GERIATRIC REHABILITATION - STATE-OF-THE-ART

OBJECTIVES: To provide a clinically useful conceptual framework for th e evaluation and treatment of disability in older persons, to review t he rehabilitation of common conditions affecting function in older per sons, and to discuss the effects of the ongoing changes in the healthc are system on geriatric rehabilitation. METHODS: MedLine search and re view of relevant texts for information on (1) geriatric disability and its treatment, (2) recent high quality research, guidelines, and revi ew articles relevant to the rehabilitation of conditions commonly caus ing geriatric disability, (3) effects of recent changes in the healthc are system on geriatric rehabilitation. RESULTS: Several pertinent mod els for geriatric disability were identified. These are explicated, al ong with information on the epidemiology of geriatric disability and i ts causes and relevant clinical applications. Rehabilitation is review ed for musculoskeletal disorders, stroke and peripheral vascular disea se, amputation, cardiopulmonary disorders, hip fracture, and deconditi oning. Changes in the healthcare system appear to be affecting geriatr ic rehabilitation, especially the advent of managed care; relevant art icles and opinions are reviewed, along with strategies to accommodate these changes. CONCLUSIONS: Our understanding of the causes of disabil ity in the older population has improved significantly over the last d ecade. There has also been noteworthy progress in our knowledge about the effects of selected rehabilitation interventions, especially exerc ise-related interventions. How ever, the cost-effectiveness of many re habilitative interventions remains unclear, particularly for differing patient groups across the continuum of care. More research will be ne eded to evaluate the effects of managed care on rehabilitation outcome s in older persons.