Rehabilitation medicine curriculum standards (adult)
Knowledge guides
LG 19: Rehabilitation of older people
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will describe the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the indications for and how to interpret the results of these investigations, procedures, and clinical assessments tools.
Advanced Trainees will know how to explain the investigation, procedure, or clinical assessment tool to patients, families, and carers.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management.
Presentations
- Deconditioning after acute illness (even relatively minor illness)
- Decreased exercise tolerance
- Dyspnoea
- Falls and balance disorders
- Functional decline
- Post-chemotherapy vulnerabilities particular to older patients
- Postoperative
- Post-stroke
- Rehabilitation prior to surgery or chemotherapy (prehabilitation)
- Speech, language, and swallowing disorders
- Trauma
Conditions
- Amputation
- Arthritis
- Chronic airflow limitation
- Coronary artery disease and congestive cardiac failure
- Deconditioning
- Delirium
- Dementia
- Depression
- Diabetes
- Falls
- Fractures, especially ankle, forearm, hip, pelvis, and vertebrae
- Frailty
- Inappropriate medication use
- Leg ulcers
- Loss of functional capacity
- Osteoporosis
- Pain
- Parkinson disease
- Restriction of vision and hearing
- Stroke/Cerebrovascular disease (CVD)
- Urinary incontinence
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Guillain–Barré syndrome – differences in presentation in older people
- Post-organ/marrow transplantation – special considerations in older people
- Spinal cord injury, particularly long-term sequelae of chronic spinal cord injury
- Traumatic/Acquired brain injury
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Changes to physiology with ageing:
- autonomic nervous system
- cardiovascular and respiratory systems
- central nervous system
- endocrine system
- gastrointestinal tract/nutrition
- kidney and urogenital systems
- musculoskeletal system
- peripheral nervous system
- sexual function
- special senses – vision, hearing, balance
- Epidemiology of disability in older people
- Normal ageing process
Examinations
- Formal assessment of functional status over time
- Hearing and vision tests
- Mental state examination and screening for depression, noting that symptoms may differ when compared to younger patients
- Physical examination, with special attention to changes associated with ageing
- Rehabilitation outcome measurement tools:
- functional assessment tools, e.g. Barthel Index, functional independence measure (FIM), Katz ADL, Lawton-Brody ADL
- mobility assessment tools, e.g. timed up and go, six-minute walk test, short physical performance battery
Investigations
- Targeted investigations based on patient presentation, such as echocardiogram and respiratory function tests in patients with breathlessness
Common comorbidities that may impact on rehabilitation management
- Complications arising from hospitalisation
- Coronary artery disease, congestive cardiac failure, and chronic airflow limitation
- Delirium and dementia
- Depression
- Inappropriate medication use and adverse drug reactions
- Incontinence
- Nutritional deficiency
- Osteoporosis
- Sepsis, especially respiratory and urinary tract
- Vision and hearing loss
- Wound and skin breakdown
Community, government assistance and residential care
- Community care and community support services
- Government benefits, such as (AU only):
- Program Of Appliances for Disabled People (PADP)
- Repatriation Appliances Program (RAP)
- support for coordinating healthcare for older people, including the Enhanced Primary Care (EPC) items
- Services for older people, such as geriatric medicine, aged care psychiatry, and palliative care
- Types of community programs, and other programs, including (AU only):
- Community Aged Care Packages (CACP)
- Extended Aged Care at Home (EACH)
- transitional aged care
- Types of residential care
Enteral feeding
- Considerations specific to ageing
- Feeding equipment and types of feeds
- Nasogastric tubes
- Percutaneous endoscopic gastrostomy
Psychology and sociology of ageing
- Changes in family dynamics
- Cognitive abilities
- Personality and adjustment
Psychosocial aspects
- Fitness for driving
- Income maintenance issues
- Mental competency and guardianship legislation
Rehabilitation technologies for older people
- Alarm systems:
- bathroom aids and modifications
- beds and pressure relieving mattresses
- home oxygen therapy, its indications, and equipment
- modern technology aides in phones/watches
- seating requirements
- Home aids and modifications
- Mobility aids
- Walking frames and wheelchairs
Types of rehabilitation programs for older people
- Community
- Inpatient
- Day hospital or equivalent
- Day therapy centre or equivalent
- Residential aged care facility