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Special communication| Volume 100, ISSUE 5, P995-1000, May 2019

Geriatric Rehabilitation Should Not Be an Oxymoron: A Path Forward

  • Jonathan F. Bean
    Correspondence
    Corresponding author Jonathan F. Bean, MD, MS, MPH, New England GRECC, VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130. Tel: 857-364-2786.
    Affiliations
    New England Geriatric Research, Education and Clinical Center, Boston VA Healthcare System, Boston, Massachusetts, United States

    Department of PM&R, Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States

    Harvard Medical School, Boston, Massachusetts, United States
    Search for articles by this author
  • Ariela R. Orkaby
    Affiliations
    New England Geriatric Research, Education and Clinical Center, Boston VA Healthcare System, Boston, Massachusetts, United States

    Harvard Medical School, Boston, Massachusetts, United States

    Division of Aging, Brigham & Women’s Hospital, Boston, Massachusetts, United States
    Search for articles by this author
  • Jane A. Driver
    Affiliations
    New England Geriatric Research, Education and Clinical Center, Boston VA Healthcare System, Boston, Massachusetts, United States

    Harvard Medical School, Boston, Massachusetts, United States

    Division of Aging, Brigham & Women’s Hospital, Boston, Massachusetts, United States
    Search for articles by this author
Published:February 05, 2019DOI:https://doi.org/10.1016/j.apmr.2018.12.038

      Abstract

      Older adults are the fastest growing segment of our population and contribute greatly to the high costs of health care. The primary concern among older adults seeking health care is maintaining or improving functional independence. This concern is the focus of both rehabilitative care and geriatric medicine; however, collaboration between these fields can be hampered by a lack of mutual understanding of the fundamental principles of the other field. We describe 3 steps that can be implemented at an organizational or individual level to bridge the fields of geriatric medicine and rehabilitation, allowing them to better serve older patients. These include (1) recognizing the interwoven concepts of multimorbidity, function, and frailty; (2) communicating with a common language; and (3) synthesizing our knowledge from both fields.

      Keywords

      List of abbreviations:

      ICD (International Classification of Disease), ICF (International Classification of Functioning, Disability and Health), PM&R (physical medicine and rehabilitation)
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      References

        • World Health Organization
        Towards an age-friendly world.
        (Available at:) (Accessed October 8, 2018)
        • Fritz J.M.
        • Hunter S.J.
        • Tracy D.M.
        • Brennan G.P.
        Utilization and clinical outcomes of outpatient physical therapy for medicare beneficiaries with musculoskeletal conditions.
        Phys Ther. 2011; 91: 330-345
        • Kirkness C.S.
        • Marcus R.L.
        • Lastayo P.C.
        • Asche C.V.
        • Fritz J.M.
        Diabetes and associated risk factors in patients referred for physical therapy in a national primary care electronic medical record database.
        Phys Ther. 2008; 88: 1408-1416
      1. A Profile of Older Americans: 2017. Administration on Aging Administration for Community Living.
        U.S. Department of Health and Human Services. 2017;
        • Boyd C.M.
        • McNabney M.K.
        • Brandt N.
        • et al.
        Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity.
        J Am Geriatr Soc. 2012; 60: E1-E25
        • Makary M.A.
        • Segev D.L.
        • Pronovost P.J.
        • et al.
        Frailty as a predictor of surgical outcomes in older patients.
        J Am Coll Surg. 2010; 210: 901-908
        • Molina-Garrido M.J.
        • Guillen-Ponce C.
        Where are we headed with research in frail elderly patients with cancer?.
        J Clin Oncol. 2016; 34: 4049-4050
        • American Board of Internal Medicine Foundation
        Choosing Wisely: an initiative of the ABIM Foundation.
        (Available at:) (Accessed October 8, 2018)
        • Porter M.E.
        • Lee T.H.
        The strategy that will fix healthcare.
        Harvard Business Review. 2013; 10: 50-70
        • Fried T.R.
        • Tinetti M.E.
        • Iannone L.
        • O'Leary J.R.
        • Towle V.
        • Van Ness P.H.
        Health outcome prioritization as a tool for decision making among older persons with mutliple chronic conditions.
        Arch Intern Med. 2011; 171: 1854-1856
        • Boyd C.M.
        • Leff B.
        • Wolff J.L.
        • et al.
        Informing clinical practice guideline development and implementation: prevalence of coexisting conditions among adults with coronary heart disease.
        J Am Geriatr Soc. 2011; 59: 797-805
        • Boyd C.M.
        • Vollenweider D.
        • Puhan M.A.
        Informing evidence-based decision-making for patients with comorbidity: availability of necessary information in clinical trials for chronic diseases.
        PLoS One. 2012; 7e41601
        • Guralnik J.M.
        • Ferrucci L.
        • Pieper C.F.
        • et al.
        Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M221-M231
        • Guralnik J.M.
        • Simonsick E.M.
        • Ferrucci L.
        • et al.
        A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
        J Gerontol. 1994; 49: M85-M94
        • Studenski S.
        • Perera S.
        • Patel Kea
        Gait speed and survival in older adults.
        JAMA. 2011; 305: 50-58
        • Studenski S.
        • Perera S.
        • Wallace D.
        • et al.
        Physical performance measures in the clinical setting.
        J Am Geriatr Soc. 2003; 51: 314-322
        • Cummings S.R.
        • Studenski S.
        • Ferrucci L.
        A diagnosis of dismobility-giving mobility clinical visibility: a mobility working group recommendation.
        JAMA. 2014; 311: 2061-2062
        • Eggermont L.H.
        • Leveille S.G.
        • Shi L.
        • et al.
        Pain characteristics associated with the onset of disability in older adults: the maintenance of balance, independent living, intellect, and zest in the Elderly Boston Study.
        J Am Geriatr Soc. 2014; 62: 1007-1016
        • Afilalo J.
        • Alexander K.P.
        • Mack M.J.
        • et al.
        Frailty assessment in the cardiovascular care of older adults.
        J Am Coll Cardiol. 2014; 63: 747-762
        • Ethun C.G.
        • Bilen M.A.
        • Jani A.B.
        • Maithel S.K.
        • Ogan K.
        • Master V.A.
        Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology.
        CA Cancer J Clin. 2017; 67: 362-377
        • Clegg A.
        • Young J.
        • Iliffe S.
        • Rikkert M.O.
        • Rockwood K.
        Frailty in elderly people.
        Lancet. 2013; 381: 752-762
        • Fried L.P.
        • Ferrucci L.
        • Darer J.
        • Williamson J.D.
        • Anderson G.
        Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care.
        J Gerontol A Biol Sci Med Sci. 2004; 59: 255-263
        • Hoover M.
        • Rotermann M.
        • Sanmartin C.
        • Bernier J.
        Validation of an index to estimate the prevalence of frailty among community-dwelling seniors.
        Health Rep. 2013; 24: 10-17
        • Orkaby A.R.
        • Hshieh T.T.
        • Gaziano J.M.
        • Djousse L.
        • Driver J.A.
        Comparison of two frailty indices in the physicians’ health study.
        Arch Gerontol Geriatr. 2017; 71: 21-27
        • Pajewski N.M.
        • Williamson J.D.
        • Applegate W.B.
        • et al.
        Characterizing frailty status in the systolic blood pressure intervention trial.
        J Gerontol A Biol Sci Med Sci. 2016; 71: 649-655
        • Rockwood K.
        • Song X.
        • Mitnitski A.
        Changes in relative fitness and frailty across the adult lifespan: evidence from the Canadian National Population Health Survey.
        CMAJ. 2011; 183: E487-E494
        • Segal J.B.
        • Varadhan R.
        • Carlson M.C.
        • Walston J.D.
        Claims-based frailty index options.
        J Gerontol Med Sci. 2018; 73: 988
        • Wells J.L.
        • Seabrook J.A.
        • Stolee P.
        • Borrie M.J.
        • Knoefel F.
        State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment.
        Arch Phys Med Rehabil. 2003; 84: 890-897
        • Varadhan R.
        • Walston J.D.
        • Bandeen-Roche K.
        Can a link be found between physical resilience and frailty in older adults by studying dynamical systems?.
        J Am Geriatr Soc. 2018; 66: 1455-1458
        • Trombetti A.
        • Hars M.
        • Hsu F.C.
        • et al.
        Effect of physical activity on frailty: secondary analysis of a randomized controlled trial.
        Ann Intern Med. 2018; 168: 309-316
        • World Health Organization
        International classification of functioning, disability and health.
        World Health Organization, Geneva2001
        • Bean J.F.
        • Latham N.K.
        • Holt N.
        • et al.
        Which neuromuscular attributes are most associated with mobility among older primary care patients?.
        Arch Phys Med Rehabil. 2013; 94: 2381-2388
        • Ward R.E.
        • Beauchamp M.K.
        • Latham N.K.
        • et al.
        Neuromuscular impairments contributing to persistently poor and declining lower-extremity mobility among older adults: new findings informing geriatric rehabilitation.
        Arch Phys Med Rehabil. 2016; 97: 1316-1322
        • Beauchamp M.K.
        • Bean J.F.
        • Ward R.E.
        • Kurlinski L.A.
        • Latham N.K.
        • Jette A.M.
        How should disability be measured in older adults? An analysis from the Boston Rehabilitative Impairment Study of the Elderly.
        J Am Geriatr Soc. 2015; 63: 1187-1191
        • Beauchamp M.K.
        • Jette A.M.
        • Ni P.
        • et al.
        Leg and trunk impairments predict participation in life roles in older adults: results from Boston RISE.
        J Gerontol A Biol Sci Med Sci. 2015; 71: 663-669
        • Beauchamp M.K.
        • Leveille S.G.
        • Patel K.V.
        • et al.
        What physical attributes underlie self-reported vs. observed ability to walk 400 m in later life? An analysis from the InCHIANTI Study.
        Am J Phys Med Rehabil. 2014; 93: 396-404
        • Keysor J.J.
        • Jette A.M.
        Have we oversold the benefit of late-life exercise?.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M412-M423
        • Whyte J.
        • Barrett A.M.
        Advancing the evidence base of rehabilitation treatments: a developmental approach.
        Arch Phys Med Rehabil. 2012; 93: S101-S110
        • DeLisa J.
        • Melvin J.
        What the U.S. physiatrist should know about the ICF.
        Physiatry Forward. 2018;Summer; : 1-2
        • Jette A.M.
        Toward a common language for function, disability, and health.
        Phys Ther. 2006; 86: 726-734
        • Freedman V.A.
        Adopting the ICF language for studying late-life disability: a field of dreams?.
        J Gerontol A Biol Sci Med Sci. 2009; 64 ([discussion: 1175-6]): 1172-1174
        • Tinetti M.
        • Huang A.
        • Molnar F.
        The geriatrics 5M's: a new way of communicating what we do.
        J Am Geriatr Soc. 2017; 65: 2115
        • American Geriatrics Society 2015 Beers Criteria Update Expert Panel
        American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults.
        J Am Geriatr Soc. 2015; 63: 2227-2246
        • Reuben D.B.
        • Herr K.A.
        • Pacula J.T.
        • Pollock B.G.
        • Potter J.F.
        • Semla T.P.
        Geriatrics at your finger tips: 2018.
        20th ed. American Geriatrics Society, New York2018
        • Chang F.H.
        • Latham N.K.
        • Ni P.
        • Jette A.M.
        Does self-efficacy mediate functional change in older adults participating in an exercise program after hip fracture? A randomized controlled trial.
        Arch Phys Med Rehabil. 2015; 96: 1014-1020
        • McAuley E.
        • Jerome G.J.
        • Elavsky S.
        • Marquez D.X.
        • Ramsey S.N.
        Predicting long-term maintenance of physical activity in older adults.
        Prev Med. 2003; 37: 110-118
        • Rejeski W.J.
        • Ettinger Jr., W.H.
        • Martin K.
        • Morgan T.
        Treating disability in knee osteoarthritis with exercise therapy: a central role for self-efficacy and pain.
        Arthritis Care Res. 1998; 11: 94-101