GERIATRIC REHABILITATION BY DR.SHIVANI GOYAL

Geriatric rehabilitation is a branch of medicine that studies rehabilitation and physical therapy issues in old age.

1. GERIATRIC REHABILITATION Presented by Dr . Shivani goyal (pt)

2. Introduction To Geriatric Rehabilitation Geriatric Rehabilitation is a branch of medicine that studies rehabilitation and physical therapy issues in old age people. Aims to restore function or restore residual functional capacity and improve quality of life in older people particularly those who suffers from any disability and impairment .

3. Geriatric population can be divided into :- Young old :- 65-75 years Middle old:-75-85years Oldest old :-above 85years

4. TYPICAL PROBLEMS IN ELDERLY Cardiovascular ,musculoskeletal ,and neurological changes in the body. Lifestyle related and age –onset diseases like hypertension , arthritis ,stroke, Parkinson , disease and dementia on rise . Functional loss and dependence Frequent falls , Depression and hearing loss and consequent social isolation Disability and death THREE MOST COMMON CAUSE OF DEATH IN ELDERLY :- CORONARY ARTERTY DISEASE STROKE CANCER

5. AGE –RELATED CHANGES IN THE BODY CARDIOVASCULAR SYSTEM :- Systolic BP is elevated because of vascular changes. Heart beats become more irregular and rate reduces. Capillary density is increased ,structural changes like thickening in the valves are seen. Reduction in maximal cardiac output ,increased afterload ,and incapability of responding to maximal exercise . Degenerative changes in myocardium and myofibril , with reduction in blood volume which makes the harder but less efficiently. There is deposit of fat and calcium and cardiac muscles decreases in size .

6. RESPIRATORY SYSTEM:- Number of alveoli ,elasticity ,and compliance of lung are decreased and maximum intake of oxygen is reduced by nearly half . All parameters like vital capacity ,peak expiratory flow ,inspiratory reserve volume and oxygen saturation are decreased . Functional capacity of (FEV1),diffusion capacity of oxygen is decreased. This causes frequent shortness of breath because of higher lactate concentration and acidosis.

7. RENAL AND GENITOURINARY :- Glomerular filtration rate (GFR) is decreased ,the tubular function of kidney decreases. Prostate enlargement is a frequent cause in elderly men of nocturia and frequency of micturition.

8. MUSCULOSKELETAL SYSTEM :- CHANGES IN THE CARTILAGES IN THE JOINTS :- Tearing off of superficial collagen bundles and rupture of pieces of cartilage on repeated stress. Age related changes in proteoglycans ,collagen , and reduced water content in the cartilage leads to osteoarthritis. Decrease in muscle power ,there is loss of muscle bulk and decreased strength by 25-45% There is loss of total protein in the muscle and disuse atrophy due to reduced firing of motor neurons Reduced endurance and susceptibility to fatigue. Changes in the posture which becomes stooped due to senile osteoporosis and Parkinson

9. CENTRAL AND PERIPHERAL NERVOUS SYSTEM :- There is anatomical ,physiological and biochemical changes in the brain with atrophy ,neuronal loss and degenerative changes in substantia nigra and lentiform nucleus results in Parkinson and dementia . Atrophy of gyri and ventricular dilatation indicate neuronal loss . Reduction in cerebral blood flow and metabolic rate . Decrease in ability to register ,retain and recall recent experience and slower rate of learning and motor performance . Alzheimer disease is a disease of geriatric population Reduced step and stride length ,cadence and pace in the elderly Increase in reaction time with an increase in the central processing time when they are asked to perform simple task .

10. In the peripheral nervous system ,there is a decrease in Pacinian corpuscles , which sense vibration . Peripheral neuropathy due to nutritional deficiency or drugs is common Diabetic neuropathy is the most common among elderly leading to neuropathic pain ,tropic ulcer, gangrene and sometimes even amputation .

11. VISUAL ACUITY :- Decline in visual acuity leads to impairment of vision and social isolation . Presbyopia or progressive loss of accommodation for near vision ,decreased contrast sensitivity ,reduced tears and dry eyes ,rise in intraocular pressure and cataracts Glaucoma ,diabetic retinopathy and macular degeneration which make daily living for elderly more and more challenging . HEARING :- Degeneration of hair cells in basal region of cochlea lead to condition called PREBYACUSIS. Loss of hearing makes person withdrawn and isolated . They are unable to participate in day to day conversation and become irritable when others shout to make themselves heard .

12. TASTE AND SMELL :- Half of taste buds are lost by the time person reaches to 80s and this is most common complaint among older age . They prefer salty or sweet foods ,potential danger for hypertensive or diabetics . As loss of smell over 50 %this leads to lower intake of food and malnourishment Old people also loss capacity of detecting foul odour and may not even notice that they have wet themselves or passed motion on the bed .

13. OTHER SYSTEMS :- Difficulty in digestion ,swallowing ,reduced gastric secreation and bowel motility Constipation Thinner and less elastic skin due to loss of subcutaneous fat ,dryness of skin Susceptibility to infection .

14. COMMON COMPLAINTS AMONG GERIATRIC POPULATION Pain Dizziness and frequent falls Urinary incontinence Osteoporosis and fractures

15. ASSEMENT OF GERIATRICS Proper assessment should be done as there may be multiple system involvement ADL CHART MEASURE WEIGHT PSYCHOLOGICAL ASSESSMENT LIST OF MEDICATIONS DIET CHART

16. REHABILITATION GERIATRIC PHYSICAL THERAPY Exercise in geriatric people is targeted at improving the endurance ,range of motion ,cardiopulmonary function and thereby quality of life THERAPY INCLUDES :- Moderate intensity aerobic training Strengthening exercise Balance and coordination exercise Range of movement and flexibility –stretching Cardiovascular endurance Maintain ambulation Relieve pain

17. TEST FOR GERIATRIC STRESS TEST Modified Bruce test is performed by cardiologist to assess cardic function This test starts at low level and increase the workload by every 2-3 minutes Should be done under ECG monitoring Do not last more than 15 min CYCLE ERGOMETER TEST - In this test patient is well supported so less chances of falls in treadmill - Protocols involves 2-4 minutes of exercise and calculate power output and then find out VO2

18. ASSISTIVE DEVICES AND ORTHOTIC SUPPORT Use of soft materials like neoprene than of rigid material like polypropylene Plastics are preferred to metal orthoses because of better fit ,lightweight , and cosmesis . Patient should given functional aids such as walker or cane if balance impairment Proper shoe fitting is necessary to prevent falls Proper shoe design for perfect fit and scanning of pressure on sole done to prevent tropic ulcers and calluses

19. ENVIRONMENTAL MODIFICATION Includes sufficient space for usage of walker or wheelchair Both sides rails in staircase Proper light facility Light ,switches at easy accessible areas Raised toilet seats Floors are well demarcated and not too polished

20. PSYCHOLOGICAL SUPPORT Proper psychological counselling session should be done for elderly people as they feels unwanted , unable to do take care of himself .or his surroundings to remove feeing of neglected .