Biomedical Engineering Reference
In-Depth Information
worker, dietician, psychologist, physiatrist, and pharmacist (Tsukuda 1990; Brown and Peel
2009). Rehabilitation treatment requires collaboration among team members, the patient,
and his/her family. On the one hand, the patient should play an active part in the care and
decision-making process, and, on the other, the family should ideally receive training on
how to assist the older patient at home. This involvement influences not only rehabilita-
tion outcomes but also the quality of life of the patient in all aspects: functional, physical,
social, and emotional. A patient's satisfaction with care tends to be greater when there is
such involvement (Toseland et al. 1996). This approach is in line with the biopsychoso-
cial model, where the functioning of an older patient is not only seen in association with
health condition but is also linked to personal and environmental factors. To prescribe an
appropriate rehabilitation treatment, the health-care team should have a common under-
standing of health and functioning in a disability context. The International Classification
of Functioning, Disability, and Health (ICF) model provides a helpful framework that illus-
trates why geriatric rehabilitation must be an interdisciplinary activity (WHO 2001).
Some common clinical problems in geriatric rehabilitation include hip fracture, stroke,
and cognitive impairments, which have been discussed above (Wells et al. 2003b). The
most serious risk factor for fracture is falling and frailty and, as a consequence, disability.
Frequently, fractures occur at home, but they also occur just as frequently in hospital and
in residential contexts. Appropriate preventive measures should be taken to protect the
elderly who are at risk. Hip fractures require the most intense use of hospital resources
and an intensive period of postoperative medical care and inpatient rehabilitation. The
risk of stroke doubles every 10 years from the age of 55:72% of all strokes occur after the
age of 65 (Feigin et al. 2003). Elderly patients suffering from a cerebrovascular accident
have a clinical onset more severe than in younger patients, with a higher mortality rate by
30 days and a greater number of long-term admittances (Asplund et al. 1992).
Among the clinical factors that contribute toward the worst outcomes, two are very
significant: the presence of a more severe initial clinical symptoms frame and reduced
recovery capabilities (Nakayama et al. 1994).
The literature underlines the need for screening to identify patients who are most likely
to benefit from geriatric rehabilitation. In this respect, CGA and the role of the geriatrician
are very essential for two main reasons. Firstly, they offer a clear picture of the patient,
the disease, and the possible health and social disadvantages that might result from the
disability. Secondly, they decide upon the type of rehabilitation treatment to be used and
the most appropriate intervention in terms of a technological aid.
An important goal of screening patients is in fact to identify comorbidities that may
affect rehabilitation outcomes by evaluating functional impairment, medical complica-
tions, psychological functioning, and social support (Mosqueda 1993). Cognitive screen-
ing is also crucial in selecting patients for geriatric rehabilitation: Cognitive disorders are
commonly and potentially critical regarding rehabilitation outcomes because they affect
different aspects of treatment (e.g., difficulties related to understanding instructions or
remembering information) (Ruchinskas and Curyto 2003). Cognitive impairments hinder
the outcome of rehabilitation treatment (Patrick et al. 2001). Evidence from the literature
shows that cognitive disorders are correlated with limited and poor results in functional
and rehabilitation outcomes in elderly patients, particularly with regard to hip fractures
(Colombo 2004). Cognitive disorders are considered as selection criteria for admission to a
rehabilitation process. When a patient is suffering from a mild form of reduced cognition,
there is good reason to be optimistic about rehabilitation outcomes. In addition, depres-
sion is a frequent complication after hip fracture or stroke that can negatively affect reha-
bilitation treatments. Furthermore, depression is a frequent complication after hip fracture
