Biomedical Engineering Reference
In-Depth Information
the person are catalogued, need for services assessed, and a coordinate care plan devel-
oped to focus interventions on the person's problems. (NIH Consensus Development
Program, 1987).
and by Rubenstein as a “a multidimensional interdisciplinary diagnostic process intended
to determine a frail elderly person's medical, psychosocial, and functional capabilities
and problems in order to develop an overall plan for treatment and long-term follow-up”
(Rubenstein 1995, p. 3). The goals of CGA have been summarized by Rubenstein (1995) as:
enhancing diagnostic accuracy, optimizing medical treatment and living location, improv-
ing medical outcomes, improving function and quality of life, reducing unnecessary ser-
vice usage, and arranging long-term care management.
A CGA can be performed in different health contexts, ranging from the hospital to
the patient's home, and requires different programs, assessment instruments, and goals
depending on the setting (Reuben and Rosen 2009).
Having identified impairments and disabilities through a comprehensive geriatric
assessment, there are alternative ways of delivering care. One of these ways is rehabilita-
tion, which represents a core element in the practice of medicine for older people.
In Section 13.4, a definition and an overview of geriatric rehabilitation are given that
highlight the key relevant clinical diagnoses and rehabilitation interventions focusing on
the role of assistive technology in the care process and everyday support of the frail and/
or disabled elderly.
13.4 Geriatric Rehabilitation
Rehabilitation is one of the basic elements of comprehensive geriatric care and it has been
defined as “an active problem-solving and educational process, focused on disability and
aiming to maximize the patient's participation in society and his or her well-being while
reducing stress on the family” (Wade 1999, p. 176; see also Wade 1992). As described in
previous sections, the elderly population is characterized by the presence of comorbidity,
disability, and frailty, which requires appropriate geriatric rehabilitation services.
Geriatric rehabilitation has two main objectives: On the one hand, it limits the impact of
disability and, on the other hand, it stimulates and strengthens residual abilities, encour-
aging and supporting motivation and needs through therapeutic interventions focused on
the person and his or her living environment. The burden of a comorbid disease influences
a patient's ability to tolerate a rehabilitative intervention. Therefore, an interdisciplinary
approach should be adopted to achieve the best functional outcomes (Wells et al. 2003a).
Geriatric rehabilitation can be provided in a rehabilitation clinic, a subacute rehabilita-
tion unit, a skilled nursing facility, or via home health assistance. The basic team consists
of different subspecialty professionals, such as a physical therapist, who will assess a wide
array of abilities, including strength, balance, transfer (rising from a chair), and walking.
An occupational therapist evaluates self-care skills, activities of daily living, and the home
environment. The occupational therapist can also provide training on how to use assis-
tive technologies, incorporating meaningful activities to promote participation in everyday
life. The occupational therapist assesses the patient's ability to perform his or her daily
activities, whereas the physical therapist focuses on improving mobility. In addition, other
professional members of the rehabilitation team are the speech therapist, nurse, social
