Lecture 4- Geriatric Rehabilitation Flashcards
Goals of geriatric rehab
Intervention (multidisciplinary!) to assist the disabled older adult in the return of or optimal completion of physcial, psychological and social skills necessary to…
- increase level of independence
- Live in the most satisfying environment
- Maintain social engagement and involvement
____ of individuals 65 years and older have at least one chronic conditions
86%
Geriatric rehab focuses on attainment of _____, not necessarily ______ functional abilities
maximal, normal
Consequences of disabilities
- increased rate of mortality
- Decreased life span
- Increased risk of acquiring chronic health issues
- Increased risk of institutionalization
- Increased use of the health care system
- Frailty- medially complex elderly
Variability of the elderly
- chronologic age not a performance predictor
- Normal aging is NOT necessarily burdened with disability.
Decreased activity leads to _____________
decreased function
Issues with immobilization (BEDREST mneumonic)
B- bladder/ bowel incontinence, bedsores E- Emotional distress D- Deconditioning, depression, demineralization of bones R- ROM loss E- Energy depletion S- Sensory depreivation T- Trouble
Who makes up a geriatric Rehab Team
- patient
- caregiver
- physician/physician assistant
- Nursing
- social worker
- physical therapist
- occupational therapist
- speech therapist
- psychologist
- Other…
Purpose of Elderly Functional assessment
- Determine current functioning level
- Determine need for intervention
- Determine discharge/placement
Components of Elderly Functional Assessments
- ADLs
- IADLs
- Mobility- community negotiation
Places where Geriatric Rehab takes place (what types of facilities?)
- Inpatient- acute care, rehab unit, skilled nursing unit
- Home health
- Outpatient
- Long term care facility
- Work Environment
ICF Model for geriatric rehab
- What are the body systems they are having an issue with ? (functional and structural integrity)
- Activities- How well can they do various activities
- Participation- because of their limitations, what does that mean for their ability to do the “normal” aspects of their life.
Is age a predictor of performance
NO!!! - do not tell them that’s just normal for getting older
Physician’s specific role in geriatric rehab
- diagnosis/prognosis
- determination of intervention site- hospital, outpatient, home
- Anticipated outcomes- if known
- identification of team - other referrals
Therapist’s role in geriatric rehab
- examination
- evaluation
- diagnosis/prognosis
- Plan of care- frequency, duration, goals, interventions
- Discharge planning
Why is team communication important in geriatric rehab?
- Facilitates collaborative interventions
- Monitoring of progress and lack of progress
- Reimbursement
- The number 2 reason for failure of rehab efforts is due to poor communication
What are geriatric rehab interventions?
- ROM
- Strengthening
- Posture, balance, fall prevention
- Transfers
- Bed mobility
- Gait and Mobility
- Fine motor skills
- Swallowing
- Eating and Feeding
- Cognition
- ADLs
- IADLs
- Energy conservation/work simplification
- Prosthetic device training
Where does HIPAA play into geriatric rehab
- The patient can know about their health info
- The physician can
- The OT/PT can
- Nobody else- unless signed off
- You must be DIRECTLY involved in their healthcare to have access- UNLESS patient gives written permission!
- Family members generally have access to their healthcare, unless patient specifically SAYS they don’t want them to
Universal Design Definition
The design of products and environments to be usable by all people, to the greatest possibly, without the need for adaptation or specialized design
Principles of Universal Design
- Equitable Use
- Flexibility in use
- Simple and intuitive
- Perceptible information
- Tolerance for error
- Low physical effort
- Size and space for approach and use.
Why complete a home assessment?
- Prevention of injury
- Increase function
- Facilitate return to home environment
Definition of home assessment and adaptation
- Identification of barriers within the home that have the potential to lead to injury or decrease function
The home assessment process
- Referral for a home assessment
- Usually done by an OT or PT
- includes home visit with client and caregivers present at the time - Report of findings and recommendations
- re-assignment of rooms
- movement and/or removal of furniture/appliances
- Purchase and installation of adaptive equipment
- Suggestion of outside services
One of the fastest growing and under-served patient populations is the….
LGBT community- the geriatric realm of this especially
Home assessment- Lighting and visual issues
- sufficient brightness in all rooms
- Limited glare from lights
- Use of contrasting colors
Home assessment- Entrances
- Nonskid surfaces in garage and on walkways
- Step edges clearly visible
- Presence of handrails on stars
- Adequate lighting
- easy to use door locks and handles
- Distance of garage to house
- location of mailbox
- distance of house to curb/length of driveway
Home Assessment- general room layout
- limited furniture, functional furniture
- open walkways
- absence of throw rugs
- floor surfaces appropriate for mobility devices
- width of doorways and hallways
Home Assessment- Kitchen
- safety features of stove
- cabinets within easy reach
- nonskid floor
- location of dining table
- anti-scald devices
Home Assessment- Bathroom
- Space between the tub/shower, vanity and commode
- Type of shower - grab bars, bath bench
- Toilet location and height
- Nonskid floors
- anti-scald devices
Home assessment- Bedroom
- adequate lighting- night lights
- height and location of bed
- accessibility to items in closet and dresser
- location to the bathroom
Home Assessment- Misc.
- presences of pets and children
- Auditory and/or visual smoke detectors, telephone and door bell
- safety devices: emergency call system, portable phone
- location and type of telephones
- relationship with neighbors, family and friends
- Methods of bill payment, access to transportation
- Medication distribution process
- Presence of clutter in the home.
Who is one person who is absolutely essential to be involved in the home assessment?
THE PATIENT!!!!- why? because she ultimately has to live there!
Does medicare/medicaid pay for home adaptations?
NO- so need to work hand in hand with social worker to find community resources.
What is the most dangerous room in the house?
The Bathroom!!!!
