Transcript Geriatric Rehabilitation

Geriatric Rehabilitation
What would be the most appropriate
assistive device?
78 y/o F S/P (L) TKA w/ severe RA of hands,
shoulders, knees
A. Large based quad cane
B. Crutches
C. Two-wheel walker
D. Forearm supports attached to a two-wheel
walker
E. Wheelchair
Hoenig H. JAGS, 1997 & GRS.
Rehabilitation: Concepts
Impairment
Disability
Handicap
Geriatric Rehabilitation
General Aspects
• Identify the correct diagnosis !
• Assess for comorbidities
• Involve the patient (& family)
• Team approach to care
• Prevent complications (A,B,C,…)
Geriatric Rehabilitation
MD
RN
Patient
Other
SW, Dietary,
Therapists
PT, OT, SpT, RecT
Rehabilitation Techniques
Exercise
Assistive Devices
• Mobility aids
• Orthotics
• Adaptive methods/equipment.
Assistive Devices- Mobility Aids
Device
• Canes
• Crutches
• Walker
Supports
15-20 % of body weight
100% of body weight
~ 50 % (not 100) of body weight
Geriatric Rehabilitation
Prevent complications A B C s
A. Aspiration, Anorexia, inActivity
B. Bedsores,
C. Constipation, Contractures, Cognition
D. DVTs, Depression, DUs
E. Else: infections (UTI, Pneumonia), pain,
incontinence
Geriatric Rehabilitation
Specifics
• Joints
– Elective replacements
– Fractures
• Stroke
• General Medical Problems
Hip Fractures
Amputations
250,000/year
50,000/year
Spinal/Compression Fracture
Mortality unclear
Age-adjusted mortality 2.15 (FIT) (a)
RR 1.66 F, 2.38 M (b)
Life expectancy
Men:
Women:
(c)
6.1 y (60-69y)
1.9 y
(a) Osteoporos Int 2000;111:556-561.
(b) Lancet 1999;353:878-882.
(c) Arch Intern Med 1999;159:1215-20
1.4 y
0.4 y
(>80)
Hip Fracture
Mortality
Acute:
1 year:
2 year:
3% F
20% F
8% M die
30-40 % M
>50 % M
(<80 y)
(>80y)
Returns to rate of general population
Am J Med 1997; 103:12S-19S &
Lancet 1999;353:878-882
Hip Fractures
Outcome at 1 year
40% cannot walk independently
60% require assistance with ADL
80% need help with IADL.
Functional Recovery S/P Hip Fx
Percentage Able toPerfrom
Independent Function Before 6 months after
•Dress
86
49
•Transfer
90
32
•Walk across a room
75
15
•Walk half a mile
41
6
JAGS 1992;40(9):863.
Joints/Fractures
Dx: fracture type determines surgical intervention
– Pins/Screws/Plates
– THA
Go to pictures
Intertrochanteric Fracture
Gardner’s 4
AP View
Lateral View
Joints / Fractures
Comorbidities:
Osteoporosis
Calcium & Vitamin D
Hormone status: Estrogen, Testosterone
Medications: Steroids, thiazides,
“too late” for DEXA ? use for f/u
Other complications . . .
Joints/Fractures
Complications
A – Activity (asap),
B – Look at skin! (NURSING!)
C – Laxatives (see pain below)
D – DVT prevention, Dislocation
Multiple regimens—LMWH, Warfarin, Fondaparinax
E- Else
Infections – Make sure foley out ASAP
Pain– Not moving so it doesn’t hurt is NOT good pain
control! (Use routine + PRN meds)
Amputation
Common
50,000/ year
Level of amputation:
BKA- work by 40-60%
AKA- work by 90-120%
Stump healing
Contractures
Risk of contralateral amputation -
20% @ 2 years
700,000 strokes/ year
Recurrence rate 7-10% annually
Stroke
Diagnosis:
Etiology (hemorrhage, thrombotic, embolic)
Developing interventions in acute phase
Location (frontal, posterior, left vs right)
May be factor in deficits and treatments needed
Coordinated care improves outcomes.
Recovery: Proximal to distal
Flaccid to spastic to recovery
Stroke
Rehabilitation is complex due to the variety of
causes and residual deficits
Recovery and time needed to reach maximal
recovery affected by the number of deficits.
– Hemiparesis, hemianopsia & sensory deficits
are less likely to ambulate (I) and will require a
longer time than those with hemiparesis only
Stroke
Comorbidities are often multiple:
DM,
Alcohol and Tobacco (withdrawal),
Hypertension,
Hyperlipidemia
Stroke
Complications:
A AspirationSpeech, LRI / Activity
B Watch skin, (NURSING!)
C Laxatives, prevent contractures,
D DVT prev, low threshhold for depression,
E Reflex sympathetic dystrophy (pain),
infection, subluxation…
General Medical/ Deconditioning
Dx:
Comorbidities:
Complications: