Intervention begins with prevention of further injury. This means preventing the complications that can arise from bedrest following the initial problem (stroke, hip fracture, medical illness). If older people are left convalescing too long, they become at risk for infections, pressure ulcers, and muscle atrophy. Early mobilization is essential. Risk factors for future falls, fractures, or strokes are identified and addressed, if possible, to try to prevent any further impairment.
The physiotherapist (PT) can design an exercise program to increase flexibility, strength, balance, and endurance. PT’s evaluate and train the patient in getting up from sitting, walking, stepping over curbs and going up stairs, using walking aids as necessary. The occupational therapist’s (OT) emphasis is on self-care skills, including bathing, dressing, and eating. They also focus on instrumental activities of daily living, such as cooking, housekeeping, using the telephone, and money management. The OT assists with education, training, compensatory skills, and adaptive equipment. The social worker plays a crucial role in discharge planning and as the primary communicator between the rehabilitation team and the family. Rehabilitation nurses encourage independence by providing physical or verbal assistance. They monitor skin care, bowel and bladder management, and provide guidance about medications.
Discharge planning begins as soon as the patient’s condition stabilizes and the likely functional outcome becomes clear. A home visit by a PT or OT may be useful to determine accessibility of the home environment and appropriate home modifications. Important considerations are the amount of support available (which can be a problem when the spouse is also frail and elderly) and the extent of care needs. Family meetings with representatives from the rehabilitation team, as well as community care providers, are often necessary to set up needed home help prior to discharge.