1. The document discusses healthy aging and maintaining functional ability in older adults through rehabilitation. It focuses on promoting independence and preventing issues like falls, immobility, and disability. 2. Functional ability depends on basic needs, mobility, relationships, decision-making, and contributing to society. Assessing for risk factors and implementing medical, lifestyle and environmental interventions can support healthy aging. 3. Rehabilitation aims to optimize physical and cognitive function so that elderly adults can safely perform daily activities and live independently for as long as possible.

1. MODERATORMODERATOR
DR.R.GANDHIBABUDR.R.GANDHIBABU
DR.V.K. MOHANDAS KURUPDR.V.K. MOHANDAS KURUP
PRESENTORPRESENTOR
Dr.R.Balamurugan
M.D PMR II YR P.G
DEPARTMENT OF PHYSICAL
MEDICINE&REHABILITATION

2. “AS MODERN MEDICINE ADDS
YEARS TO LIFE,REHABILITATION
BECOMES INCREASINGLY
NECESSARY TO ADD LIFE TO THOSE
YEARS”
-RUSK

4. “Healthy aging is the process of developing and
maintaining the functional ability that
enables wellbeing in older age”.
 Functional ability is about having the capabilities that
enable all people to be and do what they have reason to value.
 This includes a person’s ability to:
 meet their basic needs;
 learn, grow and make decisions;
 be mobile;
 build and maintain relationships;
 contribute to society.

7.  The elderly are not a homogenous group
 According to the WHO,
>=65 yrs is accepted as definition of ‘older
or Elderly ‘ persons
 According to the UN,
60+ age is considered as older population
or elderly
 65 to 75 - YOUNG OLD
 75 to 85 - OLD OLD
 >85 - VERY OLD
 20% of population >65 by 2025

9.  Vulnerability to stressors
 Need to treat underlying conditions
 Minimize risk for falls, disability, hospitilaztion,& mortality
 Primary &secondary prevention

10.  Immobility
 Intellectual impairment
 Incontinence
 Impaired homeostasis/Instability
 Insomnia & Sleep disorders
 Iatrogenic

12.  Parkinson disease
 Dementia
 Normal pressure hydrocephalus
 Malignancy
 Osteoarthritis
 Traumatic brain injury and spinal cord injury
 Disuse, immobilization, and decompensation
 Pain
 Falls
 Sleep disorders

13. Physiologic changes are
 Posture
 Proprioception
 Gait
Pathologic changes are
 Vertebral compression fractures with kyphosis,
 Arthritis,
 Degenerative cerebral changes,
 Cerebral infarcts

14.  Spinal Cord Injury
 Poliomyelitis
 Cerebral Palsy

15.  Sarcopenia – decreased muscle mass
& strength
 Osteopenia & Osteoporosis –
decreased bone strength
 Osteoarthritis – degenerative changes
in joints
 In muscle fibro-connective tissue build
up and fat accumulation affects its
quality& function

16.  Increased stride to stride variability in length
 Increased stride to stride variability in speed
 Increased time of double-support phase

17.  1/3 of elderly have a history of falls
 20% result in injury (5% end in fracture)
 Risk factors of falls include
 Poor muscle strength ,
 Neural damage on basal ganglia and cerebellum
 Diabetes & Peripheral neuropathy
 Interventions to prevent or reduce instability &
falls include
 Medical
 Rehabilitative
 Environmental modification approach

18. INTRINSIC
(1) Musculo-skeletal:
-poor muscle strength
-decreased flexibility
(2) Neurological:
-cognitive dysfunction
-inco-ordination
-peripheralneuropathy
(3) Others:
-poor vision
-vestibular disorders
-postural hypotension
-medications
EXTRINSIC
(1) Environmental:
- obstacles
- slippery floors
- poor lighting
(2) Others:
- inappropriate clothing
- improper footwear

19.  Instability phase ( balance is lost)
 Descent phase
 Impact phase
 Postimpact phase

20.  Greater challenges than the young amputee
 Less reserve in many systems
 Pre-amputation deconditioning
 Contractures
 Congestive Cardiac Failure
 COPD

21.  History
 Physical Examination
 Functional assessment
 Family
 Social support
 Environment & Architectural Problems
 Economic problems

22.  I Inflammation of joints (or joint deformity)
 H Hypotension (orthostatic blood pressure changes)
 A Auditory and visual abnormalities
 T Tremor (Parkinson's disease or other causes of
tremor)
 E Equilibrium (balance) problem
 F Foot problems
 A Arrhythmia, heart block or valvular disease
 L Leg-length discrepancy
 L Lack of conditioning (generalized weakness)
 I Illness
 N Nutrition (poor; weight loss)
 G Gait disturbance

23.  Activities of Daily Living (ADL)
 Instrumental Activities of Daily Living (IADLS)
 Functional Independence Measure Scale(FIMS)
 Barthel Index
 Mobility questionnaire
 Short Physical performance battery
 Berg balance scale
 Walking speed
 6-minute walk
 Long distance corridor walk

24.  Pharmacological
 Lifestyle modifications
 Dietary & Nutritional support
 Rehabilitation interventions
 Prevention of falls

25.  Highest priority for most elderly people for a
satisfying Quality Of Life(QOL) is to
MAINTAIN INDEPENDENCE

26.  Functional assessment
 Realistic goal setting
 Interdisciplinary Team care
 Efficacious Adjustment of Therapy interventions

27. 1.Stabilization of primary problem
2.Prevent secondary complications
3.Restore lost function
4.Adaptation of person to new disability
5.Adaptation of the living facility
6.Working with family

28.  Medical assessment
 Assessment of nursing needs
 Assessment of impairments
 Assessment of disabilities
 Assessment of cognitive function
 Assessment of the patient’s strengths / resources
 Assessment of the patient’s and family’s priorities

30.  Patient education
 Rest, Exercise, Ergonomics
 Physical Modalities
 Orthosis, Assistive devices & Ambulatory aids
 Environmental modifications
 Surgery & post-surgery rehabilitation

31.  Frequency
 Intensity
 Type
 Time

32.  Significant gains in muscle strength as well as functional
mobility have been demonstrated in older indivuials
with a structured high intensity program
 Increase muscle strength, endurance and maximal
aerobic capacity
 Increase flexibility, coordination and balance
 Reduce risk for falling & enhance mobility
 Promote socialization & self-esteem
 Helps in maintaining or promoting independence in
ADLs

33. FLOOR :
 use nonslip tiles in Bathrooms
 use nonslip adhesive strips on floor
 next to tub, sink and toilet
 carpeting (low pile & border)
Lighting :
 lighting in high-risk areas eg.stairs, bathroom,
bedroom
 Floor glare by reposition of light source

34. Stairs :
 Place light switches at top and bottom of stairway,
 Apply coloured non-skid adhesive strips to stair edges,
 Set maximum step rise at 6 inches
Handrails :
 Place cylindrical rails 1-2 in away from wall on both
sides

35. Bed Height:
 Bed ht. from patella to floor (18 in. from top of mattress
to floor)
Chair Height:
 14- 16 in. from seat edge to floor armrests ~ 7 in above
the seat and extend 1-2 in beyond the seat edge
Shelf Height:
 Rearrange frequently used items to avoid excessive
reaching and bending

36. Toilet seat :
 Use of elevated toilet with grab bars placed on wall
next to the toilet
Shower floor surfaces :
 Use of shower chair and flexible hand-held shower
 Health faucet for ablutions

37.  Avoid serious, debilitating diseases and
disability.
 Engage independently in most normal
activities of daily living.
 Maintain cognitive function.
 Able to cope with physical, social, and
emotional changes