Geriatric Rehabilitation: All Hands On-Deck

Illustration by Abeeshan Selvabaskaran for rehabINK

Commentary

By Ilakkiah Chandran & Anuijan Chandran

With our rapidly ageing population, we are seeing greater instances of older adults with disabilities requiring rehabilitation services. In 2013-2014, nearly 400 000 Ontarians over the age of 65 received rehabilitation services, such as physiotherapy and occupational therapy (1), yet the Ontario home healthcare system has limited rehabilitation services allocated to older adults (1). Rehabilitation services for older adults require standardized practices that focus on optimizing services and care provided, especially when an individual presents with comorbidities (1). However, there continues to be a lack of consensus on what optimal geriatric rehabilitation looks like, resulting in geriatric rehabilitation appearing fragmented, as different divisions of rehabilitation focus upon specific aspects of an individual.

To ensure the effective and successful rehabilitation of older adults, an interdisciplinary approach that targets both the individual’s physical and mental well-being is required. This commentary discusses the necessity of utilizing a person-centred interdisciplinary approach in both the research and practice of geriatric rehabilitation by addressing concerns of the current model, suggesting areas of focus, and discussing the implication this model can have.

To understand the shortcomings of the current model, let’s consider an example of an older adult in need of rehabilitation services after experiencing one of the most common accidents, a fall. After receiving any necessary immediate medical intervention, the individual is referred to a physical therapist trained in effectively supporting the older adult in regaining their typical motor functioning. However, it’s important to note that after experiencing a fall, older adults can experience mental health challenges such as increased anxiety, stress, or depression, reducing their quality of life (2,3). Furthermore, patients are also likely to experience sensorimotor and cognitive consequences that may exacerbate cognitive decline (4).

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Current care model

The physical therapist, whose training and education often focus on mobility, motor coordination, and exercise-based interventions, is most likely not equipped with the adequate resources or tools to support the mental well-being or cognition of the patient (5). In this case, additional personnel with mental health and cognitive rehabilitation training are necessary to provide optimal care to this patient.  However, for the patient to access additional personnel, they must either be referred by the healthcare professional treating them or be able to request these services on their own. If the professional is unable to assess or acknowledge the need for additional personnel and if the patient is unaware of the additional care they require, they end up receiving a fragment of the care they need for optimal rehabilitation.

To address the current care model gaps, geriatric rehabilitation research must be conducted using an interdisciplinary lens that acknowledges the multiple intertwined challenges faced by older adults. Current research fails to acknowledge that a physical ailment can result in mental health and cognitive challenges and vice versa. For example, research suggests that older adults experience greater degrees of loneliness and social isolation (6). But what does that mean for their cognitive or physical health? Does this speed up neurodegeneration or have no effect? Do these challenges impact balance or motor coordination?

Conducting research on the relationships between the different aspects of health will inform rehabilitation practices to be more holistic and interdisciplinary. If there is a tangible relationship, older adults experiencing physical difficulties assessed for loneliness and undergoing therapy may also benefit from accessing rehabilitation services from cognitive rehabilitation therapy. Research from an interdisciplinary perspective may also aid in gaining a deeper understanding of previous research on rehabilitation method effectiveness by identifying potential confounds (i.e., psychological-wellbeing, cognitive decline) that may have impacted the relationship between the rehabilitation method and the outcome. It may also aid in framing the evaluation of future experimental studies to assess its effectiveness across the various domains of the interdisciplinary model rather than a single main effect.

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Research for practice

Building upon research from an interdisciplinary perspective, geriatric rehabilitation practice and delivery can be fundamental in reducing hesitations and stigma related to specific aspects of care amongst older adult patients. Results from a study by Conner and colleagues suggest the older adults with depression were less likely to seek mental health services due to the stigma they perceived to be associated with them (7). By focusing research and practice of geriatric rehabilitation on an interdisciplinary model, older adults are more likely to understand the bi-directional relationship between mental health and physical health, and mental health and cognitive health increasing their awareness and likelihood of utilizing these services. This approach to rehabilitation will drive an optimal experience for patients as each patient’s experiences will be evaluated when providing them with care.

“If the professional is unable to assess or acknowledge the need for additional personnel and if the patient is unaware of the additional care they require, they end up receiving a fragment of the care they need for optimal rehabilitation.” 

Introducing this interdisciplinary approach to geriatric rehabilitation reduces the burden placed on the patient to identify their rehabilitation needs and equips the healthcare professionals with the resources and tools required to deliver this care. With the rapidly growing ageing population, an interdisciplinary approach to the research and practice of geriatric rehabilitation is necessary to educate healthcare personnel, improve services and sustain the quality of life of older adults.

Acknowledgements

Featured illustration by Abeeshan Selvabaskaran for rehabINK.

To refer to this article, it can be cited as:

Chandran I & Chandran A. Geriatric Rehabilitation: All Hands On-Deck. rehabINK. 2021:Issue#11. Available from: https://rehabinkmag.com


References

  1. Armstrong JJ, Sims-Gould J, Stolee P. Allocation of rehabilitation services for older adults in the Ontario home care system. Physiotherapy Canada. 2016;68(4):346-54.
  2. Ozcan A, Donat H, Gelecek N, Ozdirenc M, Karadibak D. The relationship between risk factors for falling and the quality of life in older adults. BMC Public Health. 2005 Dec;5(1):1-6.
  3. Kose N, Cuvalci S, Ekici G, Otman AS, Karakaya MG. The Risk Factors of Fall and Their Correlation With Balance, Depression, Cognitive Impairment and Mobility Skills in Elderly Nursing Home Residents. Saudi Medical Journal. 2005 Jun;26(6):978-81.
  4. Demanze Laurence B, Michel L. The fall in older adults: physical and cognitive problems. Current Ageing Science. 2017 Aug 1;10(3):185-200.
  5. Moffat M. A history of physical therapist education around the world. Journal of Physical Therapy Education. 2012 Jan 1;26(1):13-23.
  6. Tomaka J, Thompson S, Palacios R. The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. Journal of Ageing and Health. 2006 Jun;18(3):359-84.
  7. Conner KO, Copeland VC, Grote NK, Koeske G, Rosen D, Reynolds III CF, Brown C. Mental health treatment seeking among older adults with depression: the impact of stigma and race. The American Journal of Geriatric Psychiatry. 2010 Jun 1;18(6):531-43.