Aspects of Physical Medicine and Rehabilitation in Geriatrics

Introduction:

Aging is a natural process that results in a decline in the body's normal functioning. The body undergoes several physical, mental, and emotional changes in geriatric individuals. The risk of developing diseases like cardiovascular, diabetes mellitus, Alzheimer's, Parkinsonism, and chronic kidney disease are relatively high among geriatrics. Hence, physical medicine and rehabilitation play a vital role in maintaining and enhancing older adults' physical and psychological well-being.

What Are the Principles of Geriatric Rehabilitation?

Geriatric rehabilitation considers the biological, psychological, and social factors that influence the overall well-being of older adults. It aims to improve physical function, reduce pain, prevent falls, and enhance health by providing lifestyle modifications and therapies. The common principles involved are:

• Individualized Care: The approach to geriatric rehabilitation should be personalized, considering every patient's distinct requirements. This requires a comprehensive assessment of the patient's medical history, physical examination, and functional abilities.

• Multidisciplinary Approach: Geriatric rehabilitation often involves a team of healthcare professionals, including physical therapists, occupational therapists, nurses, and rehabilitation specialists. This team works together to develop a comprehensive rehabilitation plan that addresses the patient's physical, functional, and psychosocial needs.

• Patient-Centered Care: Geriatric rehabilitation should be focused on the patient's goals and priorities. The rehabilitation team strives to empower patients to actively participate in their care and treatment, recognizing them as active contributors to the rehabilitation process.

• Continuity of Care: Geriatric rehabilitation often requires long-term management of chronic conditions. The rehabilitation team should work with the patient's primary care physician to ensure continuity of care and effective management of comorbidities.

Who Requires Geriatric Rehabilitation?

Rehabilitation is commonly indicated in older adults with physical, psychological, or functional impairments. People with any of the following conditions may benefit from rehabilitation.

• Stroke.

• Parkinson's disease.

• Alzheimer's disease.

• Osteoarthritis.

• Fractures.

• Diabetes mellitus.

• Chronic kidney disease.

• Cardiovascular disorders.

• Diseases with cognitive impairment.

• Chronic fatigue or pain.

• Hearing or vision impairment.

In addition, rehabilitation can also be beneficial to prevent diseases and maintain a healthy lifestyle.

What Are the Aspects of Geriatric Rehabilitation?

• Physical Therapy: As people age, there is reduced muscle tone, strength, and bone mass. This results in decreased functional performance and independence in geriatric individuals. Physical therapy helps improve muscle strength, flexibility, balance, and coordination. Physical therapy may involve a range of techniques, including:

• Exercises: Physical therapists may recommend specific exercises like brisk walking or strengthening exercises.

• Manual Therapy: Therapeutic techniques involving manual therapy, such as massage, joint mobilization, and stretching, can enhance physical function, reduce pain, and improve range of motion.

• Assistive Devices: Physical therapists may recommend assistive devices, such as walkers, canes, and braces, to help older adults maintain their balance and mobility. Assistive devices may also be recommended for geriatric people after a fracture or surgery to aid healing.

• Occupational Therapy: The objective of occupational therapy is to improve the ability to perform daily routine activities like brushing, grooming, dressing, housekeeping, or bathing. Occupational therapy may also involve cognitive rehabilitation. Occupational therapists may also work with older adults experiencing cognitive impairments, such as memory loss or difficulty with decision-making. Cognitive rehabilitation techniques, such as memory training and problem-solving exercises, are used to improve cognitive function.

• Speech Therapy: Speech therapy is another service provided in geriatric rehabilitation. Speech therapists work with older adults who are experiencing speech, language, or swallowing difficulties. They may use various techniques to help older adults improve their communication and swallowing abilities. This is useful for people with conditions like stroke or Parkinson's disease. Techniques like articulation exercises, voice therapy, and language training are used to improve communication skills.

• Pain Management: Pain management is an important aspect of geriatric rehabilitation. Older adults may experience chronic pain due to conditions such as osteoarthritis or neuropathy due to a loss of muscle mass and bone density. Pain management strategies may include medications, physical therapy, or other complementary therapies such as acupuncture or massage. Rehabilitation specialists help by constantly reminding geriatric individuals to take pain medications as prescribed. This helps improve the quality of life and functional performance of older adults.

• Psychological Support: Psychological support is also an important component of geriatric rehabilitation. Older adults may experience psychological distress due to physical impairments or functional limitations. Geriatric rehabilitation may involve counseling or other psychological support services to help older adults cope with their conditions and reduce stress and anxiety.

• Nutritional Counseling: This helps in preventing diseases and maintaining a healthy life. This involves preparing diet charts and providing a balanced diet with adequate calories to older adults. In some instances, vitamins and mineral capsules may be prescribed to improve overall well-being.

• Prevention: Health promotion and prevention of diseases are essential parts of rehabilitation. It is crucial to emphasize maintaining a healthy lifestyle, promoting physical activities, and engaging in interesting activities to enhance their physical and mental health.

What Are the Benefits of Rehabilitation for Older Adults?

• Improved Functional Performance: Rehabilitation restores the body's normal functions, thus improving the strength and functional abilities of geriatric people.

• Improved Confidence: The self-confidence level increases after the rehabilitation process.

• Reduced Risk of Injuries: Through exercises and mobility training, geriatric rehabilitation can improve balance, coordination, and gait, reducing the risk of falls and injuries.

• Better Management of Chronic Conditions: Geriatric rehabilitation can help older adults better manage chronic conditions such as diabetes, heart disease, and arthritis.

• Improved Cognitive Function: Geriatric rehabilitation can include cognitive rehabilitation strategies that help older adults improve their memory, attention, and decision-making abilities.

• Enhanced Emotional Well-being: Geriatric rehabilitation can help older adults feel more independent, reducing feelings of anxiety and depression.

What Are the Challenges in Rehabilitating Geriatric People?

While rehabilitation proves to be a valuable tool for helping older adults, certain challenges are faced during the process. Some of the common challenges include:

• Lack of Motivation: Geriatric individuals may be reluctant to avail of rehabilitation services due to a lack of interest or self-confidence. They may be discouraged by physical and functional limitations.

• Inability to Access the Services: Barriers such as financial limitations, transportation issues, limited knowledge, and inadequate information may hinder individuals from accessing such services. Addressing this can be achieved by raising public awareness and implementing outreach programs.

• Coordination of Services: Rehabilitation is achieved through interdisciplinary planning by medical professionals, therapists, counselors, rehabilitation specialists, and senior individuals. A lack of coordination between these people can hinder rehabilitating individuals. Enhancing communication is important in such cases.

• Funding: People may not opt for rehabilitation due to a lack of financial support.

Conclusion:

Rehabilitation is crucial in enhancing the quality of life and fostering independence among older individuals. It is essential to discuss with medical professionals how to curate a specific rehabilitation plan based on an individual's needs and goals.