1. Geriatric rehabilitation aims to help the elderly regain independence by recovering physical, psychological, or social skills lost due to aging or disability. 2. The key principles of geriatric rehab are addressing the variability in aging, preventing the effects of inactivity, and maintaining optimal health. 3. Interventions include a variety of exercises, assistive devices, and environmental adaptations delivered through different settings and providers.

1. Principle and practice in geriatric
rehabilitation
By
Tanvi pathania
1st year MPT

2. CONTENTS
1. INTRODUCTION
2. DEFINITION
3. THEORIES OF AGING
4. PHYSIOLOGICAL CHANGES IN AGING
5. DEMOGRAPHIC DATA OF DISABILITY
6. MODELS OF DISABILITY
7. PRINCIPLES OF GERIATRIC
REHABILITATION
8. PALLIATIVE CARE

3. INTRODUCTION
• According to data from World Population Prospects: the
2015 Revision, the number of older persons—those aged
60 years or over—has increased substantially in recent
years in most countries and regions, and that growth is
projected to accelerate in the coming decades.
• As per census 2011 reports, 103.54 million( 50.91 million
males and 52.62 million females) of Indian Population is
aged 60 years or above.

4. With increasing
population of ageing
the prevalence of
diseases, injuries
and degenerative
condition increases
and so is the
demand for planned
geriatric
rehabilitation.

5. DEFINITION
 AGING: Denham Harman postulates that aging is
the result of progressive accumulation of changes in
the body which occur with passing time and which
cause the increase in the probability of the disease
and death of the individual.
 GERIATRICS: The care of aged is called geriatrics
or clinical gerontology.
 GERIATRIC REHABILITATION can be defined as
medical treatment plus prevention, restoration plus
accommodation and education

6. CLASSIFICATION ACCORDING TO AGE GROUP
•At what age old age begins cannot be universally defined.
• Most developed-world countries have accepted the
chronological age of 65 years as a definition of 'elderly' or
older person.
•The United Nations has agreed that 60+ years may be usually
denoted as old age
•Sub-grouping is
•young-old (65 to 74),
•middle-old (75–84),
•and oldest-old (85+).

7. WHY DO WE AGE?
•IS IT GENETICS?
•ENVIRONMENTAL
DAMAGE?

8. THE BIG QUESTION
DEVELOPMENTAL—
GENETIC THEORIES
• Genetic makeup
determines factors
directly affecting
aging
• Programmed &
directed in the body
• Aging is
Predetermined
ENVIRONMENTAL
NON- GENETIC
THEORIES
•Due to random events
that occur over time
•Aging caused by
environmental damage
•Controlled extrinsically

9. STOCHASTIC THEORIES
• Cross-linkage theory
• Error theory
• Redundant DNA theory
• Somatic mutation theory

10. DEVELOPMENTAL GENETIC THEORIES
 Free radical theory
 Calorie restriction theory
 Hayflick limit theory
 Neuroendocrine and hormonal theory
 Immunological theory
No single theory explains entire process of
growing old

11. AGE-RELATED CHANGES
• Physical changes related to “Normal” aging ARE
NOT diseases.
• People who live an active lifestyle lose less
muscle mass and flexibility as they age.
• Problems in elderly are multi-faceted and
often a single problem may be the result of a
complex chain of decompensation of body
functions.

12. AGING-RELATED CHANGES
Death by underlying or multiple cause, expressed in rates per
100,000 people, as a function of age for the 2001 US population
aged 85 and older. Source: CDC/NCHS, National Vital Statistics

13. SENSORY CHANGES
H
E
A
R
I
N
G
TASTE AND SMELL
VISION
TOUCH AND PAIN

14. CHANGES IN NERVOUS SYSTEM

15. CHANGES IN RESPIRATORY

17. MUSCULOSKELETAL CHANGES
IN AGING

18. PRINICIPLES OF GERIATRIC
REHABILITATION
• 3 main principles:
1. VARIABILITY of aged
2. ACTIVITY v/s inactivity
3. OPTIMAL HEALTH

19. 1. VARIABILITY OF THE AGED
 The aged are more variable in their level of
functional capabilities. The differences that
can be identified cognitively are just as
remarkable.
 Chronological age is a poor indicator of
physical or cognitive function.
 The impact of this variability is an important
consideration when defining rehabilitation
principles and the practices of the aged

20. EXAMPLES OF VARIABILITY
1. Reaction time
2. Visual capabilities
3. Strength
4. Cognition

21. 2. ACTIVITY /INACTIVITY
•Common reason for loss of function is inactivity/
immobility
•IMMOBILITY divided as-
ACUTE immobility
CHRONIC immobility
•DECONDITIONG results from immobility . It
involves multiple organ system including the
neurological, cardiovascular and musculoskeletal
system to varying degrees.

22. • A systematic review was done by Amit Agrawal in 2016 on
disability among the elder population of India. He found that
by 2030 the prevalence of chronic conditions including
Diabetes and HTN in aging population would be 45%.
• A survey report on status of elderly was done in 2011 and
they collected information on locomotors disability and they
found that disability for vision was the most (60%) and for
speech was the lowest (7%).
• A study was conducted using Barthel’s ADL qusetionnaire
and the prevalence of functional disability was 37.4%.
• Venkatarao et al . Studied the “Impact of functional
limitations on handicaps , technical aids , environmental
adaptations , human assistants ,limited community access ,
confined to home and confined to bed”. The authors
reported that speech disability (4%), hearing disability
(10%) visual disability (56%) and agility (33%) .
DISABILITY AMONG ELDER POPULATION- INDIA

23. WHAT ARE THE OBSTACLES IN
PERFORMING ACTIVITIES?
A. Process of aging itself.
B. Distinguish between the effects of inactivity
from those of disease.
C. Challenge of understanding the relationship
between physiological decline and functional
loss.

24. COMMON EFFECTS OF IMMOBILITY
• Thermoregulation is altered by bed rest.
• Decline in motor performance and balance
decrements are significant after 2-3 weeks
of bed rest.
• Orthostatic hypotension occurs within the
first week of inactivity.
• Bed rest imposes inactivity in a non uniform
way in muscle groups.
• Overall immobilization accelerates the
process of aging.

25. USE IT OR LOSE IT
• B- Bladder and bowel incontinence and
retention; bed sores
• E- Emotional trauma; electrolyte imbalance
• D- Deconditioning of muscles and nerves,
depression, demineralization of bones.
• R- ROM loss and contractures, restlessness
• E- Energy depletion
• S- Sensory deprivation, sleep disorders
• T- Trouble

26. 3.OPTIMAL HEALTH
• WHO defines health as a state of complete physical,
mental and social well-being not merely the absence of
disease.
• In elderly cumulative biological , physiological and
anatomical effects that may eventually lead to clinical
symptoms.
• A preventive approach to physical health needs to be in the
foreground when addressing the needs of the aged.
• Health status of individual in their 70s and above is in a
suboptimal range. Thus, the scope of the aged should be
focused toward preventing the complications that could
result from suboptimal health

27. COMPONENTS OF REHABILITATION
• Settings- In 1997 the Commission on Accreditation of
Rehabilitation Facilities defined three levels of
inpatient medical rehabilitation (rehabilitation units in
acute care or rehabilitation hospitals, and two levels
of nursing-home rehabilitation), as well as outpatient
and home health rehabilitation.
• Providers- Qualifications vary according to years of
education (eg, master’s degree for a physical
therapist versus an associate degree for a PT
assistant), training in unique therapeutic techniques
(eg, occupational therapist versus physical therapist),
and licensure (eg, unlicensed PT aide versus
licensed PT assistant)

29. BENEFITS AND TYPES OF EXERCISE
• There is substantial evidence that regular physical
activity has a number of health benefits.
• Each type of exercise appears to have unique
benefits. Exercise can be classified in five
categories: resistance, aerobic (endurance),
balance, flexibility, and functionally based.

30. TITLE METHOD CONCLUSION
Effect of different
exercises on bone
mineral density , pain
and QOL in people
with osteoporosis (
safoura Ghasemi
et.al , 2015 )
Systemic study was
done to clarify the
contraindication and
determine the effect
of physical activity on
bone mineral density.
Various kinds of
exercises ( land ,
water, mixed ) have
shown to be
beneficial for
patients diagnosed
with osteoporosis.

31. RESISTANCE TRAINING
• Resistive exercise has been generated
because, not only are there age-related
changes in muscle strength, but resistive
exercise has been shown to improve a
number of physiologic parameters of great
importance to the older person, including
insulin sensitivity, bone mineral density,
aerobic capacity, and muscle strength.

32. AEROBIC (ENDURANCE) EXERCISE
• Most studies show that aerobic exercise can
improve aerobic capacity.
• Keysor and Jette report that 70% of studies of
aerobic conditioning exercise in older adults
showed improvements in aerobic capacity, but
that the effect of aerobic exercise on body
composition is less consistent.
• Physiologic benefit of aerobic exercise is the
prevention of or reduction in the severity of
diseases whose end-organ effects cause
disability (eg, stroke in uncontrolled
hypertension), so older people who already
suffer disability may experience less benefit.

33. BALANCE EXERCISE
• Various types of exercise interventions, including
Tai Chi, have been used to treat persons at risk for
falls, with apparent benefit.
• A review of randomized trials of falls prevention
interventions identified 23 studies that included
exercise, 9 studies of home assessment and
surveillance, 1 study of hip protectors, and no
studies of footwear.The authors concluded that the
majority of exercise studies suggest a decrease in
falling, with balance training appearing to be the
most effective exercise intervention, and they
concluded that the majority of home assessment
studies showed benefit as well.

34. FLEXIBILITY EXERCISE
• Despite the fact that many disease processes
common among elderly people can adversely
affect flexibility (eg, stroke, arthritis), there are few
studies in the older population of the effect on
outcomes of a loss of range of motion or of the
efficacy of exercise interventions to restore
flexibility.
• Most of the studies are done on single type of
exercise . More research is required to study and
compare various forms of flexibility exercise.

35. FUNCTIONALLY BASED EXERCISE
• Task-specific resistive exercise has been used
successfully to improve the endurance during and
rapidity of rising from sitting to standing by persons
with mobility disability who live in congregate
housing facilities.
• Massed activity (repetitive exercise activities for up
to 8 hours per day), often used in conjunction with
constraint therapy for stroke patients that may
have substantial efficacy for both acute and
chronic stroke. There is some evidence that this
therapeutic approach may be effective for motor
deficits.

36. TITLE METHOD CONCLUSION
Effect of home
based functional
exercise aimed at
managing
kinesophobia
contribute to
improving
disability, QOL of
patients
undergoing total
knee arthroplasty
(RTC) marco
monticone et. al
(2012)
RCT with 6
month follow-up
110 subjects were
trained in
functional
exercises during
hospital stay were
asked to carry
same exercises at
home for 60
minutes / 6
months . control
group were
advised to stay
active.
Home based
program exercise
found to be effective
on changing the
course of disability,
fear avoidance
beliefs, pain and
QOL. With TKA.

37. • .
TITLE METHOD CONCLUSION
Effect of twelve-
month physical
exercise program on
patients with
osteoporotic
vertebral fractures: a
randomized, control
trial
( l. Estigneeva, o.
Lesnyakemail et.al),
march 2016
78 postmenopausal
women with at least
one osteoporotic
vertebral fracture
and chronic low back
ache were randomly
divided into control
and exercise.
they found that 12
months of exercise
improved quality of
life functional
mobility and balance

38. Adaptive Techniques and Assistive Technology
•Assistive technology is being used
to cope with disability.
•Assistive technology offers great
potential benefit for the older
population. Epidemiologic data and
one randomized trial show that
assistive technology may decrease
task difficulty, decrease hours of
personal assistance, and decrease
costs for institutional care.

39. PALLIATIVE CARE
• Palliative care is derived from the word
“PALLIUM” meaning cloak or cover.
• Defined as an approach that improves the
quality of life of patients and their families
facing the problems associated with life
threatening illness through the prevention and
relief of suffering by means of early
identification and assessment and treatment of
pain and other problems (physical,
psychological and social)

40. THOMAS 7 STANDARD C’S
SEVEN “C’s” gold standards for
palliative care-
1. COMMUNICATION
2. CO-ORDINATION
3. CONTROL OF SYMPTOMS
4. CONTINUITY OUT OF HOURS
5. CONTINUED LEARNING
6. CARE SUPPORT
7. CARE IN DYING PHASE

41. SUMMARY
1. Theories of aging is divided into two main groups
genetic and non genetic causes.
2. Physiological changes in aging is normal and not
a disease.
3. Purpose of geriatric rehab is to assist the disabled
in recovering lost physical, psychological or social
skills as they may become more independent.
4. Major principle of geriatric rehab are variability,
inactivity and optimal health.
5. Components of rehab includes settings,
providers, intervention, assistive device and
adaptation to the environment .

42. REFRENCES
• The Comprehensive Resource on Geriatric and Social Care.
New York, NY: Springer Publishing Company.2001
• Aging successfully until death in old age: opportunities for
increasing active life expectancy. Am J Epidemiol.
• Geriatric rehabilitation. Helen Hoenig and Hilary C. Siebens.
• Geriatric rehabilitation. A clinical Approach by Carole B.Lewis.
• Geriatric Medicine by O.P.Sharma.
• Journal of rahab and medicine,2015
• Journal of medical society,2016
• International osteoporosis foundation and national osteoporosis
foundation, 2016.
• http://esa.un.org/unpd/wpp/publications/files/key_findings_wpp_2
015.pdf.

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