Geriatric Rehabilitation

David X. Cifu, Henry L. Lew, Mooyeon Oh-Park

• Publisher: Elsevier
• Year: 2018
• ISBN:
  9780323544559
• Topic: Medicine
• Subtopic: Physiotherapy, Physical Medicine & Rehabilitation

Rehabilitation of the geriatric patient poses a unique set of challenges and conditions often not seen in younger patients, but which are common among older adults. This quick, practical resource helps physiatrists and other members of the rehabilitation team overcome these challenges, covering the wide range of topics necessary to provide the highest level of care to this rapidly increasing population.

• Presents practical guidance on arthritis and joint replacement, polypharmacy and mobility, swallowing dysfunction, nutritional recommendations, psychiatric and cognitive disorders, assistive technology, and more.
• Covers the physiologic changes and epidemiology of aging, osteoporosis and fragility fractures, fall prevention and intervention, and prevention of hospital-acquired deconditioning.
• Consolidates today's available information on geriatric rehabilitation into one convenient resource.

Chapter 1

Epidemiology of Aging, Disability, Frailty and Overall Role of Physiatry

Kanakadurga R. Poduri, MD, FAAPMR, and Maria Vanushkina, MD

Abstract

The exponential aging of population all across the world has its own significance and implications as it pertains to older adults. The incidence of comorbidities and disability is high in this age group, resulting in functional decline as a result of physiologic, pathophysiologic, environmental, and socioeconomic conditions. Functional decline leads to decreased cognition, mobility, and activities of daily living. This chapter discusses aging demographics, normal aging physiology, mechanisms of aging, implications of multimorbidity, geriatric syndromes including frailty, disability, emerging complex care team models, the role of physical activity in the prevention and treatment of common age-related conditions, and the role of the physiatrist in geriatric care models.

Keywords

Aging; Disability; Frailty; Physical activity and longevity

Introduction

There is no agreement in the literature, practice, or policymaking for considering an individual to be truly “old.” Although not the most clinically relevant, chronologic age is the commonly accepted criterion for categorization, with most Western societies arbitrarily choosing 65 years as the cutoff to consider a person as a member of the geriatric population.¹ Terms frequently used to describe this population are young old (60+), old old (75+), and oldest old (85+).¹ When demographers mention “aging,” they are referring to the increase in the proportion of the population in the older age ranges.² When life sciences experts discuss “aging,” they are referring to the progressive changes in functional properties at the cellular and tissue level leading to decreased adaptability to stressors and an overall vulnerability to morbidity and mortality.³ These changes are not linear or consistent, are sometimes reversible, and correlate only loosely with chronologic age. Some mechanisms of aging are random, whereas others are strongly associated with biological, social, environmental, and behavioral factors intrinsic to the individual.⁴

As we age our health is the predominant characteristic that affects the available opportunities and the ability to engage in meaningful activities. Individuals with good health in their later years have very few limitations. However, if the extra years in later life are dominated by consequences of deteriorating physical and mental capacities, the implications for both the society and the older individual are more detrimental. Although it is often assumed that the trend of increased longevity is accompanied by an extended period of good health and preserved function, the evidence that older people today are “healthier” than their parents is not encouraging, especially for the American population. Both demographic and biological “aging” have tremendous implications for local and global health and healthcare, public policy, and economy.⁴ Unlike most societal level changes that may occur over the next 50 years, the trends associated with aging are largely predictable and amenable to interventions. The future framework for global action should focus on strengthening and preparing older adults to thrive in a turbulent and evolving environment.⁴ This chapter provides an overview of aging demographics and physiology, reviews emerging concepts and terminology in geriatric medical practice, and addresses current practice models designed to compress morbidity and mortality in this complex population.

Epidemiology of Aging: Demographics and What Is “Normal”

Demographics

For the first time in recorded history, most individuals are expected to live beyond 60 years. Accordingly, all current research predicts a steep increase in the aging population over the next 4 decades. In some countries such as Brazil or Myanmar, a child born in 2015 can expect to live 20 years longer than one born 50 years earlier.⁴ When combined with globally decreasing fertility trends, the increasing life expectancy is expected to have dramatic impacts on the structure of global populations.⁴ Worldwide, the 65+ years sector is projected to grow from 524 to 1.5 billion between 2010 and 2050.⁵ In the United States the population of adults over the age of 65 years is expected to double between 2012 and 2050, reaching a projected maximum of 83.7 million. By 2030, more than 20.3% of US residents are projected to be over 65 years old, compared with 13.7% in 2010 and 9.8% in 1970.² This population is expected to become more racially and ethnically diverse with a shift toward more equal gender distribution during this time.² This accelerated growth is attributed to improvements in life expectancy over the past century.^2,5 In the United States, life expectancy at age 65 years was 15.2 years in 1972 and rose to 19.1 years in 2010.² For those turning 85 years in 1972, the average length of life was 5.5 years, which increased to 6.5 years in 2010.² This oldest old population is expected to grow by 351% by 2050.⁵ Similar trends have been observed in almost all developed nations.^2,5

Changes Associated With “Normal” Aging

Aging affects the physiologic function of multiple organ systems as summarized in Table 1.1.

Chronic Conditions in Older Adults

Chronic Conditions at a Glance

The life expectancy improvements discussed earlier are reflections of multiple public health efforts in the 20th century, such as advances in living conditions, sanitation, and introduction of vaccination protocols. In fact, the global burden of morbidity and mortality has shifted from infectious illnesses to chronic noncommunicable conditions, such as heart disease, stroke, diabetes, cancer, arthritis, obesity, and respiratory disease.^2,5,6 In 2008 chronic conditions accounted for an estimated 86% of the burden of disease in developed countries.⁵ The prevalence of chronic conditions will continue to increase in the future decades. In the United States, almost half the general population is projected to have at least one chronic condition by 2020.⁷ It has been estimated that 20% of the Medicare beneficiaries have five or more chronic conditions.⁸ It is important to note that chronic conditions affect all age groups and the majority of persons with chronic conditions are not disabled or “old.”⁹

Only about one-fourth of individuals with chronic conditions have one or more daily activity limitations.¹⁰ Such individuals often require family or professional caregiver presence in the house. Caregivers are currently present in only one of five US households.¹¹ Most caregiving in United States is informal, provided by women (usually wives or daughters) on ...