Questions and Answers
What percentage of the total global burden of disease is attributable to disorders in people aged 60 years and older?
What is the term used to represent the loss of one year of full health?
What is the primary goal of rehabilitation strategies developed by an MDT?
What is a key aspect of rehabilitation and community-based care that can be evaluated?
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What is a common presentation to the older person multidisciplinary team (MDT)?
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What is a challenge in goal setting within the sphere of rehabilitation services?
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What is the purpose of evaluating a rehabilitation service's key performance indicators (KPIs)?
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What is an important consideration in understanding the global burden of disease?
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What percentage of the total global burden of disease is attributable to disorders in people aged 60 years and older?
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What is a DALY used to measure?
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Which of the following morbidities is a physical morbidity?
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What is the estimated percentage of older patients who have no medical reason for being on bed rest?
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What is the name of the campaign promoted by healthcare organizations in the UK and Ireland to prevent deconditioning and promote independence?
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What is the equivalent loss in muscle aging that 10 days of bed rest can result in for an 80-year-old person?
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What is deconditioning defined as?
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What is the estimated percentage of hospitalized older adults who experience a decline in ambulatory function?
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What is the result of inactivity in hospital for older adults?
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Which of the following is NOT one of the top 10 global causes of DALYs?
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What is the primary focus of rehabilitative care, according to the philosophies of rehabilitation?
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What is the primary element for consideration within the context of an 85-year-old in-patient's case, who is depressed and unwilling to engage in physical activity?
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What is the name of the commonly used ordinal scale that measures and scores activities of daily living (ADLs) and mobility?
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What is the primary goal of rehabilitation, as outlined in Article 26 of the United Nations Convention on the Rights of Persons with Disabilities?
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What is a common psychosocial factor that patients undergoing rehabilitative care may experience?
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What is a potential physiological consequence of prolonged bed rest in older adults?
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What is the term for the loss of muscle mass and strength associated with aging?
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What is the focus of the 5Ms in rehabilitative care?
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What is the aim of rehabilitative care clinicians in terms of family support?
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What is the underlying philosophy of rehabilitative care, according to Cork University Hospital?
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What is a critical period for frail older patients in terms of early intervention?
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What is a potential consequence of inactivity in older patients?
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What is the primary purpose of the Barthel Index?
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What is a key element of the assessment process in rehabilitation?
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What is the purpose of the 5Ms framework?
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What is a characteristic of SMART goals in rehabilitation?
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Who should be involved in setting rehabilitation goals?
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What is the term used to describe the holistic process of assessment, formulation of a care plan, coordinated delivery of services, and monitoring?
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What is a potential benefit of rehabilitation strategies developed by a multidisciplinary team (MDT)?
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What is a key consideration in developing rehabilitation strategies for older patients?
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What is the main purpose of the SMART framework in goal-setting?
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What does the 'capacity' construct refer to in the ICF?
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What is the primary purpose of the FIM+FAM measurement tool?
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What is the definition of 'performance' in the ICF?
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What does the RCS-E instrument evaluate?
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What is the primary difference between 'capacity' and 'performance' in the ICF?
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What was Labibah's main concern?
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What is the purpose of the FIM measurement tool?
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What was the reason for Labibah's admission to the hospital?
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What is the level of assistance required for a patient rated as 'modified independence' on the FIM?
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What was Labibah's diagnosis?
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What is the purpose of measuring support needs in rehabilitation services?
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What was the primary goal of Labibah's rehabilitation plan?
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What was the result of the multidisciplinary team's (MDT) assessment?
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What is the benefit of using the SMART framework in goal-setting?
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What is the level of assistance required for a patient rated as 'minimal assistance' on the FIM?
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What was the reason for Labibah's delirium?
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What was the goal of the speech and language therapy review?
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What was the outcome of the occupational therapy (OT) assessment?
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What was the priority for Labibah's pubic ramus fracture?
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What is the primary concern for Labibah's rehabilitation?
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What is the purpose of the 4AT test in Labibah's case?
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Which medication was targeted for deprescribing in Labibah's medication review?
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What is the impact of bed rest on older adults like Labibah?
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What is the significance of Labibah's clinical frailty score of 4?
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What is the likely reason for Labibah's nocturnal restlessness?
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What is the goal of Labibah's rehabilitation plan?
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What is the significance of Labibah's 4AT score of 2?
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Study Notes
Rehabilitation Strategies
- Developed by a multidisciplinary team (MDT) to improve patient outcomes, reduce hospital readmission rates, and minimize the use of primary care resources
- Help patients return to activities sooner and reduce the length of stay in critical care
- Key elements of rehabilitation strategies include:
- Evaluation of physical, psychological, social, and environmental aspects of rehabilitation and community-based care
- Identification of realistic goals and common conflicts in goal setting
- Use of systems of classification, frameworks, tools, and other resources for measuring disease severity, independence, performance, capacity, and functionality
- Setting rehabilitation goals that center on "what matters most" to the patient
Global Burden of Disease
- Close to a quarter of the total global burden of disease is attributable to disorders in people aged 60 years and older
- Global burden of disease is calculated using the disability-adjusted life year (DALY)
- DALY represents the loss of the equivalent of one year of full health
- Top 10 causes of DALYs include:
- Neonatal conditions
- Ischemic heart disease
- Stroke
- Lower respiratory infections
- Diarrheal diseases
- Road injury
- Chronic obstructive pulmonary disease
- Diabetes mellitus
- Tuberculosis
- Congenital anomalies
Morbidities Requiring Rehabilitation Strategies
- Morbidities can be physical (e.g., weakness, pain, incontinence) or non-physical (e.g., anxiety, depression, hallucinations)
- Morbidities can be caused by events such as stroke, falls, dementia, and trauma
- Rehabilitation strategies must take into account the individual's physical and non-physical morbidities
Preventing Deconditioning
- Deconditioning is a complex process of physiological change following a period of inactivity, bed rest, or sedentary lifestyle
- Deconditioning can result in functional losses in areas such as mental status, continence, and ability to accomplish activities of daily living
- Strategies to prevent deconditioning include:
- Early mobilization and ambulation
- Promotion of independence and autonomy
- Minimization of bed rest and sedentary behavior
- Encouragement of physical activity and exercise
5Ms Framework
- The 5Ms framework includes:
- Mind: mentation, dementia, delirium, depression
- Mobility: impaired gait and balance, fall injury rehabilitation, physical activity, resistance exercises
- Medications: polypharmacy, deprescribing, adverse medication effects, medication burden
- Multi-complexity: multi-morbidity, complex bio-psychosocial situations
- Matters most: each patient having meaningful rehabilitative outcome goals and care preferences
Rehabilitation Potential
- Rehabilitation potential is a complex determination based on factors such as:
- The experience of the clinician
- Knowledge of the patient's medical conditions
- The patient's ability to progress with a period of rehabilitation
- Initiative and motivation on the part of the patient
- All patients should be offered rehabilitative care, regardless of their rehabilitation potential
Assessments and Measurements
- The Comprehensive Geriatric Assessment (CGA) is an organized approach to assessment that includes:
- Holistic process of assessment
- Formulation of a care plan
- Coordinated delivery of services according to the plan
- Monitoring
- The 5Ms framework can be used to adapt the CGA to individual settings
- The Barthel Index measures and scores the individual's ability to perform activities of daily living
- The Functional Independence Measure (FIM) carries an 18-item global measure of disability
- The Functional Assessment Measure (FAM) adds 12 items to FIM, addressing cognitive and psychosocial function among individuals with brain injuries### Rehabilitation and Care Model
- Labibah's rehabilitation goals include progressing to independence with a walking stick and transitioning to a normal diet.
- The physiotherapist aims to improve Labibah's mobility and independence, despite her unsteady gait and pain on mobilization.
- Bladder retraining is necessary to address Labibah's urinary incontinence.
Medication Management
- Labibah is on multiple medications, including ramipril, gabapentin, zopiclone, bumetanide, atorvastatin, l-thyroxine, escitalopram, and esomeprazole.
- The 7 Steps medication review method is used to wean Labibah off gabapentin, SSRI, and zopiclone.
- Polypharmacy is a concern, and the goal is to complete weaning of these medications as tolerated.
Health Status
- Labibah has a pubic ramus fracture, pneumonia, and chronic hyponatremia.
- She has a clinical frailty score of 4 and a 4AT of 2, indicating mild frailty and cognitive impairment.
- Labibah developed a delirium during her hospital stay, triggered by the hospital environment, which resulted in deconditioning.
Mobility and Function
- Labibah's mobility is impaired, and she requires assistance with a rollator Zimmer frame.
- Her Barthel Index score decreased from 16 to 10 on day 7 of her admission, indicating a decline in her level of function.
Social History and Priorities
- Labibah is recently widowed and active in her community, with a strong support system from her extended family.
- What matters most to Labibah is being able to get around her house independently using a stick, and preventing deconditioning is a priority.
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Description
Learn about rehabilitation strategies developed by multidisciplinary teams to improve patient outcomes, reduce hospital readmission rates, and promote community-based care. Evaluate the physical, psychological, social, and environmental aspects of rehabilitation.