Geriatric rehabilitation : a clinical approach / Jennifer M. Bottomley, Carole B. Lewis.

Format:

Book

Author/Creator:

Bottomley, Jennifer M.

Contributor:

Lewis, Carole Bernstein.

Language:

English

Subjects (All):

Physical therapy for older people.

Older people--Rehabilitation.

Older people.

Physical Therapy Modalities.

Aged.

Aging.

Geriatric Assessment.

Rehabilitation.

Medical Subjects:

Physical Therapy Modalities.

Aged.

Aging.

Geriatric Assessment.

Rehabilitation.

Physical Description:

xvii, 716 pages : illustrations ; 29 cm

Edition:

Second edition.

Place of Publication:

Upper Saddle River, N.J. : Prentice Hall, [2003]

Summary:

The special needs of the elderly in all health care settings is the unifying element of this book. It emphasizes a balance of theory, clinical application of knowledge, and clinical skills in caring for the older adult population, and focuses on the practical components for their comprehensive rehabilitation. This book addresses and incorporates aspects of prevention, fitness, and wellness into the rehabilitative model of care for elders with and without pathological conditions. A three-part organization covers demographic trends and aging theories, presents a comprehensive consideration of patient care concepts, and details administration and management topics.

Contents:

I. Applied Gerontological Concepts 1

1. Understanding the Demographics of an Aging Population 3

An Historical Perspective of the Study of Population Aging 4

Demographic Processes and Population Age Structure 4

Projected Population Trends in an Aging Society 7

Projected Components of Change in an Aging Population 9

Fertility Patterns 9

Mortality Patterns 9

Immigration and Migration Patterns 9

Age Composition of the Aging US Population 9

Gender Composition of the Aging US Population 10

Geographical Distribution of the Aging US Population 10

Income Status of the Aging US Population 10

Poverty of the Aging US Population 10

Marital Status of the Aging US Population 11

Living Arrangements of the Aging US Population 11

Housing Status of the Aging US Population 12

Employment Status of the Aging Population 12

Educational Status of the Aging US Population 12

Health Status of the Aging US Population 12

Demographic Trends and Projections in the Minority Elderly 15

Projected Population Trends in the Minority Elderly 15

Projected Components of Change in the Minority Elderly 16

Projected Trends in the World's Aging Population 20

2. Comparing and Contrasting the Theories of Aging 28

Historical Perspective 28

Animal Models of Aging 29

Fundamental Considerations 30

Theories of Aging 31

Developmental-Genetic Theories 31

Stochastic Theories of Aging 37

New Theories on Aging 39

3. Comparing and Contrasting Age-Related Changes in Biology, Physiology, Anatomy, and Function 50

Cellular Changes in Aging 51

Cardiovascular Changes with Age 51

Cellular Changes 51

Anatomic Changes 52

Physiological Changes 52

Pulmonary Changes with Age 54

Musculoskeletal Changes with Age 54

Cellular Changes 54

Changes in Cartilage 56

Changes in Body Composition 56

Muscle Changes with Age 57

Cellular Changes 57

Anatomic Changes 59

Histological Changes 59

Functional Changes 60

Skeletal Changes with Age 60

Neuromuscular Changes with Age 61

Central Neurological Changes with Age 61

Intersystem Homeostasis 61

Thermal Regulation 61

Hormonal Balance 62

Circulation 62

Peripheral Neurological Change with Age 62

Sensory Changes 63

Touch 63

Vision 63

Hearing 64

Proprioception/Kinesthesia 64

Vestibular System 64

Taste and Smell 65

Gastrointestinal Changes 65

Renal, Urogenital, and Hepatic Changes 65

Endocrine Changes with Age 66

Menopause 68

Andropause 68

Adrenopause 69

Somatopause 69

Sleep, Memory, and Intelligence Changes 70

4. Describing Psychosocial Aspects of Aging 76

Psychosocial Theories of Aging 76

Full Life Development Theories 77

Late Life Theories 78

Cognitive Changes in Late Life 80

Memory 81

Intelligence and Learning 82

Situations Requiring Coping Mechanisms 83

Depression 83

Social Isolation 84

Institutionalization 85

Anxiety Disorders 86

Chronic Illness 87

Death, Dying, Grief, and Multiple Losses 88

Delirium 89

Dementia 90

Belief Systems Regarding the Aging Process 94

Lifestyle Adaptation, Stress 94

Stress Evaluation 96

5. Pathological Manifestations of Aging 101

Pathological Manifestation of Aging 102

Aging as a Disease 102

Cardiovascular Manifestations of Aging 103

Ischemic Heart Disease 103

Cardiomyopathy/Congestive Heart Failure 105

Conduction System Disease 105

Valvular Disease of the Heart 106

Hypertension 107

Myocardial Degeneration 107

Peripheral Vascular Disease 108

Pulmonary Manifestations of Aging 108

Pneumonia 109

Obstructive and Restrictive Lung Disease 109

Musculoskeletal Manifestations of Aging 110

Muscle Changes with Aging 110

Myopathy and Myositis 110

Fibromyalgia/Myofibralgia 110

Skeletal Manifestations of Aging 111

Osteoporosis 111

Osteopenia 112

Osteomalacia 112

Osteonecrosis 113

Paget's Disease 113

Joint Changes with Aging 114

Degenerative Arthritis/Osteoarthritis 114

Rheumatoid Arthritis 115

Gout 115

Temporal Arteritis/Polymyalgia Rheumatica 115

Spondyloarthropathies 116

Neuromuscular Manifestations of Aging 116

Central Nervous System 116

Confusion/Delirium 117

Dementias 118

Alzheimer's Disease: A Special Consideration 118

Cerebrovascular Disease 119

Parkinson's Disease 120

Huntington's Disease 121

Amyotrophic Lateral Sclerosis 122

Normal Pressure Hydrocephalus 123

Cervical Spondylosis 123

Spinal Cord Injury 123

Peripheral Nervous System 124

Neurosensory Manifestations of Aging 124

Vestibular Problems 124

Skin Pathologies 126

Malignant Tumors 126

Herpes Zoster 127

Decubitus Ulcers 127

Disturbances of Touch 127

Ocular Pathologies with Age 128

Hearing Pathologies with Age 130

Proprioceptive and Vestibular Dysfunction 130

Sensory Changes in Smell 131

Sensory Changes in Taste 131

Gastrointestinal Pathologies in Aging 132

Dysphagia 132

Ulcer Disease 132

Pernicious Anemia 133

Cancer 133

Biliary Tract Disease 133

Bowel and Bladder Problems 133

Urinary Incontinence 133

Fecal Incontinence 134

Diverticulosis/Irritable Bowel Syndrome 134

Constipation 135

Diarrhea 135

Kidney Problems 135

Renal Disease 135

Acute and Chronic Renal Failure 135

Sodium and Water Balance 136

Potassium 136

Drug Intoxication 136

Endocrine Diseases 136

Glucose Metabolism and Diabetes Mellitus 137

Thyroid Disease 138

Antidiuretic Hormone Imbalance 138

Parathyroid Disease 139

Cancer 139

Immune System Diseases 140

Hypothermia 142

Hyperthermia 143

6. Assessment Instruments 152

Mental Status Measures 152

Mini-Mental State Examination 152

The Mental Status Questionnaire 154

Depression Scales 154

Stress Measures 159

Functional Assessment 159

What is Functional Assessment? 159

Functional Assessment Tools 163

Functional Assessment Scales and Indices 167

Modified Physical Therapy Measures 171

Musculoskeletal Parameters 171

Gait Assessment 178

Cardiopulmonary Tests 181

Nerve Conduction Velocity 183

Assessing Ethnicity 183

7. Exploring Nutritional Needs 191

Age-Related Changes in the Gastrointestinal System 192

Changes in the Oral Cavity 192

Sensory Changes in Taste and Smell 192

Esophageal Changes 193

Gastric Changes 193

Intestinal Changes 193

Changes in Renal Function 194

Changes in the Liver 194

Other Age-Related Changes 194

Age-Related Changes that Affect Nutrition 194

Basal Metabolic Rate 195

Age-Related Changes in Muscle Metabolism 195

Chronic Disease and Nutrition in the Elderly 198

Nutrition and Heart Disease in the Elderly 198

Nutrition and Osteoporosis in the Elderly 199

Nutrition and Diabetes Mellitus in the Elderly 201

Nutrition and Cancer in the Elderly 201

Nutrition and Alzheimer's Disease 203

Nutrition and Renal Disease in the Elderly 204

Nutrition and Urinary Incontinence 205

Nutrition and Dental Disease in the Elderly 207

Obesity and Nutrition in the Elderly 207

Nutrition and Immunity in the Elderly 207

Clinical Evaluation of Nutritional Status 210

Nutritional Requirements of the Elderly 212

Common Nutritional Deficiencies in the Aged 217

Calories/Energy Intake 217

Protein/Energy MaInutrition 218

Amino Acids 219

Calcium/Vitamin D 219

Iron 220

Vitamin B12 221

Folic Acid 221

Vitamin B1 221

Vitamin B2 221

Vitamin B3 222

Vitamin B5 222

Vitamin B6 222

Biotin 222

Vitamin C 222

Vitamin E 223

Vitamin A 223

Beta Carotene 223

Zinc 224

Copper 224

Chromium 224

Iodine 225

Magnesium 225

Manganese 225

Phosphorus 225

Potassium 225

Selenium 226

Water Intake 226

Drugs' Effects on Nutrition 226

Alcohol's Effects on Nutrition 229

Theories of Aging Related to Nutrition 229

Exercise, Nutrition,

and Aging 231

Supplementing Nutrients 231

Nutritional Programs for the Elderly 232

8. Pharmacology 247

Epidemiological Issues 248

Clinical Implications 248

Pharmacokinetics and the Elderly 248

Drug Use and Adverse Reactions in the Elderly 249

Postural Hypotension 250

Fatigue and Weakness 250

Depression 251

Dehydration 251

Confusion and Dementia 252

Movement Disorders 252

Incontinence 252

Dizziness 252

Fluid Volume Depletion 253

Drug Regimens 253

Cardiovascular Regimens 254

Neuromusculoskeletal Regimens 257

Osteoporosis Regimens 266

Psychological Regimens 267

Gastrointestinal Drugs 272

Diabetic Regimens 273

Urinary Incontinence 274

Cancer Regimens 276

Chronic Obstructive Pulmonary Disease: Drug Interventions 276

Dementia: Pharmacological Therapy 277

Compliance and Motivation in Drug Regimens 277

Over The Counter Drugs and Self-Medication 278

Drug-Induced Malnutrition 279

Herbs, Vitamins, and Nutraceuticals 279

9. Principles and Practice in Geriatric Rehabilitation 292

Disability: A Definition 292

Demographics of Disability in the Elderly 293

Frailty: Medically Complex Elderly 293

Functional Assessment of the Aged 295

Functional Abilities of the Caregiver: A Rehabilitative Consideration 295

Principles of Geriatric Rehabilitation 296

Variability of the Elderly 296

Examples of Variability in Aging 296

Activity Versus Inactivity 297

Optimal Health 305

Rehabilitation Measures 306

Special Geriatric Rehabilitation Considerations 312

Nutritional Considerations 314

Restraints 315

Falls in the Aged 317

Adapting the Environment 320

10. Patient Evaluation 329

Preparation 329

Setting 329

Tools 329

Timing 329

Expectations 330

Interview 330

Physical Assessment 330

Pain Assessment 330

Environmental Assessment 331

Psychosocial Assessment 332

11. Orthopedic Treatment Considerations 362

Strength 362

Flexibility 363

Posture 363

Osteoporosis 364

Osteoporosis: A Special Consideration of a Prevalent Pathology 364

Distinguishing "Normal" Aging of Bone from Osteoporosis 364

Changes in Bone Remodeling During the Life Cycle 365

Osteoblast and Osteoclast Activity 367

Hormonal Influence 368

Homeostatic Mechanisms: Controlling Plasma Calcium & Skeletal Minerals 368

Mechanical Stress 368

Pathophysiological Mechanism of Osteoporosis 369

Postmenopausal Osteoporosis 369

Primary Osteoporosis 369

Conditions That Influence Age-Related Decrease in Bone Mineral Content 370

Effects of Nutrition on Bone Remodeling 370

Effects of Endocrine Status on Bone Remodeling 370

Effects of Exercise on Bone Remodeling 371

Risk Factors for Osteoporosis 371

The Calcium Connection: Effects of Calcium Intake 371

Problems in Studying Exercise Effects on Bone 373

Osteopenia 374

Osteomalacia 374

Avascular Necrosis 375

Paget's Disease 376

Osteoarthritis 377

Rheumatoid Arthritis 377

The Aging Spine 378

Spinal Pathology of the Elderly 378

Lumbar Stenosis 378

Vertebral Compression Fractures 379

Vertebral Artery Syndrome 379

Cervical Spondylosis 379

Rheumatoid Arthritis 379

Ossification of the Posterior Longitudinal Ligament 380

The Upper Extremity 380

The Shoulder 380

The Lower Joints of the Upper Extremity 381

The Elbow 381

The Wrist 381

The Hand 382

The Lower Extremity 382

The Hip 382

Hip Osteoarthritis 383

Hip Fracture 383

Total Hip Replacement 383

The Knee 383

Osteoarthritis 384

Total Knee Replacement 384

The Foot and Ankle 389

II. Patient Care Concepts 397

12. Neurological Treatment Considerations 399

Parkinson's Disease 399

Evaluation 400

Treatment Considerations 403

Stroke 412

Evaluation 416

Treatment Interventions 429

Alzheimer's Disease 436

Balance and Falls 440

13. Cardiopulmonary and Cardiovascular Treatment 449

Incidence of Cardiopulmonary and Cardiovascular Disease 450

Implications 450

Physiological Aspects of Exercise 452

Cardiopulmonary Changes with Aging and Disease 452

Maximal Oxygen Consumption (VO[subscript 2] max) 453

Heart Rate 454

Stroke Volume 454

Cardiac Output 455

Blood Pressure 455

Arteriovenous Oxygen Differential 455

Peripheral Vascular Resistance 456

Neurohumoral Factors 456

Pulmonary Response to Exercise 456

Benefits of Exercise Training in the Elderly 457

Benefits of Exercise for Peripheral Vascular Circulation 458

Examination, Evaluation, and Modified Exercise Testing 460

Step Tests 461

Modified Chair-Step Test for the Elderly 461

Walking Test 461

Treadmill Tests 462

Cycle Ergometer Test 462

Buerger-Allen Test for Peripheral Circulation 462

Other Evaluation for Circulatory Status 463

Exercise Prescription 464

Special Considerations When Prescribing Exercise 465

Pacemakers and Intracardiac Defibrillators 465

Obesity 466

Diabetes Mellitus 467

Medications 468

Osteoporosis 468

Congestive Heart Failure/Cardiomyopathy 468

Hormone Replacement Therapy as a Secondary Preventative Intervention 470

Complementary Therapies and Cardiovascular Disease 471

14. Integumentary Treatment Considerations 484

Defining Integumentary Conditions 485

The Skin and the Aging Process 485

Wound Repair 486

Uninterrupted Wound Repair 486

The Effects of Aging on Wound Healing 487

Factors Complicating Wound Repair 489

Nutritional Considerations in Wound Care 491

Patient and Wound Evaluation 493

Documentation and Staging of Wound Status 494

Microbiology 498

Lower Extremity Ulcers 499

Arterial Ulcers 499

Venous Ulcers 507

Diabetic Ulcers 509

Pressure Ulcers 512

Vasculitic Ulcers 514

Other Types of Wounds 515

Extravasation Sites 515

Abrasions and Skin Tears 515

Dehisced Surgical Wounds 515

GI and GU Fistulas 515

Radiation Burns 515

Wound Management 516

Electrical Stimulation 516

Ultrasound 518

Whirlpool 518

Debridment 519

Hyperbaric Oxygen Therapy 519

Incontinence Care 519

Surgical Indications 519

Support Surfaces 520

Wound Care Products 521

Pharmaceutical Agents 521

Dressings 522

Growth Factors 522

Nutritional Agents' 523

Alternative Medicine and Wound Healing 523

15. Establishing Community Based Screening Programs 528

Prevention/Health Promotion 529

Types of Prevention 529

Health Problems in the Elderly/Symptom Prevalence 530

Screening Concerns in the Elderly 530

What to Screen For 531

Prescreening for High-Risk Populations 531

Secondary Prevention Screening Tests 532

Cardiovascular Disease 532

Cancer 532

Diabetes Mellitus 533

Osteoporosis 533

Health Habits 533

Sensory Deficits 535

Psychological Problems 535

Dementia 535

Urinary Incontinence 535

Safety 536

Primary Prevention 536

A Community Based Screening Program/Model Project 536

Screening for Foot Problems 536

Special Considerations in Screening Programs 546

16. Communication 549

Normal Changes with Age Affecting Communication 549

Hearing 549

Vision and the Other Senses 550

Voice Changes with Age 552

Ethnicity 554

The Team 555

Writing 558

Compliance and Motivation 559

III. Administration and Management 575

17. Attitudes and Ethics in Gerontology 577

How Medical Care is Changing 577

Ethics and Managed Care and Medicare 577

Personal Attitudes 578

Medical Decision Making 578

Allocation of Resources 579

Caregiver Stress 580

Elder Abuse 581

Patient Dignity 581

Patients' Rights 582

The Right to Refuse 583

Rights of Demented Patients 583

Informed Consent 584

Death Issues 585

Living Wills 585

Euthanasia 586

Cardiopulmonary Resuscitation 586

Terminal Care 587

Hospice 588

Suicide 588

Restraints 588

Minority Issues and Ethics 589

Case Studies: Ethical Dilemmas 590

18. Education and the Older Adult: Learning, Memory, and Intelligence 594

Associative Learning 595

Information Processing 596

Contextual Learning 597

Human Memory 597

The Storage Phase of Memory Related to Age 600

Retrieval Related to Age 601

Problem Solving 603

Intelligence 604

Motor Learning 605

Teaching Strategies for the Elderly 606

Teaching in the Therapeutic Setting 607

Organization of Information 608

Task Choice 608

Presentation of Information 609

Covert Strategies 609

19. Administration of Geriatric Services 615

Description of Administration 615

Financing and Budgeting 615

Organizing and Planning for Personnel, Equipment, and Supplies 616

Developing Goals, Philosophy, and Organizational Plans 616

Organizational Goals 620

Organizational Plan 620

Legal Constraints 621

Personnel Management: Employee Relations 623

Marketing 623

20. Consultation 634

Identifying the Rehabilitation Professional's Consultant Role 634

Settings for Consulting 634

Nursing Homes 634

Home Care 635

Senior Centers 635

Hospitals, Rehabilitation Centers, and Outpatient Clinics 635

Industrial Setting 635

Identifying Consultation Activities 636

Screening Programs 636

Direct Patient Care 636

Consulting on OBRA 636

Quality Assurance and Chart Review 636

The Consultant Process 638

21. Scientific Inquiry and Research in Geriatric Therapy 672

Critical Inquiry 672

How to Analyze Research Articles 673

How to Select Research Articles 673

Problems with Rehabilitation Research 674

Problems with Aging Research 674

Measurement Issues 676

Reliability 676

Validity 676

Independent and Dependent Variables 677

Variability 677

Data Analysis 677

Conducting Clinical Research in Aging 678

Single Subject Design 681

Quantitative Research 681

Qualitative Research 681

Ethnography 683

Encouraging the Use of Research 683

Ethical Issues 684

Funding Research 684

22. Aging Network Resources 688

Helpful Organizations 688

General Information 688

Hotlines 689

Support Groups 689

Women's Health Issues 690

Physical Fitness 691

Nutrition 691

Medications 691

Alternative and Complementary Medicine 692

Health Promotion and Wellness 692

Accident Prevention 692

Disease Specific Organizations 693

Osteoporosis 693

Arthritis 693

Urinary Incontinence 693

Cognitive Changes 694

Depression 694

Diabetes 694

Wound Care 695

Cancer 695

High Blood Pressure 695

Heart Disease 695

Cerebral Vascular Accident 695

Parkinson's Disease 696

Pulmonary Disease 696

Asthma and Allergy 696

Thyroid Disease 696

Visual Problems 696

Hearing Problems 697

Alcoholism 697

Long-Term Care Issues 697

Housing Options 697

Homelessness 698

Financial Planning 698

Retirement 698

Caregiving 698

Widowhood 699

Political Issues 700

Legal Issues 700

Elder Abuse 701

Advocacy 701

Educational/Career Issues 701

Computer Training and Resources for Seniors 702

Assistive Technology 702

Administration 702

Medicare 702

Helpful Organizations 703

Research Grants 704

Database Resources 704

Helpful 'Listservs' 706.

Notes:

Rev. ed. of: Geriatric physical therapy / Carole B. Lewis, Jennifer M. Bottomley. c1994.

Includes bibliographical references and index.

Related Work:

Lewis, Carole Bernstein. Geriatric physical therapy.

ISBN:

083852284X

OCLC:

49221897