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
