Intended for healthcare professionals

Education And Debate

Caring for Older People: Rehabilitation and older people

BMJ 1996; 313 doi: (Published 14 September 1996) Cite this as: BMJ 1996;313:677
  1. John Young, consultant geriatriciana
  1. a Bradford Hospitals Trust, St Luke's Hospital, Bradford BD5 0NA

    Rehabilitation is concerned with lessening the impact of disabling conditions. These are particularly common in older people and considerable health gain can be achieved by successful rehabilitation. Hospital doctors and general practitioners should be aware of the core principles of rehabilitation, be able to recognise rehabilitation need in their patients, and have sufficient knowledge of their local rehabilitation services to trigger the referral process.

    In Britain, an estimated 4.3 million people over 60 are disabled—this represents 70% of all disabled people and 46% of all older people.1 Most (over 90%) of older disabled people live in their own homes, and most (over 80%) have only “mild” disability, but many have several types of disability. Disability of all severity grades is strongly related to age, reflecting the increasing prevalence of the common disabling conditions: stroke, arthritis, cardiorespiratory diseases, fractured neck of femur, and peripheral vascular disease.

    Rehabilitation is a complex set of processes usually involving several professional disciplines and aimed at improving the quality of life of older people facing daily living difficulties caused by chronic disease. The key purposes of rehabilitation can be summarised succinctly:

    • Realisation potential

    • Re-ablement

    • Resettlement

    • Role fulfilment

    • Readjustment.

    Rehabilitation “myths”

    The process of rehabilitation is not always well understood. The commonest incorrect assumption is that rehabilitation is time limited, with a clear end point, finishing when the patient leaves hospital. Many patients deteriorate through disease progression, inactivity, new illness, or after a fall, so regular review and reassessment is an important aspect of effective rehabilitation. Another common misunderstanding is that the patient is a passive recipient of a “treatment,” as though the therapist were giving them a medicine. Rehabilitation is a highly energetic process in which the patient struggles against his or her disability with guidance from a rehabilitation team. It is not a “quick fix” but …

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