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Chapter 6

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INTRODUCTION

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COMPLEX MEDICAL PROBLEMS IN THE OLDER ADULT

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William H. Staples, PT, DHSc, DPT, GCS, CEEAA

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This chapter will investigate the geriatric client that may present with multiple comorbidities that can complicate the rehabilitation process. As life expectancy grows, chronic illness has become more common and is a hallmark of modern health care. A physical therapist has a great deal to consider when assessing the geriatric client. Conditions of normal aging such as difficulty with heat regulation, loss of eyesight and hearing can make assessment and intervention more difficult. Decline in physical reserve (homeostasis) may transform mild problems such as a cold into those that are life threatening. According to the Centers for Disease Control and Prevention, early 80% of older adults (over 65) have been diagnosed with one chronic condition and more than 50% of older adults have three or more comorbidities including chronic diseases. 1,2 Older adults with multiple health problems have higher rates of death, disability, adverse effects, institutionalization, use of resources, and a poorer quality of life. 3 A comprehensive review of all systems and a biopsychosocial or patient-centered approach must be utilized when assessing and planning intervention for these clients. Health is best understood in terms of a combination of biological, psychological, and social factors rather than purely in biological terms. This concept was first put forth by Dr Gorge Engel. 4 Older adults may have multiple medical problems and will benefit from this comprehensive approach that is multidisciplinary in scope. Physical therapists must not only understand internal factors such as physical abilities, cognition, and pharmacological interaction, but also how external factors such as environment, financial resources, and social support will affect the therapeutic relationship and eventual outcome.

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Not all older adults’ problems can be classified into specific disease categories. A term “geriatric syndrome” 5 has been utilized to categorize many of the most common health interrelated problems in older adults. Geriatric symptoms do not fit neatly into distinct categories; that is why they are classified as a syndrome. Geriatric syndromes are a group of chronic symptoms or problems that are logically connected, associated with old age, have a multifactorial etiology. There can be progressive decline, increased vulnerability to outside stressors, and an increased risk for adverse health outcomes. Often, the syndrome becomes a vicious circle and it leads to a decline in the human abilities and independence. So when treating geriatric patients, health care providers need to consider four domains inclusive of medical, psychological, functional, and social domains. Supportive services, such as assistance with food preparation, shopping, maintaining a checkbook, or transportation, may need to be provided by an outside agency or family member and are vital to success.

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Geriatric syndromes include falls, incontinence, delirium, and functional decline and represent a state of impaired health. 5 These complex syndromes are multifactorial and associated with poor outcomes, loss of mobility (hypomobility), frailty, dependence, and ...

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