Chapter 6: Complex Medical Problems in the Older Adult

INTRODUCTION

William H. Staples, PT, DHSc, DPT

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 healthcare. 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 age 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.^1–3 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 multi-disciplinary 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.

There are more than 1000 people turning 65 every day and 80% of them have one chronic disease and 70% have two.^1,2 There are varied reasons why we are having a rise in chronic diseases. We have improvements in medical care, diagnostic technology, and treatment options for these diseases. Consequences of these chronic diseases are extensive and affect normal daily function. Costs and medical resources are utilized more to treat patients with 1 or more of these chronic disease processes. There will be 74 million US citizens over the age of 65 by 2030 with hypertension, obesity, diabetes, dementia, and/or arthritis. One in 3 people need help with at least 1 ADL.^1,2 Currently 3% of the population lives in a nursing home and 1% live in residential care.^1,2 As the population ages, these numbers may rise.

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 don’t fit neatly into distinct categories; that’s 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. ...