Rehabilitation Concerns in the Geriatric Critically Ill and Injured - Part 1

Natural, physiologic changes occur with aging that make rehabilitation and return to baseline functional status more challenging and potentially prolonged in the setting of critical illness. These physiologic changes occur in multiple organ systems: nervous system, skin, musculoskeletal, cardiovascular, pulmonary, and immune system. Frailty culminates in decline across several systems causing risk for adverse outcomes including increased falls, emergency department visits, and hospitalizations. Delirium is a geriatric emergency and is widely underdiagnosed. Most of the mechanically ventilated ICU patients experience delirium. Dementia is characterized by progressive cognitive and behavioral deficits. The prevalence of pain is increased in critical illness and at the end of life. Constipation occurs in most of the critical care patients. These symptoms and syndromes have negative impacts on morbidity and mortality. Prognostication is challenging with most critically ill elderly patients. Multiple options exist for physical rehabilitation based on the patient's clinical recovery, including long-term acute care, acute rehabilitation, subacute rehabilitation, and home therapy.