23 Challenging Rehabilitation Environment for older persons Introduction The global population aged ≥60 years has increased from 382 million in 1980 to 962 million in 2017 and is expected to increase to 2.1 billion by 2050. The population aged ≥80 years is expected to increase more than threefold, from 137 million in 2017 to 425 million in 2050.1 Currently, high-income countries have the highest prevalence of older people.2 Together with the aging of the population, there is an increase in multimorbidity and geriatric syndromes (frailty, impaired cognition, continence, gait and balance problems). This leads to a higher risk of disability with impairments in functioning in daily life.2-4 Patients with frailty or multimorbidity have a higher risk for hospitalization and adverse outcomes, such as hospitalization-associated disability and the inability to live independently.5 In older persons, common reasons for hospitalization are cardiac events, infections, fall-related injuries, stroke, cancer, or medical/surgical interventions.6 Hospitalization-associated disability occurs in at least 30% of patients aged ≥70 years. For frail older persons the rates of hospitalization-associated disabilities are as high as 40% and patients may, therefore, be unable to return home.5,6 After hospitalization on an acute geriatric ward, 11% of those aged ≥75 years are referred for rehabilitation to a rehabilitation unit.7 For individuals with disability, the aim of rehabilitation is to regain and maintain optimal functioning in interaction with the environment.2,4 Specifically, geriatric rehabilitation is defined as a multidisciplinary set of evaluative, diagnostic, and therapeutic interventions whose purpose is to restore functional ability or enhance residual functional capability in elderly people with disabling impairments.8 Rehabilitation occurs within a specific period of time and involves identification of a person’s problems and needs, which leads to the defining of rehabilitation goals with subsequent interventions offered by a multidisciplinary team. The rehabilitation team consists of therapists and rehabilitation workers, such as occupational therapists, physical therapists, psychologists, social workers, speech and language therapists, dietitians, nurses and general practitioners.4 2
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