Rehabilitation, an important intervention in supporting frail older persons.

Author:  DR TASNEEM MAYAT

MBBS, FRACP

Consultant Physician and Geriatrician

Geriatric rehabilitation is geared towards older people and their unique attributes and challenges. One needs to consider that older adults tend to have less muscle strength, coordination and reaction timing, lower tolerance of physical activity and frailty.

There are vulnerabilities in an older adult that makes it harder for them to “bounce back” after a stressor such as a surgery, fall, acute illness, emotional upheaval to name a few. Coupled with frailty, diminished physiological, cognitive, and functional reserve, an older adult does not necessarily regain their previous functional baseline leading to disability and dependence, sometimes a change living arrangement.

Geriatric rehabilitation takes this into account and aims to improve an older person’s strength and endurance, prevent, or minimise deconditioning, prevent muscle atrophy, decrease falls risk and associated injuries, maintain independence in daily activities.

Rehabilitation is an important intervention in supporting frail older persons in their recovery from acute illness. It is important that a clinician determine a persons rehab potential or suitability. To predict who would benefit from rehab, one considers a range of holistic clinical and non-clinical factors. A multidisciplinary assessment, centred around patient and carer needs and wants is needed to accommodate for complexity. Ideal rehab candidates, have rehab potential, can follow instructions, and engage in therapy and have realistic and attainable rehab goals.

Patient with cognitive impairment or dementia, can also have rehab provided they can follow and engage in therapy. Families and carers also must be realistic in their expectations regarding rehab especially in the setting of a frail or cognitively impaired elder. Rehab suitability is thus considered on  case by case basis.

Sometimes a “trial of rehab” for a short period like two weeks, will need to be considered in complex or borderline cases. This might not change the discharge destination such as requiring nursing home or 24/7 care at home, though is important for quality of life.

If you would like to have a patient considered for inpatient rehab, please feel free to contact us to discuss further.