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Book Details
Abstract
Rehabilitation of the geriatric patient poses a unique set of challenges and conditions often not seen in younger patients, but which are common among older adults. This quick, practical resource helps physiatrists and other members of the rehabilitation team overcome these challenges, covering the wide range of topics necessary to provide the highest level of care to this rapidly increasing population.
- Presents practical guidance on arthritis and joint replacement, polypharmacy and mobility, swallowing dysfunction, nutritional recommendations, psychiatric and cognitive disorders, assistive technology, and more.
- Covers the physiologic changes and epidemiology of aging, osteoporosis and fragility fractures, fall prevention and intervention, and prevention of hospital-acquired deconditioning.
- Consolidates today’s available information on geriatric rehabilitation into one convenient resource.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Geriatric Rehabilitation | i | ||
| Geriatric Rehabilitation | iii | ||
| Copyright | iv | ||
| List of Contributors | v | ||
| Foreword | ix | ||
| Preface | xi | ||
| Contents | xiii | ||
| 1 - Epidemiology of Aging, Disability, Frailty and Overall Role of Physiatry | 1 | ||
| INTRODUCTION | 1 | ||
| EPIDEMIOLOGY OF AGING: DEMOGRAPHICS AND WHAT IS “NORMAL” | 1 | ||
| Demographics | 1 | ||
| Changes Associated With “Normal” Aging | 2 | ||
| CHRONIC CONDITIONS IN OLDER ADULTS | 2 | ||
| Chronic Conditions at a Glance | 2 | ||
| DISABILITY IN OLDER ADULTS | 2 | ||
| Comorbidity | 2 | ||
| Multimorbidity | 2 | ||
| GERIATRIC SYNDROMES | 4 | ||
| FRAILTY | 6 | ||
| The Concept of Frailty | 6 | ||
| Brief Note on Polypharmacy and Deprescribing | 7 | ||
| DISABILITY IN OLDER ADULTS | 7 | ||
| THE CRITICAL IMPORTANCE OF PHYSICAL ACTIVITY | 7 | ||
| Benefits and Limitations | 8 | ||
| The Geriatric Exercise Prescription | 8 | ||
| Arthritis | 9 | ||
| THE EMERGING ROLE OF MULTIDISCIPLINARY CARE TEAMS | 10 | ||
| The Problem | 10 | ||
| The Role of Physiatrists | 10 | ||
| The Comprehensive Geriatric Assessment | 11 | ||
| CONCLUSIONS | 12 | ||
| REFERENCES | 12 | ||
| 2 - Sarcopenia | 19 | ||
| INTRODUCTION | 19 | ||
| DEFINITION OF SARCOPENIA | 19 | ||
| MAKING THE DIAGNOSIS | 20 | ||
| PREVALENCE OF SARCOPENIA | 21 | ||
| PHYSIOLOGICAL CHANGES ASSOCIATED WITH SARCOPENIA | 22 | ||
| Muscle Strength | 23 | ||
| Muscle Size | 23 | ||
| Muscle Function and Performance | 23 | ||
| THE CELLULAR AND MOLECULAR BASIS OF MUSCLE WEAKNESS AND ATROPHY | 23 | ||
| EXERCISE AND NUTRITIONAL SUPPLEMENTATION AS COUNTERMEASURES | 24 | ||
| CONCLUDING STATEMENT | 24 | ||
| REFERENCES | 25 | ||
| 3 - Osteoporosis and Fragility Fracture | 27 | ||
| INTRODUCTION | 27 | ||
| OSTEOPOROSIS | 27 | ||
| Definition and Diagnosis of Osteoporosis in the Geriatric Population | 27 | ||
| Epidemiology and Risk Factors | 28 | ||
| Approaches | 29 | ||
| Laboratory studies | 29 | ||
| Treatment of osteoporosis | 30 | ||
| FALLS AND FRAGILITY FRACTURES | 31 | ||
| Epidemiology | 31 | ||
| Outcomes of Fragility Fractures | 31 | ||
| ORTHOPEDIC TREATMENT | 32 | ||
| Preoperative Care | 32 | ||
| Perioperative Care Before and After Surgery | 32 | ||
| Orthopedic management | 32 | ||
| Postoperative complications | 34 | ||
| REHABILITATION IN ACUTE CARE | 34 | ||
| Establishment of a Postoperative Rehabilitation Program | 34 | ||
| Rehabilitation in the acute phase and subacute phase | 35 | ||
| COMMUNITY CARE AND LONG-TERM CARE | 36 | ||
| Nutrition | 37 | ||
| Vitamin D | 37 | ||
| Mobile Outreach Program | 38 | ||
| FALL PREVENTION | 38 | ||
| Fall Risk Measurements | 38 | ||
| Interventions to Prevent Falls | 38 | ||
| CONCLUSION | 39 | ||
| REFERENCES | 39 | ||
| 4 - Fall Prevention and Intervention | 43 | ||
| INTRODUCTION | 43 | ||
| DEFINITION OF FALLS | 43 | ||
| EPIDEMIOLOGY OF FALLS | 43 | ||
| Fall Rates and Risks | 43 | ||
| Outcomes of Falls | 44 | ||
| Orthopedic Injuries | 45 | ||
| Traumatic Brain Injury | 45 | ||
| Spinal Cord Injury | 46 | ||
| Postfall Syndrome (“Postfall Anxiety Syndrome”) | 46 | ||
| RISK FACTORS FOR FALLS | 46 | ||
| Intrinsic Risk Factors | 46 | ||
| Extrinsic Risk Factors | 48 | ||
| SCREENING AND ASSESSMENT FOR FALL RISK | 48 | ||
| INTERVENTIONS | 48 | ||
| Older Community-Dwelling Adults | 48 | ||
| Interventions to reduce the fear of falling | 48 | ||
| Older Adults in Long-Term Care Facilities | 51 | ||
| Older Adults in Hospitals and Rehabilitation Facilities | 53 | ||
| Older Individuals With Cognitive Impairment37 | 53 | ||
| Implementing Fall Prevention Programs as a Public Health Intervention | 53 | ||
| Cost-Effectiveness of Fall Prevention | 53 | ||
| Technological Applications and Novel Interventions for Fall Prevention | 53 | ||
| CONCLUSION | 54 | ||
| REFERENCES | 54 | ||
| 5 - Central Nervous System Disorders Affecting Mobility in Older Adults | 57 | ||
| AGING AND CENTRAL NERVOUS SYSTEM | 57 | ||
| Visual and Auditory Changes | 57 | ||
| Sensory and Motor Changes | 58 | ||
| Cognitive, Memory, and Behavioral Changes | 58 | ||
| Medication Metabolism Changes | 58 | ||
| EPIDEMIOLOGY OF NEUROLOGIC DISORDERS IN GERIATRIC POPULATION | 59 | ||
| CENTRAL NERVOUS SYSTEM DISORDERS THAT AFFECT GERIATRIC POPULATIONS | 59 | ||
| Cerebrovascular Disease (Stroke) | 59 | ||
| Parkinson disease | 60 | ||
| Multiple sclerosis | 62 | ||
| Traumatic Brain Injury in the Elderly | 63 | ||
| Normal Pressure Hydrocephalus | 63 | ||
| CONCLUSION/SUMMARY | 64 | ||
| REFERENCES | 64 | ||
| 6 - Peripheral Nervous System and Vascular Disorders Affecting Mobility in Older Adults | 69 | ||
| HISTORY TAKING FOR OLDER ADULTS WITH MOBILITY IMPAIRMENT AND SUSPECTED PNSD OR PVD | 69 | ||
| PERIPHERAL NERVOUS SYSTEM DISORDERS | 70 | ||
| Mobility Disability Related to Peripheral Nervous Disorders | 70 | ||
| History and Physical Examination | 70 | ||
| Diagnostic Workup for PNSD | 72 | ||
| Electrodiagnosis | 73 | ||
| Laboratory test | 74 | ||
| Imaging study | 74 | ||
| Rehabilitation Management of Peripheral Neuropathy | 74 | ||
| PERIPHERAL VASCULAR DISORDERS | 75 | ||
| Peripheral Arterial Disease | 75 | ||
| Mobility disability related to peripheral arterial disease | 75 | ||
| History and physical examination | 75 | ||
| Diagnostic workup | 76 | ||
| Rehabilitation management of peripheral arterial disease | 77 | ||
| Venous System Disorders | 77 | ||
| Clinical presentation | 77 | ||
| Management | 78 | ||
| CONCLUSION | 78 | ||
| REFERENCES | 78 | ||
| 7 - Arthritis and Joint Replacement | 81 | ||
| INTRODUCTION | 81 | ||
| GENERAL OVERVIEW OF OSTEOARTHRITIS EPIDEMIOLOGY | 81 | ||
| PATHOGENESIS OF OSTEOARTHRITIS | 81 | ||
| Inflammation and Primary Osteoarthritis | 81 | ||
| Individual Joint Components and Primary Osteoarthritis | 82 | ||
| HIP OSTEOARTHRITIS | 84 | ||
| Epidemiology | 84 | ||
| Anatomy and Biomechanics of the Hip | 85 | ||
| Hip Joint Pathomorphologies | 85 | ||
| Femoroacetabular impingement syndrome | 86 | ||
| Developmental dysplasia of the hip | 87 | ||
| ASSOCIATED RISK FACTORS FOR HIP OSTEOARTHRITIS | 89 | ||
| Gender | 89 | ||
| Genetics and Ethnicity | 89 | ||
| Dietary Factors | 90 | ||
| Obesity | 90 | ||
| Age | 91 | ||
| Occupation | 91 | ||
| CLINICAL DIAGNOSTIC CRITERIA FOR HIP AND KNEE OSTEOARTHRITIS | 91 | ||
| GRADING OSTEOARTHRITIS OF THE HIP AND KNEE | 92 | ||
| CARING FOR THE ELDERLY OSTEOARTHRITIC HIP AND KNEE JOINT | 94 | ||
| Patient Education on Osteoarthritis | 94 | ||
| Activity and Lifestyle Modification | 94 | ||
| Physical Therapy Program | 95 | ||
| Assistive Devices: The Formidable Cane | 96 | ||
| Pharmacologic Management | 97 | ||
| Supplements | 97 | ||
| Acetaminophen | 98 | ||
| Nonsteroidal Antiinflammatory Medications | 99 | ||
| Alternative Oral Agents | 99 | ||
| Intraarticular Injections | 99 | ||
| TOTAL JOINT REPLACEMENT (ARTHROPLASTY) | 101 | ||
| Incidence and Prevalence | 101 | ||
| Hip Arthroplasty Patient and Implant Selection | 101 | ||
| Total Hip Replacement Complications | 102 | ||
| Total Hip Replacement Survivorship | 103 | ||
| FUTURE CONSIDERATIONS | 104 | ||
| REFERENCES | 104 | ||
| 8 - Prevention of Hospital-Acquired Deconditioning | 111 | ||
| EPIDEMIOLOGY AND EFFECT OF DECONDITIONING | 111 | ||
| IMPACT OF BED REST AND IMMOBILITY | 111 | ||
| Musculoskeletal System | 111 | ||
| Sarcopenia | 111 | ||
| Joint Contracture | 112 | ||
| Osteoporosis | 113 | ||
| CIRCULATORY AND RESPIRATORY SYSTEM | 114 | ||
| Effects on the Circulatory System | 114 | ||
| Effects on the Respiratory System | 114 | ||
| Orthostatic Hypotension | 114 | ||
| Deep Vein Thrombosis | 114 | ||
| METABOLIC AND ENDOCRINE SYSTEM | 115 | ||
| OTHER ORGAN SYSTEMS | 115 | ||
| ASSESSMENT | 116 | ||
| PREVENTION OF COMPLICATION OF BED REST IN ACUTE HOSPITALIZATION | 116 | ||
| Pneumonia | 116 | ||
| Urinary Tract Infection and Functional Incontinence | 116 | ||
| Joint Contracture | 116 | ||
| Pressure Injury (Ulcer) | 116 | ||
| Orthostatic Hypotension | 116 | ||
| Deep Vein Thrombosis | 116 | ||
| INTENSIVE CARE UNIT REHABILITATION | 116 | ||
| RECONDITIONING REHABILITATION AT SUBACUTE STAGE | 117 | ||
| Motor Function Training | 117 | ||
| Cognition Rehabilitation and Psychologic Support | 117 | ||
| Activity of Daily Living Training | 117 | ||
| Nutrition and Metabolic Disorders | 117 | ||
| CONCLUSION | 118 | ||
| REFERENCES | 118 | ||
| 9 - Polypharmacy and Mobility | 121 | ||
| EPIDEMIOLOGY | 121 | ||
| AGE-RELATED PHYSIOLOGIC CHANGES AFFECTING MOBILITY | 124 | ||
| PHARMACOKINETIC CHANGES WITH AGING23 | 125 | ||
| PHARMACODYNAMIC CHANGES WITH AGING23 | 125 | ||
| MEDICATION CLASSES AND MOBILITY IMPAIRMENT | 125 | ||
| EVALUATION OF PATIENTS FOR POLYPHARMACY AND MOBILITY IMPAIRMENT | 125 | ||
| INTERVENTION | 126 | ||
| SUMMARY | 127 | ||
| REFERENCES | 128 | ||
| 10 - Nutritional Issues and Swallowing in the Geriatric Population | 131 | ||
| INTRODUCTION | 131 | ||
| HOW COMMON IS MALNUTRITION IN OLDER ADULTS? | 131 | ||
| IS WEIGHT LOSS PART OF NORMAL AGING? | 131 | ||
| WHAT IS THE BEST WAY TO IDENTIFY MALNUTRITION IN OLDER ADULTS? | 132 | ||
| WHAT IS THE BEST APPROACH TO MALNUTRITION? | 132 | ||
| HOW COMMON IS DYSPHAGIA IN OLDER ADULTS? | 135 | ||
| HOW DOES AGING AFFECT SWALLOWING? | 135 | ||
| WHAT ARE CAUSES OF DYSPHAGIA IN OLDER ADULTS? | 135 | ||
| HOW IS DYSPHAGIA IDENTIFIED? | 136 | ||
| WHAT ARE SYMPTOMS AND SIGNS OF DYSPHAGIA? | 137 | ||
| HOW IS DYSPHAGIA DIAGNOSED? | 137 | ||
| Clinical (or Bedside) Swallow Evaluation | 138 | ||
| Instrumental Swallow Examination | 140 | ||
| HOW IS DYSPHAGIA TREATED? | 141 | ||
| Education and Counseling | 141 | ||
| Compensatory Approaches | 141 | ||
| Rehabilitative Approaches | 142 | ||
| REFERENCES | 143 | ||
| 11 - Diagnosis and Rehabilitation of Hearing Disorders in the Elderly | 145 | ||
| INTRODUCTION | 145 | ||
| AGE-RELATED HEARING LOSS | 145 | ||
| Definition of Age-Related Hearing Loss | 145 | ||
| Symptoms and Impact of Age-Related Hearing Loss | 145 | ||
| Pathology, Etiology, and Contributing Factors of Age-Related Hearing Loss | 146 | ||
| Evaluation of Age-Related Hearing Loss | 146 | ||
| Case history | 146 | ||
| Otoscopic examination | 146 | ||
| Standard audiologic evaluation | 148 | ||
| Immittance audiometry | 150 | ||
| Other auditory testing and questionnaires | 151 | ||
| Surgical and medical treatment | 154 | ||
| Prevention of Age-Related Hearing Loss | 155 | ||
| CASE STUDY | 155 | ||
| Evaluation | 155 | ||
| Management | 155 | ||
| Evaluation | 156 | ||
| Management | 156 | ||
| CONCLUDING STATEMENT | 157 | ||
| REFERENCES | 158 | ||
| 12 - Rehabilitation in Musculoskeletal and Sports Injuries in Older Adults | 161 | ||
| INTRODUCTION | 161 | ||
| BASIC CONCEPTS OF SPORTS INJURY IN THE OLDER ADULT | 161 | ||
| Epidemiology of Sports Injury | 161 | ||
| Identification of Risk Factors | 162 | ||
| Classification of Injury | 162 | ||
| Patient Evaluation | 163 | ||
| Phases of Sports Rehabilitation | 163 | ||
| REHABILITATION OF INJURIES COMMON IN THE OLDER ATHLETE | 164 | ||
| Rotator Cuff Injury | 164 | ||
| Knee Osteoarthritis | 165 | ||
| Lumbar Spine Injury | 166 | ||
| Return to Play Considerations | 166 | ||
| Prevention of Sports Injury | 166 | ||
| SUMMARY | 167 | ||
| REFERENCES | 167 | ||
| 13 - Geriatric Psychiatric and Cognitive Disorders: Depression, Dementia, and Delirium | 169 | ||
| DEPRESSION | 169 | ||
| Definition of Depression | 169 | ||
| Clinical Features of Depression | 169 | ||
| Causes of Depression | 169 | ||
| Diagnosis of Depression | 170 | ||
| Treatment of Depression | 170 | ||
| Prevention of Depression | 171 | ||
| DEMENTIA | 171 | ||
| Definition of Dementia | 171 | ||
| Mild Cognitive Impairment | 172 | ||
| Vascular dementia | 173 | ||
| Other causes of dementia | 174 | ||
| Diagnosis of Dementia | 174 | ||
| Treatment of Dementia | 174 | ||
| Prevention of Dementia | 175 | ||
| DELIRIUM | 175 | ||
| Definition of Delirium | 175 | ||
| Clinical Features of Delirium | 176 | ||
| Causes of Delirium | 177 | ||
| Diagnosis of Delirium | 177 | ||
| Treatment of Delirium | 178 | ||
| Prevention of Delirium | 178 | ||
| CONCLUSION | 178 | ||
| REFERENCES | 179 | ||
| 14 - Exercise Recommendations for Older Adults for Prevention of Disability | 181 | ||
| EPIDEMIOLOGY | 181 | ||
| PHYSIOLOGY OF AGING | 181 | ||
| DECONDITIONING AND EXERCISE | 182 | ||
| PRECONDITIONING ASSESSMENT | 183 | ||
| EXERCISE PRESCRIPTION | 183 | ||
| AEROBIC EXERCISE RECOMMENDATIONS | 184 | ||
| THE ROLE OF EXERCISE THERAPY AND PREVENTION OF DISABILITY | 185 | ||
| BENEFITS OF SPECIFIC EXERCISE MODALITIES | 185 | ||
| Progressive Resistance Training | 185 | ||
| Tai Chi | 186 | ||
| Walking Programs | 187 | ||
| INJURY PREVENTION IN OLDER ADULTS | 187 | ||
| FUTURE DIRECTIONS | 188 | ||
| SUMMARY OF RECOMMENDATIONS | 189 | ||
| REFERENCES | 189 | ||
| 15 - Spine Disorders in Older Adults | 195 | ||
| INTRODUCTION | 195 | ||
| SPINE STRUCTURE AND FUNCTION | 195 | ||
| AGING | 195 | ||
| IS DEGENERATIVE DISC DISEASE A DISEASE? | 197 | ||
| INTERVERTEBRAL DISC | 197 | ||
| VERTEBRAL BODY AND ENDPLATE | 197 | ||
| FACET JOINTS | 198 | ||
| MUSCLES AND LIGAMENTS | 198 | ||
| SPINE CONDITIONS AFFECTING OLDER ADULTS | 199 | ||
| Osteoporosis and Vertebral Fractures | 199 | ||
| Normal bone metabolism | 199 | ||
| Risk factors | 199 | ||
| Diagnosis | 200 | ||
| Prevention | 200 | ||
| Management | 201 | ||
| Facet Arthropathy | 201 | ||
| Pathogenesis | 201 | ||
| Clinical presentation | 201 | ||
| Diagnosis | 203 | ||
| Management | 203 | ||
| Cervical Myelopathy | 203 | ||
| Pathogenesis | 203 | ||
| Clinical presentation | 205 | ||
| Imaging assessment | 206 | ||
| Management | 206 | ||
| Lumbar Spinal Stenosis | 207 | ||
| Pathogenesis | 207 | ||
| Clinical presentation | 208 | ||
| Imaging assessment | 208 | ||
| Management | 208 | ||
| Sarcopenia | 209 | ||
| Pathogenesis | 209 | ||
| Management | 210 | ||
| CONCLUSIONS | 210 | ||
| REFERENCES | 210 | ||
| 16 - Assistive Technologies for Geriatric Population | 213 | ||
| INTRODUCTION | 213 | ||
| CATEGORIES AND TARGET AREAS OF ASSISTIVE TECHNOLOGIES IN THE CARE OF OLDER ADULTS | 213 | ||
| Accessing and Retrieving Health Information | 214 | ||
| Assisting Caregiving | 218 | ||
| Management of Chronic Diseases by Telemedicine and “e-Health” | 214 | ||
| Medication Optimization | 215 | ||
| Improving Social Isolation, Loneliness, and Well-being | 216 | ||
| Falls and Physical Functioning | 217 | ||
| Mobility Assistance | 218 | ||
| Power wheelchairs | 218 | ||
| Wearable devices | 218 | ||
| FUTURE DIRECTIONS IN THE DEVELOPMENT AND ADOPTION OF ASSISTIVE TECHNOLOGY IN THE CARE OF OLDER ADULTS | 219 | ||
| REFERENCES | 220 | ||
| Index | 223 | ||
| A | 223 | ||
| B | 223 | ||
| C | 223 | ||
| D | 223 | ||
| E | 224 | ||
| F | 224 | ||
| G | 225 | ||
| H | 225 | ||
| I | 226 | ||
| J | 226 | ||
| K | 226 | ||
| L | 226 | ||
| M | 226 | ||
| N | 226 | ||
| O | 226 | ||
| P | 227 | ||
| R | 227 | ||
| S | 227 | ||
| T | 228 | ||
| U | 228 | ||
| V | 228 | ||
| W | 228 | ||
| Z | 228 |