Geriatric Rehabilitation
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Transcript of Geriatric Rehabilitation
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Geriatric RehabilitationGeriatric Rehabilitation
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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
walkerE. Wheelchair
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Hoenig H. JAGS, 1997 & GRS.
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Rehabilitation: Rehabilitation: ConceptsConcepts
ImpairmentDisability Handicap
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Geriatric RehabilitationGeriatric Rehabilitation
General Aspects• Identify the correct diagnosis !• Assess for comorbidities• Involve the patient (& family) • Team approach to care• Prevent complications(A,B,C,…)
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Geriatric RehabilitationGeriatric Rehabilitation
MD
Therapists
RN
Other
Patient
SW, Dietary, PT, OT, SpT, RecT
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Rehabilitation TechniquesRehabilitation Techniques
ExerciseAssistive Devices• Mobility aids• Orthotics• Adaptive methods/equipment.
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Assistive Devices- Mobility AidsAssistive Devices- Mobility Aids
Device Supports• Canes 15-20 % of body weight
• Crutches 100% of body weight • Walker ~ 50 % (not 100) of body weight
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Geriatric RehabilitationGeriatric Rehabilitation
Prevent complications A B C sA. Aspiration, Anorexia, inActivityB. Bedsores,C. Constipation, Contractures, CognitionD. DVTs, Depression, DUsE. Else: infections (UTI, Pneumonia), pain,
incontinence
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Geriatric RehabilitationGeriatric Rehabilitation
Specifics• Joints
– Elective replacements– Fractures
• Stroke• General Medical Problems
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Hip Fractures 250,000/yearAmputations 50,000/year
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Spinal/Compression FractureSpinal/Compression FractureMortality unclear
Age-adjusted mortality 2.15 (FIT) (a)
RR 1.66 F, 2.38 M (b)
Life expectancy (c)
Men: 6.1 y (60-69y) 1.4 y (>80)Women: 1.9 y 0.4 y
(a) Osteoporos Int 2000;111:556-561.(b) Lancet 1999;353:878-882.(c) Arch Intern Med 1999;159:1215-20
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Am J Med 1997; 103:12S-19S & Lancet 1999;353:878-882
Hip FractureHip FractureMortalityMortality
Acute: 3% F 8% M die1 year: 20% F 30-40 % M (<80 y)
>50 % M (>80y)
2 year: Returns to rate of general population
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Hip FracturesHip Fractures Outcome at 1 yearOutcome at 1 year
40% cannot walk independently60% require assistance with ADL80% need help with IADL.
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Functional Recovery S/P Hip FxFunctional Recovery S/P Hip Fx
Independent Function Before 6 months after
•Dress 86 49
•Transfer 90 32
•Walk across a room 75 15
•Walk half a mile 41 6
Percentage Able toPerfrom
JAGS 1992;40(9):863.
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Joints/FracturesJoints/Fractures
Dx: fracture type determines surgical intervention– Pins/Screws/Plates– THA
Go to pictures
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Intertrochanteric Fracture
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Gardner’s 4
Lateral View
AP View
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Joints / FracturesJoints / FracturesComorbidities:
OsteoporosisCalcium & Vitamin DHormone status: Estrogen, TestosteroneMedications: Steroids, thiazides,“too late” for DEXA ? use for f/uOther complications . . .
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Joints/FracturesJoints/FracturesComplications
AA – Activity (asap), BB – Look at skin! (NURSING!)
CC – Laxatives (see pain below)D D – DVT prevention, DislocationMultiple regimens—LMWH, Warfarin, FondaparinaxEE- Else
Infections – Make sure foley out ASAPPain– Not moving so it doesn’t hurt is NOT good pain control!
(Use routine + PRN meds)
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AmputationAmputation
Common 50,000/ yearLevel of amputation:
BKA- - work by 40-60%AKA- - work by 90-120%
Stump healingContracturesRisk of contralateral amputation - 20% @ 2 years
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700,000 strokes/ yearRecurrence rate 7-10% annually
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StrokeStroke Diagnosis: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 distalRecovery: Proximal to distalFlaccid to spastic to recoveryFlaccid to spastic to recovery
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StrokeStroke
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
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StrokeStroke
Comorbidities are often multiple: DM, Alcohol and Tobacco (withdrawal),Hypertension, Hyperlipidemia
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StrokeStroke
Complications:AA AspirationSpeech, LRI / ActivityBB Watch skin, (NURSING!)
CC Laxatives, prevent contractures, DD DVT prev, low threshhold for depression, E E Reflex sympathetic dystrophy (pain),
infection, subluxation…
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General Medical/ DeconditioningGeneral Medical/ Deconditioning
Dx:Comorbidities:Complications:
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