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Pulmonary rehabilitation is a multidisciplinary education and exercise programme of care for patients with chronic respiratory disease, particularly Chronic Obstructive Pulmonary Disease (COPD). It aims to reduce symptoms, decrease disability, increase participation in physical and social activities and improve overall quality of life in patients who may still be very disabled despite optimal pharmacological treatment. Pulmonary rehabilitation first began more than 30 years ago and is now established as an important part of the management of COPD.
Nutrient inadequacies, especially in older persons, impact adversely on health, increasing the risk of acute and chronic disease and prolonging recovery from illness. Malnutrition is a condition due to an inadequate calorie and micronutrient intake that fails to meet the basic requirements for body maintenance, growth and development. Malnutrition often occurs in older people in acute hospital settings, among residents in nursing homes and in long-term care. Malnutrition in institutionalized older people is as high as 40–50%.
This review examines the relationship between unsteadiness, falling and anxiety, and their combined impact on the lives of older people. Over one in four people over 69 fall each year, and a higher proportion of those over 74. Although only one in ten incur serious injury as a direct result of the fall, fear of falling can often lead not only to psychological distress but also to restriction of activity and an unnecessary and undesirable loss of independence. Naturally, symptoms of unsteadiness constitute a key risk factor for falling. As many as one in three older people have suffered from unsteadiness and/or dizziness at some time. Like falling, dizziness and unsteadiness are also associated with distress and restriction of activity.
As the number of people living to reach old age increases, so the proportion of cancers presenting in this age group increases to an even greater degree. Although 70% of all cancers in men and women occur over the age of 65 and in the over-75s, who are perhaps more appropriately classified as ‘elderly’, the figures are still very high (46% of all cancers occur in women over 75 and 35% in men over 75). As a consequence, cancer is rapidly becoming a problem of late life, and the management of patients in old age is an important part of general oncology. The magnitude of the overlap between old age and cancer is increasing because of improved life expectancy, more sensitive methods of diagnosing cancer and the biological fact that most cancers occur more commonly with increasing age. It is interesting, however, to put these figures into a more general context by examining the different causes of death in older patients by decade.
The term person-centred care has become all-pervasive on the UK dementia care scene. It has been suggested that it has become synonymous with good quality care. It seems that any new approach in dementia care has to claim to be pc (person-centred) in order to be P.C. (politically correct). The term is used frequently in the aims and objectives for dementia care services and provision in the UK and the US, although what lies behind the rhetoric in terms of practice may be questionable.
Rehabilitation can be described either as a set of technologies, akin to drug treatment, or as a person-centered process. We will use both frames of reference in this review. Our orientation in Part 1 will be technological, with initial consideration of the pathophysiology of parkinsonian impairments, before examining the rationale for non-drug interventions in Parkinson's disease (PD). In Part 2 we describe how the process of rehabilitation can be applied in a progressive disease such as PD.
Rehabilitation is a necessary step in the process of recovery from most serious illness and from many clinical interventions. The nature of rehabilitation, and the form of any programme of rehabilitation provided to help patients with this process, depends greatly on patient, illness, treatment or intervention, co-morbidity and on the availability of appropriate services. Heart disease is the leading cause of death in most developed countries and acute myocardial infarction (MI) is a major cause of acute medical admissions to hospitals, and revascularization by coronary artery bypass graft surgery (CABG) is a leading surgical intervention. Both MI and CABG involve a day or more in intensive care followed by several days recuperation in hospital. There is a fairly obvious case for rehabilitation for patients surviving the truly life-threatening experience of MI (20% sudden deaths and a further 10% die within 24 hours of onset of pain), and for patients following the major ‘trauma’ of open heart surgery (operative mortality about 1%). The specific needs of these two groups may differ because their experiences differ; one medical the other surgical, and, possibly more significantly, one unexpected, the other planned.
A basic notion relating to development during adulthood and old age, according to a lifespan perspective, refers to the progressive increase in individual differences in psychological wellbeing. It is possible to find diverse ‘health trajectories’, shaping patterns of evolution regarding the general health of adult and elderly individuals, such as (1) permanent good health (2) good health most of the time and decline by the end of life (3) health decline and recovery (4) permanent poor health, (5) progressive decline and (6) irregular health.
The publication of the Black Report in 1980 is rightly seen as a landmark in the acknowledgement of an association between poverty and increased incidence of and premature mortality from a wide range of diseases. However, an increased incidence of disease with certain lifestyles or habits has been recognized since the time of Hippocrates, who identified ‘the mode in which inhabitants live, and what are their pursuits, whether they are fond of drinking and eating in excess’ as determinants of illness.