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GERIATRIC REHABILITATION American Geriatrics Society (AGS) *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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