual fast- fast-
twitch type II muscle fibers decreases with age,
like vastus lateralis, tibialis anterior & biceps
brachii; whereas slow-
slow-twitch
twitch type I fiber does not
change).
Motor unit number & size (there is a decrease in
total number of motor units with age).
 7. Intersystem homeostasis:
Thermal regulation: Impaired thermoregulatory
thermoregulatory
mechanisms are more susceptible to
hyperthermia and hypothermia.
Circulation: older person may have
have as
as much
much as
as
20% reduction in cerebral perfusion by the age
of 70.
 8. Sensory changes:
Touch ± declines with age.
age.
Vision ± blurring of vision, eyelid
eyelid wrinkles,
wrinkles,
diminished tear production.
Hearing ± sensorineural hearing
hearing loss
loss
(presbycusis).
Proprioception/kinesthesia.
Vestibular system.
Taste & smell ± becomes less acute with
with age.
age.
 9. Gastrointestinal Changes:
Intermaxillary spaces reduces.
Tooth pulp may atrophy and regress.
Esophagus- decreased mobility and
Esophagus- and decreased
decreased
sphincter relaxation with swallowing
(presbyesophagus).
Diverticulosis- immobile/dehydration leads
Diverticulosis- leads to
to
constipation leads to fecal impaction & bowel
obstruction leads to diverticulosis.
 10. Renal, Urogenital & Hepatic
changes:
Liver mass and blood perfusion decrease with
age.a
Biliary stones incidence increases.
Efficiency of cholesterol stabilization in body
decreases.
Decrease in kidney mass and weight reduction
in glomerular capillary loops.
Glomerular filtration rate decreases.
Renal tubules
tubules-- decrease in excretory
excretory and
and
reabsorptive capacities.
Urinary bladder
bladder-- increased uninhibited
uninhibited
contractions, residual urine & bacteriuria.
 11. Endocrine changes:
Three hormones show decrease in circulating
hormone concentrations during aging:
Andropause-- decrease in gonadal
Andropause gonadal function
function in
in
men.
Adrenopause-- prepubertal increase
Adrenopause increase in
in adrenal
adrenal
secretion of DHEA.
Somatopause- decrease in function of
Somatopause- of growth
growth
hormone releasing, growth hormone insulin ±like
±like
growth factor.
 EVALUATION & ASSESSMENT
Assessment of an elder can be divided into
following headings:

Physical and functional assessment.

Pain assessment.
Environment assessment.
Psychosocial assessment.
 REHABILITATION OF ELDERLY
Most common conditions encountered by elderly
OSTEOPOROSIS.
PARKINSON¶S DISEASE.
STROKE MANAGEMENT.
BALANCE AND FALLS.
URINARY INCONTINENCE.
IMPAIRED RESPIRATION AND VENTILATION.
POSTURE.
Thank you..