Patient Profile: Geriatrics
Browse resources on patients with geriatric conditions that are commonly observed in the acute inpatient rehab setting.
Please click on a topic or see what catches your interest down below.
Geriatrics Collection
Conditions
From the authors: "Older frail adults are more vulnerable to health crises. They are more likely to be hospitalized or to need critical care, use emergency medical services, and have a longer in-hospital length of stay."
+ Theou, O., Squires, E., Mallery, K. et al. What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr 18, 139 (2018). https://doi.org/10.1186/s12877-018-0823-2
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From the authors: "Altered mental status is one of the most common presenting symptoms in elderly patients often related to 3 Ds- delirium, dementia, and depression. Out of the 3 Ds, Delirium and dementia are more commonly encountered in clinical practice. Most of the time, the two terms are used interchangeably and therefore unrecognized on the initial assessment. It is critically important to understand that delirium and dementia are distinct syndromes with different prognoses and management.[2] While an acute confusional state that fluctuates and develops over days to weeks is likely to be delirium, a more persistent and chronic progression suggests dementia."
+ Arvanitakis Z, Shah RC, Bennett DA. Diagnosis and Management of Dementia: Review. JAMA. 2019;322(16):1589-1599. doi:10.1001/jama.2019.4782
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From the authors: "Dehydration may cause illness or be caused by an illness, so searches of databases may not capture all cases of dehydration. The data that we do have shows that older adults are more likely to develop dehydration. The elderly population is also 20% to 30% more prone to developing dehydration due to immobility, impaired thirst mechanism, diabetes, renal disease, and falls."
+ Taylor K, Jones EB. Adult Dehydration. [Updated 2022 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555956/
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From the authors: "Urinary tract infection (UTI) is common in older adults, mainly due to several age-related risk factors. Symptoms of UTI are atypical in the elderly population, like hypotension, tachycardia, urinary incontinence, poor appetite, drowsiness, frequent falls, and delirium. UTI manifests more commonly and specifically for this age group as delirium or confusion in the absence of a fever."
+ Dutta C, Pasha K, Paul S, et al. Urinary Tract Infection Induced Delirium in Elderly Patients: A Systematic Review. Cureus. 2022;14(12):e32321. Published 2022 Dec 8. doi:10.7759/cureus.32321
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From the authors: "Falls in older adults are a common occurrence and may lead to serious injuries (like head injury and fractures). Recurrent falls are also frequent and are responsible for significant morbidity and mortality in older adults. It points toward an overall poor physical and cognitive status of the individual. In addition to physical injury, recurrent falls may result in fear and psychological trauma (“post-fall syndrome”), where an elderly refuse to move for fear of recurrent falls and injury."
+ Vaishya R, Vaish A. Falls in Older Adults are Serious. Indian J Orthop. 2020;54(1):69-74. Published 2020 Jan 24. doi:10.1007/s43465-019-00037-x
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From the authors: "Older adults are at an increased risk of contracting infectious pathogens due to their declining immune system, in addition to other age-related changes throughout all body systems. Due to these vulnerabilities, older adults are at an increased risk of sepsis."
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+ Clifford KM, Dy-Boarman EA, Haase KK, Maxvill K, Pass SE, Alvarez CA. Challenges with Diagnosing and Managing Sepsis in Older Adults. Expert Rev Anti Infect Ther. 2016;14(2):231-241. doi:10.1586/14787210.2016.1135052
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For the authors: "There are multiple known causes of rhabdomyolysis in adults such as strenuous exercise, heat stroke, seizure, delirium tremens, hypokalemia, hypophosphatemia, enzyme deficiencies, trauma, burns, heat stroke myopathy, immobility, hyponatremia, hypernatremia, arterial emboli, endocrinopathies, prolonged immobilization, shock, infections, and medications."
+ Wongrakpanich S, Kallis C, Prasad P, Rangaswami J, Rosenzweig A. The Study of Rhabdomyolysis in the Elderly: An Epidemiological Study and Single Center Experience. Aging Dis. 2018;9(1):1-7. Published 2018 Feb 1. doi:10.14336/AD.2017.0304
Treatments
Rehabilitation
Knee Extension Force:Independence in STS Performance in Pts in Acute Rehab
From the authors: "The inability to rise from a sitting position is recognized by the World Health Organization (WHO) as a disabling condition...Difficulty in rising from a sitting position is a predictor of future disability, falls, nursing home use, increased utilization of hospital services, and mortality..The ability to complete an independent chair rise successfully is highly valued by older individuals. Although STS performance has been found to be influenced by lower-extremity range of motion and balance, the physiologic variable shown most consistently to relate to STS performance is lower-extremity muscle force."
+ Ola Eriksrud, Richard W Bohannon, Relationship of Knee Extension Force to Independence in Sit-to-Stand Performance in Patients Receiving Acute Rehabilitation, Physical Therapy, Volume 83, Issue 6, 1 June 2003, Pages 544–551, https://doi.org/10.1093/ptj/83.6.544
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Role of PTs in Reducing Hospital Readmissions
From the authors: "Physical therapists can contribute meaningfully to existing care transition models and work collaboratively with other health care disciplines in reducing avoidable hospital readmissions. They also are uniquely qualified to assess physical function, which represents a strong independent risk factor for hospital readmission. Yet, physical therapists have not routinely been included in care transition efforts beyond recommendations of discharge location—an important, but limited, utilization of our skills as health care professionals for older adults. This omission should start a conversation about how we shift the rehabilitation paradigm in acute care settings away from a distinct “silo” of care that ends when the patient leaves the hospital toward a model where acute care physical therapists extend their plan of care to include the 30-day transitional care period during which hospitals remain accountable for patient outcomes."
+ Jason R. Falvey, Robert E. Burke, Daniel Malone, Kyle J. Ridgeway, Beth M. McManus, Jennifer E. Stevens-Lapsley, Role of Physical Therapists in Reducing Hospital Readmissions: Optimizing Outcomes for Older Adults During Care Transitions From Hospital to Community, Physical Therapy, Volume 96, Issue 8, 1 August 2016, Pages 1125–1134, https://doi.org/10.2522/ptj.20150526
Walking Speed Threshold for Classifying Walking Independence in Hospitalized Older Adults
From the author: "Existing walking speed standards and risk threshold values are not practical for hospitalized older adults who are acutely ill. There is useful information, however, within the compact distribution of walking speeds in this population. Our findings suggest that 0.35 m/s may serve as an initial risk threshold/target value for maintaining in-hospital walking independence. This value is approximately 50% lower than the lowest published risk threshold derived from community-dwelling older adults."
+ James E. Graham, Steve R. Fisher, Ivonne-Marie Bergés, Yong-Fang Kuo, Glenn V. Ostir, Walking Speed Threshold for Classifying Walking Independence in Hospitalized Older Adults, Physical Therapy, Volume 90, Issue 11, 1 November 2010, Pages 1591–1597, https://doi.org/10.2522/ptj.20100018
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Assessment for the Prediction of Falls in Older Adults: A Systematic Review
From the authors: "Falls are multifactorial, the use of a single clinical test is flawed,15 and a comprehensive falls risk assessment should involve an investigation of the many other factors associated with falls that may not affect the performance of a balance test."
+ Humberto Omaña, Kari Bezaire, Kyla Brady, Jayme Davies, Nancy Louwagie, Sean Power, Sydney Santin, Susan W Hunter, Functional Reach Test, Single-Leg Stance Test, and Tinetti Performance-Oriented Mobility Assessment for the Prediction of Falls in Older Adults: A Systematic Review, Physical Therapy, Volume 101, Issue 10, October 2021, pzab173, https://doi.org/10.1093/ptj/pzab173
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From the authors: "Analysis of our study results showed that age had no direct relationship with the efficacy of physiotherapy...The type of disease that was the main indication for physiotherapy had a significant influence on the efficacy...Functional status at the time of admission to the ward was the worst in patients after a stroke and the best in elderly patients with chronic diseases. The greatest physiotherapy efficacy and improvement in functional status were recorded in patients after fractures. It should be noted that this was the group of patients with the best cognitive state at baseline, which further emphasizes the relationship between cognitive state and physiotherapy efficacy."
+ Joanna Kowalska, Justyna Mazurek, Natalia Kubasik & Joanna Rymaszewska (2019) Effectiveness of physiotherapy in elderly patients with dementia: a prospective, comparative analysis, Disability and Rehabilitation, 41:7, 815-819, DOI: 10.1080/09638288.2017.1410859
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Effectiveness of Physical Interventions in Older Adults with Frailty/Prefrailty
From the authors: "Mobility-related outcomes (gait speed, Timed Up and Go test, Sit-to-Stand test, Short Physical Performance Battery, balance test and Physical Performance Test) and ADLs (measured with valid tools such as the Barthel Index, Lawton Instrumental Activities of Daily Living Scale, Instrumental Activities of Daily Living instrument and Groningen Activity Restriction Scale) were significantly improved by almost all physical activity intervention types...Mixed training has been shown to be effective at managing frailty in older adults, with improvements in mobility-related outcomes such as muscle strength and balance, and reductions in disability and falls. Previous reviews have also shown that older adults with frailty can improve mobility and ADL status with progressive resistance-based (muscle-strengthening) training."
+ Racey M, Ali MU, Sherifali D, et al. Effectiveness of physical activity interventions in older adults with frailty or prefrailty: a systematic review and meta-analysis. CMAJ Open. 2021;9(3):E728-E743. Published 2021 Jul 13. doi:10.9778/cmajo.20200222
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Therapy Options For Those Affected By A Long Lie After a Fall
From the authors: "Of particular importance in this regard are the primary caregivers who accompany the affected persons to the acute inpatient setting, the nursing professionals who, in the context of a consultation, support the affected person in recognizing a need for treatment, and the physical therapists who can influence the patient's self-confidence by strengthening physical abilities. Psychological or psychotherapeutic services are required to counter the psychological consequences of the long period of helplessness and, in some cases, fear of death."
+ Kubitza, J., Haas, M., Keppeler, L. et al. Therapy options for those affected by a long lie after a fall: a scoping review. BMC Geriatr 22, 582 (2022). https://doi.org/10.1186/s12877-022-03258-2
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How Can We Keep Patients with Dementia Safe in Our Acute Hospitals? A Review of Challenges/Solutions
From the authors: "Patients with dementia do badly in hospital with frequent adverse events resulting in the geriatric syndromes of falls, delirium and loss of function with increased length of stay and increased mortality. Contributory factors include inadequate assessment and treatment, inappropriate intervention, discrimination, low staff levels and lack of staff training. Unfortunately there is no one simple solution to this problem, but what is needed is a multifactorial, multilevel approach at the seven levels of care – patient, task, staff, team, environment, organisation and institution."
+ George J, Long S, Vincent C. How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions. J R Soc Med. 2013;106(9):355-361. doi:10.1177/0141076813476497