Geriatric Rehabilitation - An Overview

Introduction:

As old age comes, health issues and disabilities follow. Geriatric rehabilitation is the provision of special health care for older adults with significant difficulties and disabilities. The patients that are affected by chronic illnesses and those who are bedridden for so long require rehabilitation to proceed with their normal life. For this purpose, physical and occupational therapy is given to the individuals. Physical therapy consists of various exercises and therapeutic modalities to restore function and reduce symptoms.

Why Is Rehabilitation Mandatory for the Senior Population?

Geriatric rehabilitation is important for senior citizens to provide them with quality care and help them restore the difficulties that they face, and prepare them for functioning individually. Geriatric rehabilitation is done for the following:

• Patients who recently had a stroke attack. A stroke is also known as a cerebrovascular accident and occurs due to the interruption of blood supply to the brain resulting in brain damage.

• Patients who have long-standing diabetes.

• Cardiac rehabilitation for patients with issues with the heart or patients who have undergone cardiac surgery.

• Wound care for the elderly.

• Rehabilitation for patients who have neurologic problems.

• Orthopedic care for the old-aged.

• Post-surgery care.

What Bodily Changes Occur in Old-Aged People?

Due to old age, various health problems arise as immunity is weakened and metabolism becomes slower. The following changes can be observed in older adults:

1. The skin becomes thin and fragile, loose and elastic. In addition, ultraviolet light accelerates the skin aging process.

2. Many eye problems occur, such as cataracts and poor vision. A cataract is a common condition in older people which causes clouding of the eye.

3. Eyes usually become dry, with frequent tearing up. Ptosis (drooping of the eyelid) of the eye also occurs in the majority of the patients.

4. Hearing problems due to increased ear wax can affect hearing.

5. The ability of kidneys to excrete water, waste products, and drugs is diminished.

6. The contingency of the bladder is reduced, and there is frequent urination.

7. Loss of bone mass and there is an increase in the risk of fractures as the bones are brittle.

8. Malaligned posture, such as drooping and poor balance.

9. The reserve of neurons declines as the degeneration process is faster.

10. Reduced sleep and loss of short-term memory.

11. The ability to feel pain, pressure and temperature is reduced.

12. Systolic blood pressure is increased in the old-aged. Systolic blood pressure is the pressure of the arteries of the heart when it beats and is the first number written in blood pressure. It normally ranges from 120 to 130 mmHg (millimeters of mercury).

13. Irregular heartbeat is found to be common in old-aged people.

14. Reduced immunity is the biggest threat to many diseases in the old-aged.

15. Weakening and falling out of the teeth.

How Is Geriatric Rehabilitation Implemented for Various Conditions?

• Falls: Older adults usually tend to have poor balance and tend to fall often. If it is due to a neuromuscular problem or orthopedic problem, assistive devices and orthotics such as splints and braces are given to ease walking and standing. In addition, tripods are given to patients who cannot be retrieved through surgery or physiotherapy.

• Gait Changes: Usually, due to old age, there will be changes in the walking stance and posture. For such patients, gait training will be given. Parallel bars and mirrors are fitted in the area around them so that they can see how they walk and improve their gait. Plaster of Paris and toe-raising calipers (a type of orthotics) are used for the prevention of sagging knees when walking. Balance training and appropriate walking aids are provided for better gait patterns.

• Auditory Impairments: These occur due to poor and reduced speech discrimination and also due to excess wax accumulation. Removal of cerumen (ear wax) and providing them with a hearing aid can greatly help. Audiological and neurological evaluations should be done at regular intervals.

• Aphasia: It is a type of communication disorder that usually occurs after a stroke, and the individual finds it difficult to form a proper sentence. Speech and language therapy can be given to these patients.

• Cardiovascular Impairments: Postural hypotension is a condition in which the blood pressure drops when the individual tries to change pose abruptly, such as standing or getting up from a chair suddenly. Postural hypotension is common among the old aged. This can be maintained by adequate fluid intake, exercising in horizontal positions regularly, such as swimming, and exercises that are done by lying flat. Avoid changing posture abruptly and also standing still. Fitted elastic hose (for non-ambulatory patients) and compression stockings (for ambulatory patients) are the devices used in the legs that can improve cardiac output and blood pressure on standing by applying pressure to the legs.

• Visual Impairment: Visual impairments can be corrected by refraction correction and cataract extraction in cases of cataract-affected patients.

• Dementia: Dementia is not a single condition but a group of conditions affecting the memory, speech, thinking, and cognitive (perception disorder) functions that are impaired. Cognitive rehabilitation is carried out, which helps in improving the skills like communication, establishing connections, and motor learning. Patients should be given gait training and exercise under supervision. Sedatives should be avoided in such patients.

• Foot Disorders: Removal of calluses and bunions, if any. Calluses are thickened layers of skin caused due to frequent friction of the foot. Bunions are the bony bumps usually seen near the big toe, formed in patients with arthritis. Bunionectomy is a procedure done to remove bunions. Patients who suffer from chronic pain and knee stiffness must undergo physiotherapy. Stretching and strengthening exercises should be taught. Massage therapy and heat therapy should be used to relieve spasms. Ultrasound and cold therapy can also be used. These therapies also help diminish pain.

• Amputation: Slow movements can be started in patients who have undergone amputation after healing. Immobilization for a long time can precipitate other severe conditions. Post-operative rehabilitation aims at mobilization, shaping the stump (healthy joint present after removing part of the limb), and wound healing. The prosthesis can be fitted to restore form and function. Mobility aids such as walkers and canes can be given to the patients.

• Arthritis: Arthritis-related pain is a distress to the patients and can be cured by diathermy. Diathermy is a procedure in which heat is applied to the affected parts by a high-frequency electric current which in turn will relieve pain and stimulate healing. The knee flexion (bending) deformity seen in arthritis is treated using soaked towels in ice water and wringing and wrapping around the knee. This will help relieve the pain.

• Chronic Pain Management: Pain can be in many organs in the elderly. A proper pain history is taken to symptomatically cure every sort of pain. The cause behind the pain is eliminated, and appropriate treatments are done. Physical therapy and drugs like non-steroidal anti-inflammatory drugs (NSAIDs) and non-opioid analgesics are given to eliminate pain.

• Parkinson’s Disorder: It is a degenerative condition of the brain cells, and the patients experience uncontrollable movements, jerks, and stiffness of the muscles. All the problems like respiratory and balance problems should be addressed. Proper nutrition and psychotherapy are administered to manage the patients. Strength training and flexibility exercises are taught in physiotherapy.

• Bladder Dysfunction: The timed voiding program teaches the patients to urinate at specific intervals. A surgical procedure can be done in extreme cases that have sphincter (muscles that act as valves to open and close) incompetence. Anticholinergics are also given for detrusor (muscle of the urinary bladder) instability.

• Stroke: In stroke-affected patients, neuromuscular proprioception, a stretching technique, is done to reactivate the muscles to re-educate the muscles to function normally. The physiotherapist gives passive movements to prevent contractures.

What Are the Exercises Prescribed for the Geriatric Population?

Exercise can be based on the following five types:

1. Endurance (Aerobic) Exercise: These exercises have been proven to reduce the disability caused by end-organ defects such as heart, kidney, and brain damage. Exercise-based training is done for coronary heart disease patients. Coronary heart disease is a birth abnormality affecting the vessels of the heart. Walking and weight-bearing exercises are educated for reducing bone loss in elderly women. Some of the aerobic exercises are swimming, jogging or running, bike riding, and water walking.

2. Resistance Exercise: Resistance exercises are trained for the patients to improve strength and aerobic capacity. It has also been helpful in improving bone mineral density and muscle strength. Wall push-ups, squats, and side planks are some of the exercises that can strengthen the muscles.

3. Balance Exercise: Exercise interventions such as ‘tai-chi’ have been proven effective in improving the balance of the elderly. They have been suggested to decrease the incidence of falls.

4. Flexibility Exercises: Many patients suffering from musculoskeletal disorders usually experience muscle stiffness, and flexibility exercises can cure this. Flexibility exercises combined with resistance training have been shown to improve the range of motion in older men. Stretching of the shoulder, neck, chest, and legs are done.

5. Functionally Based Exercises: These exercises are task-specific and help the patients to improve their speed of getting up or lying down. These exercises allow the patient to be independent when they do their daily chores. These exercises are performed in repetitions for demented patients.

Conclusion:

Geriatric rehabilitation is even more difficult than the normal rehabilitation done in younger people. The results can be slow, the compliance of the patients can be reduced, and it can be challenging. But it has changed the lives of many patients suffering from chronic debilitating conditions. Rehabilitation is done to improve the quality of life of such patients. The basic requirements of the individual are analyzed, and the therapists provide a planned treatment protocol. Therefore, rehabilitation is indispensable to living a healthy life, even in old age.