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Objectives

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After completion of this chapter, the physical therapist should be able to do the following:

  • Describe the facets of the normal aging process in terms of successful aging.

  • Identify and apply common principles for managing older patients/clients with orthopedic disorders.

  • Describe system changes that occur predictably with aging, inactivity and disease.

  • Describe musculoskeletal injuries common to the geriatric population and the related treatment principles.

  • Discuss and describe key elements of the history and physical examination for the rehabilitation of the older patient/client that may differ from younger patient/client populations.

  • Understand the importance of rehabilitation for targeted functional outcomes and maintenance of functional independence in the geriatric population.

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Rehabilitative care of older adults has evolved into a specialty area of practice for many clinicians. Geriatrics, or the care of the older adult, is based on the recognition that the aging process causes the body to respond differently to injury, disease, and medical care than when it was younger. The field of geriatrics continues to gain attention as a result of the rapid growth of this segment of the population and its predicted socioeconomic impact in the present century.

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Traditionally, demographers have used the age of 65 years to delineate an individual reaching “old age.” Reasons for this delineation include established social practices, such as retirement from work, and eligibility for benefits such as Social Security and Medicare. This segment of the population is growing steadily, both in absolute numbers and in proportion to the total population. A tremendous increase in the number of individuals reaching “old age” is projected to occur during the next 40 to 50 years. In 1900, there were 3 million persons aged 65 years and older in the United States, representing 4% of the total population. In 1988, the number of persons age 65 years and older grew to 31.6 million or 12.7% of the total population.76 It is estimated that in 2030, more than 70 million individuals will be older than the age of 65 years, representing nearly 20% of the population.81 This dramatic growth is a result of the large cohorts born during the post-World War II “baby boom” that will be reaching old age, and the improved survivorship in all age cohorts, especially those regarded as the oldest-old at 85+ years. The number of older adults age 85 years or older is predicted to triple in number by 2014.14 Since the mid-19th century, life expectancy in the United States has nearly doubled, from 40 years to almost 80 years,73 because of both medical and scientific breakthroughs and improved health habits. However, for the first time in history, life expectancy at birth has the potential to decline as a result of the effects of widespread, chronic diseases associated with obesity.65 Thus, the United States may be faced with a large number of older adults ...

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