A Comprehensive Guide to Rehabilitation of the Older Patient

4th Edition - November 17, 2020
Editors: Shane O'Hanlon, Marie Smith
Language: English
Paperback ISBN:
9 7 8 - 0 - 7 0 2 0 - 8 0 1 6 - 6
eBook ISBN:
9 7 8 - 0 - 7 0 2 0 - 8 0 1 7 - 3

This book will help all health professionals involved in the rehabilitation of older people to provide their patients with the highest possible quality of life and autonomy.… Read more

A Comprehensive Guide to Rehabilitation of the Older Patient

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This book will help all health professionals involved in the rehabilitation of older people to provide their patients with the highest possible quality of life and autonomy.

Expanded and rewritten by a diverse team of authors, the text is suitable for doctors in all specialties that see older patients, as well as nurses, physiotherapists, occupational therapists, psychologists, dietitians, speech and language therapists/pathologists, physician associates/assistants, healthcare assistants, and many others including patients, family members and students.

The book is written in an accessible, no-jargon style and provides a patient-centred perspective on recent advances in the field of rehabilitation – an increasingly important aspect of care for older people.

Cover
Title page
Table of Contents
Copyright
Contributors
Foreword
Preface
Introduction
Unit 1: Introduction to Rehabilitation for Older People
1: Person-Centred Care
Concept of person-centred care
Elements of the person-centred practice framework
Summary points
2: Comprehensive Assessment of Older People
Frailty and comprehensive assessment
Comprehensive geriatric assessment
The international classification of functioning, disability and health
Summary points
3: Effects of Ageing
Introduction
Definitions of ageing
The cardiovascular system in older people
The respiratory system in older people
The musculoskeletal system in older people
The nervous system in older people
The special senses in older people
The importance of physiological decline in the rehabilitation setting
Summary points
4: Frailty
Introduction
What Does ‘Frailty’ Mean?
Conclusion
Summary points
5: Rehabilitation for Older People
Impairment, disability, frailty
Evolution of rehabilitation
Rehabilitation in older people
Components of rehabilitation
Settings for rehabilitation
Rehabilitation in the community
Rehabilitation in residential settings
Prehabilitation
Summary points
6: The Rehabilitation Team
Members of the rehabilitation team
How do we coordinate the rehabilitation of an older adult?
Summary points
7: What Can Patients and Families Do to Help with Rehabilitation?
Introduction
Summary points
Further reading
8: What Can We Do to Help Patients and Families?
Introduction
Summary points
Unit 2: Rehabilitation: How it Works
9: Rehabilitation Potential and Selection for Rehabilitation
What is rehabilitation potential?
Indicators of rehabilitation potential
Practical considerations for undertaking rehabilitation
Use of the term ‘no rehabilitation potential’
Case conclusion
Summary points
10: Setting Rehabilitation Goals
Introduction to goal setting
Factors to consider when setting rehabilitation goals
Goal setting and baseline function
Goal setting for different environments
Goal setting in residential care
Considerations for undertaking rehabilitation goal setting
Engagement in the rehabilitation process
Unrealistic goals
Conclusion of case
Summary points
11: Rehabilitation Equipment
Introduction
Eating
Dressing
Personal hygiene: bathing, washing, showering and toileting
Bed mobility
Mobility equipment
Case conclusion
Summary points
12: Physiotherapy: How It Works
What is physiotherapy?
Physiotherapy: how it works
Assessment of movement and balance
Case continued
Summary points
13: Occupational Therapy: Function and Cognition
What is occupational therapy?
Occupational therapy and rehabilitation
Assessment of cognition
Assessment of function
Equipment
Case: mira – assessment
Case: mira – interventions
Summary points
14: Nursing Patients Through Rehabilitation
Summary
Why are nurses important for patients having rehabilitation?
Looking after older people during rehabilitation
Gathering information about patients
Agreeing goals
Individualising care
Communication
Summary points
15: Speech Therapy: Communication and Swallowing
Introduction
Swallowing
Communication
Summary points
16: Psychological Input
What is a clinical psychologist?
Why might older adults need the help of a clinical psychologist?
What does a clinical psychologist do?
Assessment of cognitive function
Cognitive interventions
Assessment of behaviour
Behavioural interventions
Assessment of emotion, distress and/or mental health difficulty
Psychological therapy interventions
Evaluation, research and service development
How does a clinical psychologist support the healthcare team?
Summary points
Unit 3: Supporting Rehabilitation
17: Nutrition and Hydration
Malnutrition
Dehydration
Role of the dietitian
Artificial feeding (‘Tube Feeding’)
How dietitians can support patients in rehabilitation
Food fortification
Summary points
18: Social Work
What is social work?
Social work in rehabilitation
Safeguarding
Care planning meetings
Support for adjustment
Planning for the future
Summary points
19: The Patient Story
The individual
Continuity of care
Helping you to help your patients
Summary points
20: Brain Health and Mental Capacity
Introduction
Brain health
Cognitive reserve
Delirium and dementia
Smoking, alcohol and vascular risk
Health promotion
Mental capacity
Summary points
21: Avoiding Deconditioning
Introduction
What is deconditioning?
The harms of bed rest
Impact of deconditioning
Deconditioning: an old chestnut or a new medical diagnosis?
Preventing deconditioning
Conclusion
Summary points
22: Measuring Progress with Rehabilitation
Why do we measure progress?
How progress is measured
Communicating progress with rehabilitation
Summary points
23: Keeping People Engaged in Rehabilitation
Introduction
Adherence
Motivation
Engagement
Interventions
Summary points
24: The Rehabilitation Environment & Culture
Introduction
Indoor environment
Outdoor/nature environment
Enriched environment
Socialisation facilitated by the environment
Other positive distractions
Summary points
Unit 4: Common Issues During Rehabilitation
25: Pain
Physiology of pain
Assessment
Non-pharmacological treatments
Pharmacological treatments
Special populations: patients with cognitive impairment
Practical advice
Summary points
26: Muscle and Joint Problems
Healthy joint structure
Common joint and muscle conditions in older people
Non-pharmacological management of rheumatological conditions in older people
Pharmacological management
Summary points
27: Posture
Introduction
Axial and appendicular skeletal changes
Soft tissue
Clinical considerations
Summary points
28: Falls, Dizziness and Funny Turns
Introduction
Falls, syncope and dizziness occurring during rehabilitation in older patients
Treatment strategies
Prevention
Rehabilitation as a treatment strategy in syncope, falls and dizziness
Candidates for rehabilitation
Timing and warnings of rehabilitation
Summary points
29: Anxiety and Depression
Background
How depression and anxiety can affect rehabilitation
How to identify anxiety or depression in a rehabilitation setting
Treatment options for anxiety and depression
Question to Think About
Fear of falling
Other management options and approaches
Summary points
30: Cognitive Problems
Dementia and mild cognitive impairment
Delirium
Other conditions to consider
Specific issues and interventions in rehabilitation
Does rehabilitation for patients with dementia work?
Does rehabilitation for patients with delirium work?
How can we manage risk in patients with cognitive impairment in rehabilitation?
Summary points
31: Exercise Tolerance
Medical conditions that may affect exercise tolerance
Cognitive and psychological factors that may affect exercise tolerance
Polypharmacy
Acute decline in exercise tolerance
Summary points
32: Sleep and Fatigue
Sleep in the older person
Sleep hygiene
Insomnia
Restless leg syndrome
Obstructive sleep apnoea
Parasomnias
Other medical causes of fatigue
Summary points
33: Oral Health
Introduction
The importance of oral health
Common oral problems in older people
Effects of long-term conditions
Supporting oral health care
Care of the lips
Summary points
34: Weight Loss and Overweight
Introduction
What causes undernutrition?
Hip fracture
Anthropometric measurements
Does anthropometry predict or match biochemical parameters?
Biochemical markers
Oral intake
The role of oral nutritional supplements
What other measures may improve nutrition
Hospital food service
Measuring oral intake
Summary points
35: Continence and Elimination
Bladder
Bowels
Summary points
36: Sexuality
Introduction
Influence of ageing on sexual function
Sexual considerations for older women
Sexual considerations for older men
Sexually transmitted disease in older adults
Sexuality and cognitive impairment
Attitudes towards sexuality of older adults
Sexual activity considerations in rehabilitation
Conclusion
Summary points
37: Optimising Pharmacotherapy
Introduction
Inappropriate prescribing and polypharmacy
Medication reconciliation
Medication administration and adherence
Medications and common conditions seen in older rehabilitating adults
Deprescribing
Education and communication
Summary points
Which Medications Contributed to Her Fall?
What Potential Drug Interactions Is She Exposed to?
Which Drugs Would You Stop (Deprescribe)?
What Medications Would You Consider Starting?
Which Medications May Potentially Be Difficult for the Patient to Administer?
Final Prescription on Discharge
38: Osteoporosis and Bone Health
Introduction
Bone in health and disease
Treatment
Summary points
39: Vision and Hearing
Vision
Hearing
Summary points
40: Skin Care and Podiatry
Introduction
Changes in older persons’ skin
Eczema
Tinea pedis and onychomycosis
Skin tears
Pressure sores
Incontinence associated dermatitis
Complete emollient therapy
Prevention of lower leg ulceration
Summary points
Unit 5: Specialised Rehabilitation
41: Rehabilitation in the Acute Setting
Comment on the case
The care plan
Actionable information added by a comprehensive geriatric assessment
Rehabilitation on the acute care ward and the need for further inpatient rehabilitation
Conclusion
Summary points
42: Stroke Rehabilitation
Introduction
Risk factors
Signs and symptoms
Initial management
Diagnosis
Prognosis
Impairments
Interventions
Conclusion
Summary points
43: Speech and Swallow Rehabilitation After Stroke
Introduction
Communication impairments following stroke
Setting goals in therapy
Dysphagia due to stroke
Summary Points
44: Swallow Rehabilitation in Frailty
Introduction
The normally ageing swallow
The impact of frailty on swallowing
The diagnosis and management of dysphagia in the context of frailty
How can the team, relatives and carers help?
Summary points
45: Spasticity
Spasticity
Management
Goal setting
Specific mdt team interventions
Summary points
46: Vertebral and Lower Limb Fractures and Surgery
Introduction
Orthopaedic surgery and the older patient
Vertebral fractures
Lower limb fractures and types of surgery
Promoting healthy bones
Planned (elective) joint replacements
Summary points
47: Upper Limb Fractures
Introduction
Principles of injury management
Principles of rehabilitation
Multidisciplinary working
Summary points
48: Rehabilitation After Surgery
Surgery in older people
Addressing barriers to successful rehabilitation
Prehabilitation
Conclusion
Summary points
49: Rehabilitation in and After the Intensive Care Unit
Introduction to the ICU
Progression of rehabilitation
Challenges in the ICU
Progression to the general ward from the ICU
Summary points
50: Rehabilitation in Cancer
Cancer and the older population
Cancer and its treatment
Symptoms and side effects of cancer and its treatment
The changing face of rehabilitation in cancer
Summary points
51: Rehabilitation in Movement Disorders
Introduction
Parkinson’s disease
Rehabilitation interventions to help parkinson’s disease
Summary points
Further Reading
52: Vestibular Rehabilitation
Introduction to vestibular problems in the older person
Anatomy and physiology of the vestibular system
Effects of ageing on vestibular system
Common vestibular disorders in the older person
Approach to rehabilitation
Summary points
Further reading
53: Rehabilitation in Dementia
Introduction
Common impairments in people with dementia
Rehabilitation for people with dementia
Physical activity for people with dementia
Case: Intervention strategies for madeline
Conclusion
Summary points
54: Rehabilitation in Peripheral Vascular Disease
Introduction
Carotid endarterectomy
Abdominal aortic aneurysm
Aortoiliac occlusion
Functional assessments
Summary points
55: Amputee Rehabilitation
Causes of amputation in older people
Challenges to successful rehabilitation
Rehabilitation pathways
Prehabilitation
Post-amputation rehabilitation
Assessing rehabilitation potential
Prosthetic rehabilitation
Monitoring outcomes
Summary points
56: Lymphoedema Rehabilitation
What is lymphoedema?
How does lymphoedema usually occur?
How lymphoedema affects mobility and function
How to undertake lymphoedema rehabilitation
Therapeutic and community options for lymphoedema rehabilitation
Summary points
57: Cardiac Rehabilitation
Introduction
Heart disease
Cardiac rehabilitation
Structure
Indications for CR
Contraindications for CR
Cardiac rehabilitation in older people
Summary points
58: Pulmonary Rehabilitation
Introduction
Pulmonary rehabilitation
What are the benefits of pulmonary rehabilitation?
Considerations for the older person with chronic lung disease
Summary points
59: Trauma in Older People
Introduction
Trauma outcomes in older people
Management of polytrauma
Key aspects of rehabilitation in polytrauma
Summary points
60: Traumatic Brain Injury
Introduction
Causes
Mechanism of injury
Management of traumatic brain injury
Outcome following traumatic brain injury
Consequences of traumatic brain injury
How does recovery happen after traumatic brain injury?
Rehabilitation
Main stages of rehabilitation
Ongoing care for highly dependent patients
Current situation
Managed clinical rehabilitation networks
Conclusion
Summary points
61: Spinal Injury
Spinal cord injury in older individuals
Prognosis for recovery after sci in older individuals
Neurological assessment of individuals with SCI
Secondary conditions related to SCI in older individuals
Goals and treatment approaches in SCI rehabilitation
Summary points
62: Rehabilitation for People with Progressive Neurological Conditions
Introduction
Some ideas and reflections on rehabilitation services for people with PNCs
Working with people with PNCs and their families and friends
Summary points
63: Rehabilitation in the Community
Why Provide Rehabilitation In Community Settings?
What does rehabilitation in the community look like?
Transitions to and from community settings
Summary points
64: Palliative Rehabilitation
What is palliative care?
Who provides palliative care?
What is palliative rehabilitation?
Goal setting and treatment planning in palliative rehabilitation
Psychosocial and spiritual needs of older adults in palliative care
Making adaptations for palliative patients
Rehabilitation at the end of life
Summary points
65: The Ageing Athlete
Introduction
The effect of ageing on the musculoskeletal system: sarcopenia
The effects of ageing on the musculoskeletal system: balance
Rehabilitation after injury or illness
Summary points
Unit 6: Planning for Discharge
66: Discharge Planning: When, How and Who?
Why do it?
When to do it?
How to do it?
Who is involved?
Potential delays
Discharge destinations
Practicalities for health staff
Top tips
Summary points
67: Care Planning Meetings
Multiprofessional collaboration – interdisciplinary approach
Meeting frequency and required infrastructure
Roles within the multiprofessional, interdisciplinary team
Conducting effective meetings
Dealing with conflicts
Disagreements between patients and family
Summary points
68: The Home Environment Assessment
Environmental assessment
Home assessment visit
Recommendations following an environmental or home assessment visit
Cognition and HAVs
Mental capacity and HAVs
HAV case examples
Summary points
69: Home Supports
Homecare
Telecare
Shopping services
Hot food delivery services
Home safety fire check
Befriending/volunteer services
Community transport
Home library service
Handy person service
Summary points
70: Informal Care
Introduction
Rehabilitation and caregiving at home
Carer health
Conclusion
Summary points
Acknowledgements
71: Loneliness
What is loneliness?
Why are people lonely?
Why does it matter?
Measuring loneliness
What can we do about it?
Are interventions successful?
Who can help?
Conclusion
Summary points
72: Continuing Rehabilitation at Home
Introduction
Section 1: transitioning from hospital to home
Section 2: categorising older people according to function and physical activity levels and not age
Section 3: enablers and barriers to staying fit for life
Conclusion
Summary Points
73: Driving Assessment and Rehabilitation
A key element of social inclusion and well-being
Theoretical basis of mobility
Clinical aspects of driving and ageing
Elements of the driving assessment
Taking a driving/transportation history
What factors are important in driving assessment?
What interventions can we make?
When driving is no longer possible
When patients continue to drive despite advice to cease
Summary points
74: Advance Care Planning
What is advance care planning?
Case study of advance care planning in rehabilitation
The importance of advance care planning
Barriers and facilitators
Making an advance care plan – key components
Written instructions – advance directives and dnar orders
Care planning in rehabilitation
The role of health and social care professionals
Summary points
75: Health Promotion
Introduction
Health promotion for older adults with disability
Post-rehabilitation decline
Transitioning from rehabilitation: screening and prevention interventions
Barriers to healthy lifestyle after rehabilitation
Health promotion strategies to increase participation
Conclusion
Summary points
Appendix 1: Resources for Patients and Families
MCQ Answers
Index