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…)

Over the past 60 years, many documents, including the 1948 Universal Declaration of Human Rights, have addressed the rights of all persons. But it was not until the Declaration on Social Progress and Development in 1969 that the human rights of the elderly were specifically mentioned in an international rights document (Office of the United Nations High Commissioner for Human Rights). The United Nations adopted the first International Plan of Action on Ageing in 1987 and the General Assembly of the United Nations adopted the Principles for Older Persons in 1991. (more…)

Weight loss improves many of the adverse health outcomes associated with obesity, including preventing or delaying the onset of diabetes, improving blood sugar control in those with diabetes, reducing low-density lipoprotein (bad cholesterol), raising high-density lipoprotein (good cholesterol), improving hypertension, improving symptoms of osteoarthritis, and providing an improved sense of well-being. (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…)

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…)

Several clinical tools are available for identification of patients at risk of cardiac arrhythmias or its consequences that may benefit from interventions to reduce morbidity and risk of sudden death. These include noninvasive tests, such as a standard (more…)

Aging is associated with progressive fibrosis of the sinoatrial node and AV conduction system, resulting in bradycardia, which may be further exacerbated by disease and medications, resulting in symptoms requiring permanent pacemaker implantation. More than 80% of pacemaker recipients in the United States are older than 65 years, and the median age is 75 years. As the population ages, it is anticipated that the number of older persons requiring permanent cardiac pacemakers, as well as the associated costs, will continue to rise. (more…)

In older patients without apparent cardiovascular disease, the number of cardiac myocytes declines, while residual myocytes enlarge. Concurrently, there is an increase in elastic and collagenous tissue in all parts of the interstitial matrix and conduction system with advancing age. (more…)

The majority associated with leading cause of deaths in America are due to medical health issues, not accidents, regardless of what your mother told you. The National Center for Health Statistics compiles the listing of killers and leading causes of death in America. A number of on the list you can not manage but others you can. There are several things that you can do to minimize getting the risk of the leading causes of death. If you eat right, exercise, don’t smoke, keep your weight under control, and manage your stress, then you are having a big change to live longer and having prolonged life than average American. (more…)