Beneficiaries of the Medicare program have three rehabilitation-related benefits established by federal statute: physical therapy rehabilitation, occupational therapy, and speech-language therapy (speech-language pathology). All therapists, who must be graduates of accredited programs, must pass a national examination and be licensed, certified, or registered in their respective professions within the state in which the services are furnished. Medicare covers services that are necessary and likely to result in improvement in a reasonable period of time. Medicare does not currently regard prevention services provided by therapists as falling under therapy benefits and will not cover services intended to maintain a current level of function. (more…)

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The proportion of elderly at any age without any chronic conditions is small, and disease can trigger a cascade of events resulting in functional deficits and disability. An increase in the number of activities with which an elder has difficulty increases linearly with comorbidity, that is, coexistent medical conditions that further complicate not only the genesis of a functional deficit but also its treatment. For example, rehabilitation for a stroke for an individual who also has painful, degenerative changes in the foot and a low tolerance for stressful activity secondary to angina with exertion would present a particular rehabilitation challenge. Yet, this example encapsulates geriatric rehabilitation specialist’s emphasis on care and function, not cure and disease. (more…)

Aging begins before we are born, is a lifelong process and continues throughout life. Throughout the life course, differing life experiences influence our capabilities and well-being in our later years. The functional capacity of our biological systems increases during the first years of life, reaches its peak in early adult-hood and naturally declines thereafter. Throughout most countries (but not all), persons experience a long childhood and a long old age. These two lengthy developmental spans have provided great utility. Throughout history, it has enabled older persons to educate the younger and pass on values to them. (more…)

Compulsive hoarding disorder consists of three components: acquiring a large number of possessions, storing of items and not discarding unused objects, and keeping or storing them in such a way that it interferes with daily living, with possible severe neglect of living space. This behavior was first described in 1975 in a sample of 30 individuals, all of whom were elderly and demonstrated extreme neglect of their home, appearance, and health, and was termed Diogenes syndrome. (more…)

Because there are no placebo-controlled treatment studies of Obsessive Compulsive Disorders in elderly, Obsessive Compulsive Disorders treatment guidelines are generally extrapolated from studies of younger populations and case reports of treated elderly. Selective serotonin reuptake inhibitors (SSRIs) are the drugs of first choice for OCD. (more…)

Obsessive-compulsive disorder (OCD) is a common neuropsychiatric condition that is frequently unrecognized and untreated, resulting in significant personal suffering and functional impairment. This article reviews the current state of knowledge of OCD epidemiology, clinical features and natural history, differential Obsessive-compulsive disorder diagnosis, and Obsessive Compulsive Disorders treatment options, focusing on how Obsessive Compulsive affects elderly. (more…)

Not all body fat is equally bad for your health. It is widely known that body fat distribution is extremely important. There is increasing evidence for the deleterious effects of Visceral Fat on aging. Waist-to-hip ratio (WHR) is an epidemiological tool that demonstrates a correlation between Visceral Fat and development of diabetes mellitus, stroke, coronary artery disease, and mortality. This ratio is easily determined by dividing the measurement of waist circumference by hip circumference. (more…)

Cardiac Resynchronization Therapy improves functional capacity and quality of life in patients with persistent class III and IV heart failure despite optimal medical therapy, and there is also evidence that Cardiac Resynchronization Therapy may reverse structural remodeling in selected patients. Although individual trials of Cardiac Resynchronization Therapy were underpowered to assess survival, a meta-analysis of outcomes from four randomized trials involving more than 800 patients found that Cardiac Resynchronization Therapy reduces mortality from heart failure. (more…)

Neurocardiogenic Vasovagal syncope is more common in younger patients but also should be considered in elderly patients with unexplained syncope. Although the triggering mechanisms are complex and may differ among young and elderly patients, the efferent responses generally can be categorized as cardioinhibitory (pauses of = 3 seconds or heart rate <40 beats per minute for more than 10 seconds), vasodepressor (systolic blood pressure falls by 50 mm Hg or more without symptoms or 30 to 50 mm Hg with symptoms of syncope or presyncope, and the heart rate does not decrease by more than 10%), (more…)

Pacemaker therapy is indicated in patients with symptomatic bradycardia (syncope, presyncope, dyspnea, and exercise intolerance) correlated to sinus node dysfunction (pauses, persistent bradycardia, or chronotropic incompetence). In elderly patients, sinus node dysfunction is often associated with atrial tachyarrhythmias, including AF. Because of the frequent association of sinus node dysfunction with AF, VVI and VVIR pacing were once considered the preferred pacing modes. Recent studies suggest that atrial-based pacing in patients with sinus node dysfunction is beneficial for preventing progression of AF. (more…)