Rehabilitation and Group 5

variety of deficit
activities among
elderly
1. KELLY ROSALIA RICHARD (193337)
2. FARHANI BINTI MOHD FAUZI (193335)
3. MOHAMAD SHARIE BIN MOHD NOR(192947)
4. MOHAMAD HAFIZ FIRDAUS BIN ALANG (194390)
5. MUHAMMAD AIZATTULLAH BIN AHMAD SUHARI (194846)
LEARNING OUTCOME.
By the end of the presentation, you are able to :

01 Define the meaning of rehabilitation and

activity deficit
.
05 Examine how the challenges affect the
elderly in psychological and socially

02 State the principle of rehabilitative

nursing

06 Determine the roles of nurses in functional

assessment for elderly

03 Identify activity deficit and provide examples

07 Explain the nursing intervention in facilitating

and improving the function among elderly

04 Recognize the challenges of elderly living

with disabilities and their frequent problem
in rehabilitation
DEFINITION
REHABILITATION FUNCTIONAL DEFICIT

• A set of interventions designed • Limitation or impairment of

to optimize functioning and physical abilities/function
reduce disability in individuals resulting in evaluation and
with health conditions in inclusion in a treatment plan
interaction with their of care.
environment.

(World Health Organization, 2020)

(American Medical Association,
2017)
 Promote
adaptation

Disability
affects the PRINCIPLES OF Emphasize
entire REHABILITATIVE NURSING abilities
family

Treat the whole

person
 PRINCIPLES OF REHABILITATIVE NURSING
Promote adaptation
• The proses of rehabilitation helps individuals adjust or adapt to life-
altering situations without giving false hope of total recovery.
• The clients may not return the way they were before the illness or
accident but they can learn to make adjustments in their lifestyle to
cope with changes that have occurred.
• Many persons living the functional deficits do not consider
themselves disabled. There are things that they cannot do, but other
things they can do.
• Rehabilitation assists the persons in making the most of abilities and
strengths that remain and working with what they have.
• Create a sense of adaptation in the clients increase their level of self-
confidence and improve their acceptance of their self-image and
adjustment to roles following health challenges.
 PRINCIPLES OF REHABILITATIVE NURSING
(CONT.)

Emphasize abilities
• Rehabilitation emphasizes an optimistic perspective for individuals who
have undergone different health challenges based on life-altering
conditions.
• Rehabilitation focuses not on what is lost but what can be regained and
achieved through mutual goal-setting by the rehabilitation professional
and the client.
• Emphasize what the client can do.
• Avoid expressions such as, “You can’t use your right arm.” Instead, say,
“You can use your left arm.”
• Do not assume the clients cannot complete a task until they tried,
particularly the clients who are cognitively impaired.
 PRINCIPLES OF REHABILITATIVE NURSING
(CONT.)

Treat the whole person

• It has to be remembered at all times that an individual is
being treated and not the disease.
• The disability affects not only the physical, but also psychology
and social in elderly.
• Clients that require a long period of treatment will experience
multiple changes in their lives.
• The clients’ preferences, background, culture, religious beliefs,
social support, physical abilities, developmental stages,
psychology, and others must be considered as plans of care
are being developed by the rehabilitation team members.
 PRINCIPLES OF REHABILITATIVE NURSING
(CONT.)

Disability affects the entire family

• Grieving is a normal part of the rehabilitative process for those who have
suffered loss.
• Both the client and his/her family are also grieving.
• The wives of the stroke client often remain in the depression phase of
grieving longer than the client that coping with chronic health problem
requires many changes to the client’s entire support system.
• Assist the client and his/ her family to attain a quality of life that is
acceptable to them.
• Identify the appropriate resources, whether financial, emotional, or
spiritual to assist the family.
• Follow-up program can also have a positive impact on the long-term coping
skills.
 What is Activity Deficit?
Most commonly known as Functional deficit
Self reportedly having difficulty/ reduce in ability of doing one or more task within each of
four of functional Domain

Mobilty/Exercise tolerance Upper Extremity

- Walking in a one quarter mile ( 400 meter
radius)
- Walking up 10 steps without resting
- Getting in and out of bed/chairs
- Doing heavy housework
- Raising arms over head
- Using finger to grasp or handle
- Lifting or carrying 4 kg’s

Higher functioning Self Care

- Using telephone - Dressing

- Doing light housework - Bathing
- Preparing meals - Showering
- Shopping for personal items -Using Toilet
- Eating

Source: (Jerome et al., 2006)

What is Activity Deficit? (Cont. )
“ .. A new loss of physical or cognitive functions that impacts the
ability to participate in Activities of Daily Livings (ADL) or
Instrumental activities if daily living (IADL)”
(Vos et al, 2015)

“ a reduction in ability to perform self- care activities of daily living

(ADL) because if a decrement in physical or cognitive functioning”

(Madden,2016)
 Ageing and
Demograpics

.
Increase in
ageing
Population

Source: Department of Statistics Malaysia, 2014; 2015:

2020
Changes in
Functional
with ageing

Source: Centers for Disease Control and Prevention

Sharie
 Roles of nursing

Treat the whole Working multi-

person disciplinary
Rehabilitation
begins at
“day one”

Emphasize Observe
abilities holistically

Promote
adaptation, not
only recovery
ASSESSMENT TOOLS
 General
Assessment Tools
Mood
• Fulmer Cognitive
SPICE • Geriatri
• Mini- c
Mental Depressi
State on Scale
Social Examina (GDS)
tion Frailty
• deJong Falls
Gierveld
(MMSE) • Frailty
• Falls Index
Loneline Risk for
ss Scale Assessm Elders
ent Tool Caregiver
(FIFE)
Environm
Physical (FRAT)
ent • Caregive
• Grip r Strain
strength • HOME Burden
(for FAST Index
sarcope
FUNCTIONAL ASSESSMENT
 Functional Assessment

• Functional impairment – difficulty in performing or

requiring the assistance of another person to
perform one or more Activities of Daily Living (ADL).
• It is important to assess the functional status
because inability to independently perform even
one activity may indicate a need for supportive
services,
 Functional Assessment (cont.)
• Assessment of functional status involves determining an individual’s level
of independence in performing ADLs and instrumental activities of daily
living (IADL).
• For ADLs, Katz Index of Independence can be used for assessment.
• Assessment of IADL examines the skills beyond the basics that enable the
individual to function independently in the community, such as the ability
to prepare meals, shop, use a telephone, safely use medications, clean,
travel in the community, and manage finances.
• Lawton-Brody Instrumental Activities of Daily Living (IADL) Scale can be
used for assessment for IADL.
Functional Assessment (cont.)
Functional Assessment (cont.)
NURSING INTERVENTION
 Nursing intervention
• Self-care deficit
• Impaired physical mobility
• Fatigue
• Risk of fall
 Self care deficit: intervention
• Use the Foster Self-care abilities which is allow as
much time as they can be independent within safe
limits.
• Give positive reinforcement for the successful
attempt.
• Recommend assistive devices.
• Focus on their gross movement first, then their fine
motor.
• Assess sign of frustration and tolerance.
• Assist in accepting self-care dependence
Impaired physical mobility: intervention
• Assess patient muscle tone, ability to move, joint
movement and positioning.
• Position properly to prevent contractures.
• Maintain muscle strength and joint mobility by
perform active and passive ROME
• Promote independent mobility, but need to tell
patient about orthostatic hypotension when sudden
standing.
Impaired physical mobility: intervention (cont.)
• Assist patient with transfer and assess patient ability
to participate.
• Assist patient to prepare for ambulation (crutch/
walker)
 Fatigue: intervention
• Assist the client with setting priorities for preferred activities and role
responsibilities.
• Recommend client to take sufficient nutritional intake.
• Support the client in escalating levels of physical activity and exercise.
• Promote activity that suitable with client condition.
• Implement the use of assistive devices for ADLs and IADLs
• Encourage client to get enough sleep and effective rest.
 Risk of fall: intervention
• Place assistive devices and commonly use items within reach.
• Make sure the walkway is clear from obstacles and the floors are kept
dry and clean.
• Advise the client to wear shoes or slippers with non-slip soles when
walking.
• Advise client to wear appropriate walking aids.
• Orient the client to the surroundings. Avoid re-arranging the furniture in
the room.
 Risk of fall: intervention (cont.)
• Make sure there is adequate lighting for client.
• Advise client to always wear hearing and glasses aid.
 Conclusion
• Rehabilitations is a strategy for enhancing the quality of life for activity
deficit among elderly.
• It can be done by improving service, by promoting and protecting their
human rights.
References
American Medical Association. (2017). Functional Status Change for Patients with Shoulder Impairments – National Quality
Strategy Domain: Communication and Care Coordination. Retrieved from
https://www.geniusdoc.com/Pdf/2018_Measure_221_Registry.pdf

Mauk, K. L. (n.d.). Overview of rehabilitation. Retrieved from

http://samples.jbpub.com/9781449634476/80593_ch01_5806.pdf

World Health Organization (WHO). (2020). Rehabilitation. Retrieved from

https://www.who.int/news-room/fact-sheets/detail/rehabilitation

Jerome, G. J., Glass, T. A., Mielke, M., Xue, Q.-L., Andersen, R. E., & Fried, L. P.
(2006, November 1). Physical Activity Participation by Presence and Type of Functional Deficits in Older Women: The Women's Health
and Aging Studies. OUP Academic.
https://academic.oup.com/biomedgerontology/article/61/11/1171/630433
 Stay in
touch Stay informed about the Notify your work or school if
local outbreak situation. your schedule or arrangements
need to change.

If you live alone, ask family, Stay in touch with family

friends, and health care providers and friends with chronic
to check on you during the medical conditions as well.
outbreak.

Source: Centers for Disease Control and Prevention

Thank you
 Use a few minutes of your
day to do something you
enjoy.

Especially if you are working

at home, take a short break to
rest your eyes and your mind.

Source: Centers for Disease Control and Prevention

 )
“ .. A new loss of physical or cognitive functions that impacts the
ability to participate in Activities of Daily Livings (ADL) or
Instrumental activities if daily living (IADL)
(Vos et al, 2015)

Source: Centers for Disease Control and Prevention

Connect
with
others.
Talk to people you trust about your
concerns and how you're feeling.

Check on your loved ones too. It's would be

nice to know that you're not going through
a stressful time alone.

Source: Centers for Disease Control and Prevention

Aside from looking after
ourselves, it's important to
be aware of the real risks of
the virus and how we can
protect ourselves and our
loved ones.
Source: Centers for Disease Control and Prevention
Plan and
prepare.
Get the recent information about local Covid-19
activity from public officials and departments.

Create a list of important organizations and

providers your household can call in case of
emergencies.

Choose a designated room that can be used to

separate family members who are sick or under
monitoring.
Source: Centers for Disease Control and Prevention
 01 Wash your hands frequently.

Take everyday 02 Avoid touching your eyes,

nose and mouth.

preventive
action. 03
Let family members who are sick or
have underlying issues stay at
home and away from the office,
school or crowded places.

Source: Centers for Disease Control and Prevention

04
Cover your cough or
sneeze with a tissue then
throw the tissue in the
trash.

05 Clean and disinfect frequently

touched objects and
surfaces.

06
Stay indoors as much as
you can, and wear a face
mask if ever you need to go
outside.

Source: Centers for Disease Control and Prevention