A Comprehensive Guide to Rehabilitation of the Older Patient

A Comprehensive Guide to Rehabilitation of the Older Patient

[previously entitled Geriatric Rehabilitation Manual]

4th Edition - November 17, 2020

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  • Editors: Shane O'Hanlon, Marie Smith
  • Paperback ISBN: 9780702080166
  • eBook ISBN: 9780702080173

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Description

This book will help all health professionals involved in the rehabilitation of older people to provide their patients with the highest possible quality of life and autonomy. Expanded and rewritten by a diverse team of authors, the text is suitable for doctors in all specialties that see older patients, as well as nurses, physiotherapists, occupational therapists, psychologists, dietitians, speech and language therapists/pathologists, physician associates/assistants, healthcare assistants, and many others including patients, family members and students. The book is written in an accessible, no-jargon style and provides a patient-centred perspective on recent advances in the field of rehabilitation – an increasingly important aspect of care for older people.

Table of Contents

  • Cover
  • Title page
  • Table of Contents
  • Copyright
  • Contributors
  • Foreword
  • Preface
  • Introduction
  • Unit 1: Introduction to Rehabilitation for Older People
  • 1: Person-Centred Care
  • Concept of person-centred care
  • Elements of the person-centred practice framework
  • Summary points
  • 2: Comprehensive Assessment of Older People
  • Frailty and comprehensive assessment
  • Comprehensive geriatric assessment
  • The international classification of functioning, disability and health
  • Summary points
  • 3: Effects of Ageing
  • Introduction
  • Definitions of ageing
  • The cardiovascular system in older people
  • The respiratory system in older people
  • The musculoskeletal system in older people
  • The nervous system in older people
  • The special senses in older people
  • The importance of physiological decline in the rehabilitation setting
  • Summary points
  • 4: Frailty
  • Introduction
  • What Does ‘Frailty’ Mean?
  • Conclusion
  • Summary points
  • 5: Rehabilitation for Older People
  • Impairment, disability, frailty
  • Evolution of rehabilitation
  • Rehabilitation in older people
  • Components of rehabilitation
  • Settings for rehabilitation
  • Rehabilitation in the community
  • Rehabilitation in residential settings
  • Prehabilitation
  • Summary points
  • 6: The Rehabilitation Team
  • Members of the rehabilitation team
  • How do we coordinate the rehabilitation of an older adult?
  • Summary points
  • 7: What Can Patients and Families Do to Help with Rehabilitation?
  • Introduction
  • Summary points
  • Further reading
  • 8: What Can We Do to Help Patients and Families?
  • Introduction
  • Summary points
  • Unit 2: Rehabilitation: How it Works
  • 9: Rehabilitation Potential and Selection for Rehabilitation
  • What is rehabilitation potential?
  • Indicators of rehabilitation potential
  • Practical considerations for undertaking rehabilitation
  • Use of the term ‘no rehabilitation potential’
  • Case conclusion
  • Summary points
  • 10: Setting Rehabilitation Goals
  • Introduction to goal setting
  • Factors to consider when setting rehabilitation goals
  • Goal setting and baseline function
  • Goal setting for different environments
  • Goal setting in residential care
  • Considerations for undertaking rehabilitation goal setting
  • Engagement in the rehabilitation process
  • Unrealistic goals
  • Conclusion of case
  • Summary points
  • 11: Rehabilitation Equipment
  • Introduction
  • Eating
  • Dressing
  • Personal hygiene: bathing, washing, showering and toileting
  • Bed mobility
  • Mobility equipment
  • Case conclusion
  • Summary points
  • 12: Physiotherapy: How It Works
  • What is physiotherapy?
  • Physiotherapy: how it works
  • Assessment of movement and balance
  • Case continued
  • Summary points
  • 13: Occupational Therapy: Function and Cognition
  • What is occupational therapy?
  • Occupational therapy and rehabilitation
  • Assessment of cognition
  • Assessment of function
  • Equipment
  • Case: mira – assessment
  • Case: mira – interventions
  • Summary points
  • 14: Nursing Patients Through Rehabilitation
  • Summary
  • Why are nurses important for patients having rehabilitation?
  • Looking after older people during rehabilitation
  • Gathering information about patients
  • Agreeing goals
  • Individualising care
  • Communication
  • Summary points
  • 15: Speech Therapy: Communication and Swallowing
  • Introduction
  • Swallowing
  • Communication
  • Summary points
  • 16: Psychological Input
  • What is a clinical psychologist?
  • Why might older adults need the help of a clinical psychologist?
  • What does a clinical psychologist do?
  • Assessment of cognitive function
  • Cognitive interventions
  • Assessment of behaviour
  • Behavioural interventions
  • Assessment of emotion, distress and/or mental health difficulty
  • Psychological therapy interventions
  • Evaluation, research and service development
  • How does a clinical psychologist support the healthcare team?
  • Summary points
  • Unit 3: Supporting Rehabilitation
  • 17: Nutrition and Hydration
  • Malnutrition
  • Dehydration
  • Role of the dietitian
  • Artificial feeding (‘Tube Feeding’)
  • How dietitians can support patients in rehabilitation
  • Food fortification
  • Summary points
  • 18: Social Work
  • What is social work?
  • Social work in rehabilitation
  • Safeguarding
  • Care planning meetings
  • Support for adjustment
  • Planning for the future
  • Summary points
  • 19: The Patient Story
  • The individual
  • Continuity of care
  • Helping you to help your patients
  • Summary points
  • 20: Brain Health and Mental Capacity
  • Introduction
  • Brain health
  • Cognitive reserve
  • Delirium and dementia
  • Smoking, alcohol and vascular risk
  • Health promotion
  • Mental capacity
  • Summary points
  • 21: Avoiding Deconditioning
  • Introduction
  • What is deconditioning?
  • The harms of bed rest
  • Impact of deconditioning
  • Deconditioning: an old chestnut or a new medical diagnosis?
  • Preventing deconditioning
  • Conclusion
  • Summary points
  • 22: Measuring Progress with Rehabilitation
  • Why do we measure progress?
  • How progress is measured
  • Communicating progress with rehabilitation
  • Summary points
  • 23: Keeping People Engaged in Rehabilitation
  • Introduction
  • Adherence
  • Motivation
  • Engagement
  • Interventions
  • Summary points
  • 24: The Rehabilitation Environment & Culture
  • Introduction
  • Indoor environment
  • Outdoor/nature environment
  • Enriched environment
  • Socialisation facilitated by the environment
  • Other positive distractions
  • Summary points
  • Unit 4: Common Issues During Rehabilitation
  • 25: Pain
  • Physiology of pain
  • Assessment
  • Non-pharmacological treatments
  • Pharmacological treatments
  • Special populations: patients with cognitive impairment
  • Practical advice
  • Summary points
  • 26: Muscle and Joint Problems
  • Healthy joint structure
  • Common joint and muscle conditions in older people
  • Non-pharmacological management of rheumatological conditions in older people
  • Pharmacological management
  • Summary points
  • 27: Posture
  • Introduction
  • Axial and appendicular skeletal changes
  • Soft tissue
  • Clinical considerations
  • Summary points
  • 28: Falls, Dizziness and Funny Turns
  • Introduction
  • Falls, syncope and dizziness occurring during rehabilitation in older patients
  • Treatment strategies
  • Prevention
  • Rehabilitation as a treatment strategy in syncope, falls and dizziness
  • Candidates for rehabilitation
  • Timing and warnings of rehabilitation
  • Summary points
  • 29: Anxiety and Depression
  • Background
  • How depression and anxiety can affect rehabilitation
  • How to identify anxiety or depression in a rehabilitation setting
  • Treatment options for anxiety and depression
  • Question to Think About
  • Fear of falling
  • Other management options and approaches
  • Summary points
  • 30: Cognitive Problems
  • Dementia and mild cognitive impairment
  • Delirium
  • Other conditions to consider
  • Specific issues and interventions in rehabilitation
  • Does rehabilitation for patients with dementia work?
  • Does rehabilitation for patients with delirium work?
  • How can we manage risk in patients with cognitive impairment in rehabilitation?
  • Summary points
  • 31: Exercise Tolerance
  • Medical conditions that may affect exercise tolerance
  • Cognitive and psychological factors that may affect exercise tolerance
  • Polypharmacy
  • Acute decline in exercise tolerance
  • Summary points
  • 32: Sleep and Fatigue
  • Sleep in the older person
  • Sleep hygiene
  • Insomnia
  • Restless leg syndrome
  • Obstructive sleep apnoea
  • Parasomnias
  • Other medical causes of fatigue
  • Summary points
  • 33: Oral Health
  • Introduction
  • The importance of oral health
  • Common oral problems in older people
  • Effects of long-term conditions
  • Supporting oral health care
  • Care of the lips
  • Summary points
  • 34: Weight Loss and Overweight
  • Introduction
  • What causes undernutrition?
  • Hip fracture
  • Anthropometric measurements
  • Does anthropometry predict or match biochemical parameters?
  • Biochemical markers
  • Oral intake
  • The role of oral nutritional supplements
  • What other measures may improve nutrition
  • Hospital food service
  • Measuring oral intake
  • Summary points
  • 35: Continence and Elimination
  • Bladder
  • Bowels
  • Summary points
  • 36: Sexuality
  • Introduction
  • Influence of ageing on sexual function
  • Sexual considerations for older women
  • Sexual considerations for older men
  • Sexually transmitted disease in older adults
  • Sexuality and cognitive impairment
  • Attitudes towards sexuality of older adults
  • Sexual activity considerations in rehabilitation
  • Conclusion
  • Summary points
  • 37: Optimising Pharmacotherapy
  • Introduction
  • Inappropriate prescribing and polypharmacy
  • Medication reconciliation
  • Medication administration and adherence
  • Medications and common conditions seen in older rehabilitating adults
  • Deprescribing
  • Education and communication
  • Summary points
  • Which Medications Contributed to Her Fall?
  • What Potential Drug Interactions Is She Exposed to?
  • Which Drugs Would You Stop (Deprescribe)?
  • What Medications Would You Consider Starting?
  • Which Medications May Potentially Be Difficult for the Patient to Administer?
  • Final Prescription on Discharge
  • 38: Osteoporosis and Bone Health
  • Introduction
  • Bone in health and disease
  • Treatment
  • Summary points
  • 39: Vision and Hearing
  • Vision
  • Hearing
  • Summary points
  • 40: Skin Care and Podiatry
  • Introduction
  • Changes in older persons’ skin
  • Eczema
  • Tinea pedis and onychomycosis
  • Skin tears
  • Pressure sores
  • Incontinence associated dermatitis
  • Complete emollient therapy
  • Prevention of lower leg ulceration
  • Summary points
  • Unit 5: Specialised Rehabilitation
  • 41: Rehabilitation in the Acute Setting
  • Comment on the case
  • The care plan
  • Actionable information added by a comprehensive geriatric assessment
  • Rehabilitation on the acute care ward and the need for further inpatient rehabilitation
  • Conclusion
  • Summary points
  • 42: Stroke Rehabilitation
  • Introduction
  • Risk factors
  • Signs and symptoms
  • Initial management
  • Diagnosis
  • Prognosis
  • Impairments
  • Interventions
  • Conclusion
  • Summary points
  • 43: Speech and Swallow Rehabilitation After Stroke
  • Introduction
  • Communication impairments following stroke
  • Setting goals in therapy
  • Dysphagia due to stroke
  • Summary Points
  • 44: Swallow Rehabilitation in Frailty
  • Introduction
  • The normally ageing swallow
  • The impact of frailty on swallowing
  • The diagnosis and management of dysphagia in the context of frailty
  • How can the team, relatives and carers help?
  • Summary points
  • 45: Spasticity
  • Spasticity
  • Management
  • Goal setting
  • Specific mdt team interventions
  • Summary points
  • 46: Vertebral and Lower Limb Fractures and Surgery
  • Introduction
  • Orthopaedic surgery and the older patient
  • Vertebral fractures
  • Lower limb fractures and types of surgery
  • Promoting healthy bones
  • Planned (elective) joint replacements
  • Summary points
  • 47: Upper Limb Fractures
  • Introduction
  • Principles of injury management
  • Principles of rehabilitation
  • Multidisciplinary working
  • Summary points
  • 48: Rehabilitation After Surgery
  • Surgery in older people
  • Addressing barriers to successful rehabilitation
  • Prehabilitation
  • Conclusion
  • Summary points
  • 49: Rehabilitation in and After the Intensive Care Unit
  • Introduction to the ICU
  • Progression of rehabilitation
  • Challenges in the ICU
  • Progression to the general ward from the ICU
  • Summary points
  • 50: Rehabilitation in Cancer
  • Cancer and the older population
  • Cancer and its treatment
  • Symptoms and side effects of cancer and its treatment
  • The changing face of rehabilitation in cancer
  • Summary points
  • 51: Rehabilitation in Movement Disorders
  • Introduction
  • Parkinson’s disease
  • Rehabilitation interventions to help parkinson’s disease
  • Summary points
  • Further Reading
  • 52: Vestibular Rehabilitation
  • Introduction to vestibular problems in the older person
  • Anatomy and physiology of the vestibular system
  • Effects of ageing on vestibular system
  • Common vestibular disorders in the older person
  • Approach to rehabilitation
  • Summary points
  • Further reading
  • 53: Rehabilitation in Dementia
  • Introduction
  • Common impairments in people with dementia
  • Rehabilitation for people with dementia
  • Physical activity for people with dementia
  • Case: Intervention strategies for madeline
  • Conclusion
  • Summary points
  • 54: Rehabilitation in Peripheral Vascular Disease
  • Introduction
  • Carotid endarterectomy
  • Abdominal aortic aneurysm
  • Aortoiliac occlusion
  • Functional assessments
  • Summary points
  • 55: Amputee Rehabilitation
  • Causes of amputation in older people
  • Challenges to successful rehabilitation
  • Rehabilitation pathways
  • Prehabilitation
  • Post-amputation rehabilitation
  • Assessing rehabilitation potential
  • Prosthetic rehabilitation
  • Monitoring outcomes
  • Summary points
  • 56: Lymphoedema Rehabilitation
  • What is lymphoedema?
  • How does lymphoedema usually occur?
  • How lymphoedema affects mobility and function
  • How to undertake lymphoedema rehabilitation
  • Therapeutic and community options for lymphoedema rehabilitation
  • Summary points
  • 57: Cardiac Rehabilitation
  • Introduction
  • Heart disease
  • Cardiac rehabilitation
  • Structure
  • Indications for CR
  • Contraindications for CR
  • Cardiac rehabilitation in older people
  • Summary points
  • 58: Pulmonary Rehabilitation
  • Introduction
  • Pulmonary rehabilitation
  • What are the benefits of pulmonary rehabilitation?
  • Considerations for the older person with chronic lung disease
  • Summary points
  • 59: Trauma in Older People
  • Introduction
  • Trauma outcomes in older people
  • Management of polytrauma
  • Key aspects of rehabilitation in polytrauma
  • Summary points
  • 60: Traumatic Brain Injury
  • Introduction
  • Causes
  • Mechanism of injury
  • Management of traumatic brain injury
  • Outcome following traumatic brain injury
  • Consequences of traumatic brain injury
  • How does recovery happen after traumatic brain injury?
  • Rehabilitation
  • Main stages of rehabilitation
  • Ongoing care for highly dependent patients
  • Current situation
  • Managed clinical rehabilitation networks
  • Conclusion
  • Summary points
  • 61: Spinal Injury
  • Spinal cord injury in older individuals
  • Prognosis for recovery after sci in older individuals
  • Neurological assessment of individuals with SCI
  • Secondary conditions related to SCI in older individuals
  • Goals and treatment approaches in SCI rehabilitation
  • Summary points
  • 62: Rehabilitation for People with Progressive Neurological Conditions
  • Introduction
  • Some ideas and reflections on rehabilitation services for people with PNCs
  • Working with people with PNCs and their families and friends
  • Summary points
  • 63: Rehabilitation in the Community
  • Why Provide Rehabilitation In Community Settings?
  • What does rehabilitation in the community look like?
  • Transitions to and from community settings
  • Summary points
  • 64: Palliative Rehabilitation
  • What is palliative care?
  • Who provides palliative care?
  • What is palliative rehabilitation?
  • Goal setting and treatment planning in palliative rehabilitation
  • Psychosocial and spiritual needs of older adults in palliative care
  • Making adaptations for palliative patients
  • Rehabilitation at the end of life
  • Summary points
  • 65: The Ageing Athlete
  • Introduction
  • The effect of ageing on the musculoskeletal system: sarcopenia
  • The effects of ageing on the musculoskeletal system: balance
  • Rehabilitation after injury or illness
  • Summary points
  • Unit 6: Planning for Discharge
  • 66: Discharge Planning: When, How and Who?
  • Why do it?
  • When to do it?
  • How to do it?
  • Who is involved?
  • Potential delays
  • Discharge destinations
  • Practicalities for health staff
  • Top tips
  • Summary points
  • 67: Care Planning Meetings
  • Multiprofessional collaboration – interdisciplinary approach
  • Meeting frequency and required infrastructure
  • Roles within the multiprofessional, interdisciplinary team
  • Conducting effective meetings
  • Dealing with conflicts
  • Disagreements between patients and family
  • Summary points
  • 68: The Home Environment Assessment
  • Environmental assessment
  • Home assessment visit
  • Recommendations following an environmental or home assessment visit
  • Cognition and HAVs
  • Mental capacity and HAVs
  • HAV case examples
  • Summary points
  • 69: Home Supports
  • Homecare
  • Telecare
  • Shopping services
  • Hot food delivery services
  • Home safety fire check
  • Befriending/volunteer services
  • Community transport
  • Home library service
  • Handy person service
  • Summary points
  • 70: Informal Care
  • Introduction
  • Rehabilitation and caregiving at home
  • Carer health
  • Conclusion
  • Summary points
  • Acknowledgements
  • 71: Loneliness
  • What is loneliness?
  • Why are people lonely?
  • Why does it matter?
  • Measuring loneliness
  • What can we do about it?
  • Are interventions successful?
  • Who can help?
  • Conclusion
  • Summary points
  • 72: Continuing Rehabilitation at Home
  • Introduction
  • Section 1: transitioning from hospital to home
  • Section 2: categorising older people according to function and physical activity levels and not age
  • Section 3: enablers and barriers to staying fit for life
  • Conclusion
  • Summary Points
  • 73: Driving Assessment and Rehabilitation
  • A key element of social inclusion and well-being
  • Theoretical basis of mobility
  • Clinical aspects of driving and ageing
  • Elements of the driving assessment
  • Taking a driving/transportation history
  • What factors are important in driving assessment?
  • What interventions can we make?
  • When driving is no longer possible
  • When patients continue to drive despite advice to cease
  • Summary points
  • 74: Advance Care Planning
  • What is advance care planning?
  • Case study of advance care planning in rehabilitation
  • The importance of advance care planning
  • Barriers and facilitators
  • Making an advance care plan – key components
  • Written instructions – advance directives and dnar orders
  • Care planning in rehabilitation
  • The role of health and social care professionals
  • Summary points
  • 75: Health Promotion
  • Introduction
  • Health promotion for older adults with disability
  • Post-rehabilitation decline
  • Transitioning from rehabilitation: screening and prevention interventions
  • Barriers to healthy lifestyle after rehabilitation
  • Health promotion strategies to increase participation
  • Conclusion
  • Summary points
  • Appendix 1: Resources for Patients and Families
  • MCQ Answers
  • Index

Product details

  • No. of pages: 624
  • Language: English
  • Copyright: © Elsevier 2020
  • Published: November 17, 2020
  • Imprint: Elsevier
  • Paperback ISBN: 9780702080166
  • eBook ISBN: 9780702080173

About the Editors

Shane O'Hanlon

Consultant Geriatrician & Adjunct Assistant Professor, St Vincent’s University Hospital and University College Dublin

Marie Smith

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