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*Last Updated May 1, 1999*
BACKGROUND
We define rehabilitation as the maintenance
and restoration of physical and psychological health necessary for independent
living and functional independence. Access to comprehensive rehabilitative
services is critical to the attainment of independent living and functional
independence, which are fundamental goals of all people.
Certain illnesses that occur commonly in
older persons can be associated with a decline in the individual's ability
to function independently. Medical and social support services, including
rehabilitative programs, are most effective they are delivered in a timely
and coordinated fashion. Geriatric rehabilitation services designed to
enhance and restore functional ability may enable many older people to
live in less restrictive environments, thereby producing a net savings
in health-care costs.
POSITIONS
1. Rehabilitation services should be available
in all settings in which older persons receive health care.
Rationale: Access to rehabilitative services
is essential to maintain independent living in the community. Rehabilitation
should not be restricted to short-term hospital rehabilitation units or
free-standing rehabilitation hospitals; it should be pursued in settings
such as medical units of general hospitals, nursing homes, outpatient
clinics, and home care programs. Managed care programs should support
rehabilitative services in appropriate settings and provide assistive
services as part of routine benefits. In addition, utilization review
of rehabilitative services are needed to insure that effective and necessary
services are provided in an efficient manner.
2. An interdisciplinary approach should
be used in the delivery of comprehensive geriatric rehabilitative services.
Rationale: Some older persons require rehabilitation
of only a single impairment that may be well treated at their primary
provider with the support of one or more therapists as needed. Multiple
disabilities, however, are more prevalent with advancing age. Because
rehabilitation to full independence is less likely in the presence of
multiple problems, these problems often necessitate psycho-social and
other supportive components of rehabilitative care. Rehabilitative or
restorative care for older persons with complex needs is therefore optimally
provided by an interdisciplinary approach, which may involve physical,
speech, occupational and recreational therapists, physicians, nurses,
social workers, and/or other health professionals. For specific needs,
patients may be well served by the provider (MD, NP, PA) and one or more
therapists.
3. Primary-care providers should be trained
to assess the need for rehabilitative services and should be actively
involved in the provision of these services.
Rationale: Primary-care providers play
an essential role in the identification of functional disability in their
older patients and can incorporate rehabilitative goals into the current
care of their patient. In addition, they need to know when to seek the
consultation of rehabilitation professionals. Primary-care providers must
also be able to monitor the progress of patients toward their rehabilitation
goals. Currently, education in this important area is inadequate; it is
needed at many levels of clinical training..
4. Funding for rehabilitative services
of various durations and intensities should be provided for older persons.
Rationale: The funding of rehabilitative
services is now restricted to specific settings, diagnoses, and levels
of care. These funding mechanisms provide for rehabilitative services
only where rapid progress in functional improvement can be documented
and long sessions of rehabilitative services can be tolerated. Older persons
often have multiple chronic disabilities as well as reduced functional
and homeostatic reserves that may slow or otherwise affect their response
to therapies used. Therefore, an older patient often requires a longer
period of restorative-care services to achieve or maintain the same level
of function as a younger individual with a similar level of disability.
Failure to take these differences into account results in excess disability
that could possibly be corrected by longer but less intensive treatment.
5. Research is needed in order to determine
the optimal application of rehabilitative services for the older person.
Rationale: Although rehabilitative services
are often beneficial, few studies have focused specifically on the relative
merits and costs of various approaches. Because 'targeting' of services
is an important component of geriatric care, additional data are needed
to determine which older individuals with functional disability will derive
the greatest benefit from these services. In addition, the optimal location,
duration, and combination of types of rehabilitative services for specific
problems of elderly persons have not been determined. Research in these
areas should be given high priority by funding agencies.
Developed by the AGS Public Policy Committee
and approved by the AGS Board of Directors in November 1989. Journal of
the American Geriatrics Society 38:1049-1050, 1990. Reviewed April 1993.
Reviewed May 1999. AGS, The Empire State Building, 350 Fifth Avenue, Suite
801, New York, NY 10118.
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