What would be the most appropriate assistive device? 78 y/o F S/P (L) TKA w/ severe RA of hands, shoulders, knees • Large based quad cane • Crutches • Two-wheel walker • Forearm supports attached to a two-wheel walker • Wheelchair
Rehabilitation: Concepts Impairment Handicap Disability
Geriatric Rehabilitation General Aspects • Identify the correct diagnosis ! • Assess for comorbidities • Involve the patient (& family) • Team approach to care • Prevent complications (A,B,C,…)
Geriatric Rehabilitation MD RN Patient Therapists Other PT, OT, SpT, RecT SW, Dietary,
Rehabilitation Techniques Exercise Assistive Devices • Mobility aids • Orthotics • Adaptive methods/equipment.
Assistive Devices- Mobility Aids Device Supports • Canes 15-20 % of body weight • Crutches 100% of body weight • Walker ~ 50 % (not 100) of body weight
Geriatric Rehabilitation Prevent complications A B Cs • Aspiration, Anorexia, inActivity • Bedsores, • Constipation, Contractures, Cognition • DVTs, Depression, DUs • Else: infections (UTI, Pneumonia), pain, incontinence
Geriatric Rehabilitation Specifics • Joints • Elective replacements • Fractures • Stroke • General Medical Problems
Joints Hip Fractures 250,000/year Amputations 50,000/year
Spinal/Compression Fracture Mortality 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 Int2000;111:556-561. (b)Lancet 1999;353:878-882. (c) Arch Intern Med 1999;159:1215-20
Hip FractureMortality Acute: 3% F 8% M die 1 year: 20% F 30-40 % M (<80 y) >50 % M (>80y) 2 year: Returns to rate of general population Am J Med 1997; 103:12S-19S & Lancet 1999;353:878-882
Hip FracturesOutcome at 1 year 40% cannot walk independently 60% require assistance with ADL 80% need help with IADL.
Functional Recovery S/P Hip Fx Percentage Able toPerfrom JAGS 1992;40(9):863.
Joints/Fractures Dx: fracture type determines surgical intervention • Pins/Screws/Plates • THA Go to pictures
Gardner’s 4 AP View Lateral View
Joints / Fractures Comorbidities: Osteoporosis Calcium & Vitamin D Hormone status: Estrogen, Testosterone Medications: Steroids, thiazides, “too late” for DEXA ? use for f/u Other complications . . .
Joints/Fractures Complications A– Activity (asap), B – Look at skin! (NURSING!) C – Laxatives (see pain below) D – DVT prevention, Dislocation Multiple regimens—LMWH, Warfarin, Fondaparinax E- Else Infections – Make sure foley out ASAP Pain– Not moving so it doesn’t hurt is NOT good pain control! (Use routine + PRN meds)
Amputation Common 50,000/ year Level of amputation: BKA- - work by 40-60% AKA- - work by 90-120% Stump healing Contractures Risk of contralateral amputation - 20% @ 2 years
Stroke 700,000 strokes/ year Recurrence rate 7-10% annually
StrokeDiagnosis: 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 distal Flaccid to spastic to recovery
Stroke 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
Stroke Comorbidities are often multiple: DM, Alcohol and Tobacco (withdrawal), Hypertension, Hyperlipidemia
Stroke Complications: AAspirationSpeech, LRI / Activity BWatch skin, (NURSING!) CLaxatives, prevent contractures, DDVT prev, low threshhold for depression, E Reflex sympathetic dystrophy (pain), infection, subluxation…
General Medical/ Deconditioning Dx: Comorbidities: Complications: Hazards of Hospitalization