Romke van Balen is an Elderly Care Physician in Rotterdam and Senior Researcher in Leiden. His main field of interest is geriatric rehabilitation. He will be speaking at the upcoming BGS Autumn Meeting in London.
Although geriatric rehabilitation in most countries is considered to belong to the core tasks of geriatricians, there is no consensus about definition and target groups of patients.
Decades ago, the Boston Working Group defined geriatric rehabilitation as a multidisciplinary set of evaluative, diagnostic and therapeutic interventions whose purpose it is to restore functional ability or enhance residual functional capacity in elderly people with disabling impairments. When looking at this definition, one wonders if it separates geriatric rehabilitation from the general aim of geriatric medicine. Only palliative care clearly has another aim.
The Dutch Society of Elderly Care Physicians (Verenso) uses a somewhat different definition: integrated multidisciplinary care aimed at restoration of function and participation in frail older patients after an acute medical event, or decline in function. It differs from the above definition in the key words “acute decline in function”. This allows obvious target groups for rehabilitation to be delineated, such as stroke and trauma-hip fracture. It is no surprise that scientific research and developments in the organisation of care (stroke units, orthogeriatric units) are mostly restricted to these diagnosis groups.
However, frail older hospitalized patients with other primary diagnoses, for example COPD, heart failure and cancer, could also potentially benefit from geriatric rehabilitation. An acute decline in function could also be a consequence of an interaction between several diagnoses and underlying physical and cognitive frailty, as often is the case in patients seen by geriatrician. There is a further group of patients, where gradual or acute functional decline in the community may not mandate hospitalisation but may indicate scope for multidisciplinary rehabilitation.
Does geriatric rehabilitation belong to the field of rehabilitation or geriatrics? Which skills and competences are required of professionals? Should it be concentrated in special facilities?
Should it be confined to patients with an acute decline of function and good functional prognosis or could all older patients with gradual functional decline benefit? And does exercise intervention to maintain mobility and independence (“preventative rehabilitation”) have a role?
There is no consensus about these issues within geriatric rehabilitation. There is no international platform or journal specifically dedicated to this field. This is different from other geriatric medicine specialties, such as orthogeriatrics, where consensus within and between regions is more evident. There is the possibilty that the failure to achieve consenses and a core agenda has hampered the development of evidence-based interventions and best practice.
Nonetheless, we expect that in most curricula for postgraduate geriatric medicine education in Europe, rehabilitation is mentioned and required competencies are described. By mapping these descriptions we should be able to make a start with obtaining consensus about definition and range of geriatric rehabilitation in Europe.
At the BGS Autumn Meeting in London, 24th of November, we will discuss the results of this search. Hopefully, it will lead to international consensus and give a boost to set up an international platform.