Overview of geriatric rehabilitation: Patient

assessment and common indications for

rehabilitation
Authors:
Helen Hoenig, MD, MPH
Cathleen Colon-Emeric, MD
Section Editor:
Kenneth E Schmader, MD
Deputy Editor:
Jane Givens, MD
Contributor Disclosures
All topics are updated as new evidence becomes available and our peer review process is
complete.
Literature review current through: Jan 2019. | This topic last updated: Apr 18, 2018.

INTRODUCTION Disability, or limitation in the ability to carry out basic

functional activities, becomes increasingly common with advancing age; nearly one
in four United States Medicare beneficiaries report at least one health-related
disability [1]. Crude rates of disability are rising around the globe, with over 700
million years lived with disability (YLDs) in 2010 compared with 583 million in 1990;
however, after adjusting for population growth rates of YLDs per 100,000, rates
have remained largely constant over time but rise steadily with age [2]. While there
is considerable heterogeneity across countries in the dominant causes of disability,
in general, the global disease burden has shifted from communicable to
noncommunicable diseases, with many countries experiencing increases in age-
related conditions and YLDs [3]. The most common contributors to YLDs in 2010
included low back pain, major depressive disorder, iron deficiency anemia, neck
pain, chronic obstructive pulmonary disease (COPD), anxiety disorders, migraine,
diabetes, and falls [2].

The primary purpose of rehabilitation is to enable people to function at the highest

possible level despite physical impairment. While rehabilitation may be provided to
all age groups, the fastest growing population of persons requiring rehabilitation
services is adults over 65 years of age.

This topic will discuss assessing patients for rehabilitation services and indications
for rehabilitation. Issues regarding comprehensive geriatric assessment, disability
assessment, and components and settings for rehabilitation are discussed
separately. (See "Comprehensive geriatric assessment" and "Disability
assessment and determination in the United States" and "Overview of geriatric
rehabilitation: Program components and settings for rehabilitation".)
 EPIDEMIOLOGY OF DISABILITY Functional disabilities are

commonly categorized as activities of daily living (ADLs) (table 1) or instrumental

activities of daily living (IADLs) (table 2). ADLs include bathing, dressing, toileting,
transferring, eating, and continence. IADLs include cooking, cleaning, shopping,
transportation, finances, and medication management.

Disability has a tremendous impact on the quality of life of individuals and their
caregivers [4]. Disability also impacts health care utilization; increasing the number
of ADL disabilities from zero to six results in a sevenfold increase in health care
costs [1]. Multiple chronic conditions are associated with increasing levels of
disability, and the proportion of older adults in the United States reporting multiple
chronic conditions is increasing over time, with 17.4 percent reporting four or more
chronic conditions in 2008 compared with 11.7 percent in 1998, although the
proportion reporting an ADL or IADL disability has remained stable at
approximately 25 percent over this period [5].

In younger populations, disability frequently arises suddenly from a catastrophic

illness or accident. In older persons with limited functional reserve, lesser stressors
such as a fall, infection, or hospitalization may precipitate disability. In a
prospective cohort study of previously nondisabled community-dwelling adults
newly admitted to a nursing facility after a hospitalization, only one-third were able
to return home at or above their previous level of function, while 46 percent
returned home with new disability and 27 percent remained in the nursing home
with disability [6].

Older adults also frequently present with subacute onset of disability and no clear
precipitating event [7]. Disability resulting from multiple chronic conditions is
dynamic, with patients' abilities and needs changing over time [7-9]. Observational
studies suggest that while many disability episodes are brief, lasting one to two
months, these events identify individuals who are at risk for recurrent or
progressive decline in function and require evaluation and intervention to prevent
disability. (See "Disability assessment and determination in the United States".)

The World Health Organization's International Classification of Function, Disability,

and Health (ICF) model describes disability as arising from the interaction between
physical impairments resulting from health conditions and contextual factors that
impact the person's ability to adapt to those impairments, such as social support
and environment [10]. Models for the development of disability are discussed
separately. (See "Overview of geriatric rehabilitation: Program components and
settings for rehabilitation", section on 'Conceptual models for disability'.)
 APPROACH TO ASSESSING LATE-LIFE

DISABILITY Because of the complex interactions between multiple health

conditions, impairments resulting from the health conditions, and contextual

factors, a systematic approach is useful for the assessment of new onset or
progressive disability in an older adult (table 3). In patients with multiple health
conditions, it is frequently impossible (and unnecessary) to identify a primary cause
or trigger for the disability. Rather, identifying all contributing conditions,
impairments, and contextual factors and addressing these factors with appropriate
interventions is the most effective means of reducing functional dependence.

Characterize the disability — The first step is to clearly describe the disability,
including its onset, time course, and impact on patient and caregivers. In addition,
attention should be paid to soliciting the following information:
●Associated symptoms to help identify the affected organ systems or
musculoskeletal components and potential underlying conditions, eg:
•Sudden loss of function with an acute hip fracture versus insidious
loss of function with osteoarthritis of the hip
●Compensatory strategies in use by the patient and caregiver to help
guide choices in treatment interventions, eg:
•Physical (eg, use of assistive device),
•Environmental (eg, moving bedroom downstairs)
•Social (eg, Meals on Wheels, family support)
Identify impairments — The initial history and physical should focus on identifying
the organ systems involved in causing the functional decline or disability (eg,
musculoskeletal, cardiopulmonary). This can be achieved through use of screening
questions and examination maneuvers to identify contributory sensory impairment,
cognitive impairment, and/or impaired nutritional status (table 4).

Example assessments might include:

●A brief screening test for cognitive impairment in a patient with new or

progressive disability, even if the patient does not endorse memory
problems
•The Clock Draw Test [11] or Time and Change Test [12] –
Validated cognitive screens requiring less than three minutes
(see "Mild cognitive impairment: Epidemiology, pathology, and
clinical assessment", section on 'Office evaluation')
●Assessment of gait or mobility
•The “Get Up and Go” or timed "Up & Go” test (table 5) [13]
 ●Assessment of executive function, joint range of motion, and fine motor
skills [14]
•Watch the patient perform a simple functional task – Putting on a
sock, taking off a jacket, or picking a small item off the floor

Identify health conditions — When the relevant organ systems are identified,
standard differential diagnostic methods are used to identify the specific health
conditions underlying or contributing to the patient's disability. In older adults, these
are most commonly:
●Musculoskeletal conditions (arthritis, sarcopenia)
●Cardiopulmonary disease (heart failure, chronic lung disease)
●Affective disorders (depression, anxiety)
●Neurologic conditions (dementia, stroke, Parkinsonism)

Laboratory or other testing should be guided by findings from the history and
physical. Screening for anemia or common endocrinologic conditions, such as
hypothyroidism, may be indicated if supporting symptoms are present.

Identify contextual factors — Understanding the patient's physical environment,

social support, and financial resources is important in developing a feasible
management plan. The perspectives of both the patient and caregiver are
important to consider. When feasible, a home visit is the best way to understand
how the patient functions within his or her environmental and social context;
physical or occupational therapy (OT) home health assessments or other
community programs may help to accomplish this.

APPROACH TO THE MANAGEMENT OF LATE-LIFE

DISABILITY Once the underlying health conditions, impairments, and

contextual factors are understood, a practical management plan can be developed

with the patient and family. These plans generally include strategies to enhance
functional abilities (ie, improve capacity), decrease functional demands (ie, reduce
demand), or both (table 6).

Strategies to improve capacity — For each health condition and impairment

identified, the clinician should identify ways to improve the patient's capacity to
cope with physical and environmental challenges. These generally fall into several
broad categories.
●Medications, eg:
•Oxygen or cardiac medications to improve hemodynamics in
patients with heart failure
•Antidepressants for patients with depression
•Analgesics for chronic pain
 •Discontinuing unnecessary medications that may have adverse side
effects (eg, chronic use of proton pump inhibitors [PPIs] that may
have effects on cognition and bone health)
●Surgery, eg:
•Cataract excision to improve visual capacity
•Joint replacement in disabling arthritis
●Nutritional intervention, eg:
•Weight loss for obesity
•Nutritional supplements when nutrition is impaired
●Exercise [15,16], eg:
•General physical activity to improve aerobic capacity [17]
•Targeted exercises to address a specific impairment (eg, knee
range of motion and strengthening)
●Prosthetics and assistive devices, eg:
•Hearing aids
•Artificial limbs
•Ankle orthoses
Strategies to reduce demand — If the patient's capacity for physical function
cannot be sufficiently improved by treating the underlying health
conditions and/or use of interventions such as exercise alone, then strategies to
reduce the task demands should be considered. Four general categories may be
employed to reduce task demands:
●Environmental modifications [18], eg:
•Adding railings
•High-contrast/low-glare lighting
●Assistive devices [19] and adaptive equipment, eg:
•Walkers
•Reaching aids
•Tub/shower chair
•Raised toilet seat
●Increasing human help, eg, referrals for:
•Home health aide
•Assisted living environment
•Driving service
•Meals on Wheels
●Adaptive training to help patients learn strategies to reduce demand
[20], eg:
•Low vision rehabilitation
•Energy conservation techniques
Role of the interprofessional team — Implementing a plan to reduce late-life
disability requires coordination among multiple professionals, the patient, and
caregivers. The role of physical and occupational therapists is discussed in detail
elsewhere. (See "Overview of geriatric rehabilitation: Program components and
settings for rehabilitation".)
Social work and nursing frequently are helpful for addressing contextual issues and
providing patient self-management training or caregiver support. Nutrition and
pharmacy professionals are critical when relevant impairments are identified. When
available, geriatric evaluation and management clinics can provide such
interdisciplinary care for older adults with disability. (See "Comprehensive geriatric
assessment".)

REHABILITATION FOR SPECIFIC CONDITIONS Types of

rehabilitation for several conditions that commonly causing late-life disability are
shown in the table (table 7), which includes the frequency, care duration, and
settings in which that care is provided.

Rehabilitation in the older population is made more challenging by the common

need to provide rehabilitation care across multiple settings. As an example, for
patients with hip fractures or strokes, rehabilitation may start while the patient is in
the acute hospital and then transition to intensive inpatient rehabilitation, skilled
nursing facility, home health, and outpatient care over the course of the patient's
recovery. Transitions across multiple locations increase the risk of multiple
problems, including errors in medication orders, discontinuity in rehabilitation
interventions, patient confusion, and depression [21].

Neurologic

Stroke — A stroke can affect functionality across diverse organ systems (eg,
speech, vision, strength, coordination, balance), and multidisciplinary rehabilitation
is the norm. Stroke rehabilitation may involve a wide spectrum of rehabilitation
providers and care settings, ranging from the neurologic intensive care unit to
outpatient clinics and the patient's home. Meta-analyses show benefit from early
intensive rehabilitation, particularly in an organized, coordinated setting [22]. Stroke
rehabilitation may encompass a wide array of interventions, ranging from exercise
to cognitive retraining to learning compensatory strategies.

Methods for stroke rehabilitation are advancing rapidly, facilitated in part by new
technology, such as functional magnetic resonance imaging (fMRI), which provides
information on the neurologic effects of rehabilitation and the effectiveness of novel
methods to enhance delivery of exercise-related interventions. For example, a
systematic review of randomized trials evaluated a variety of interventions for
improving upper limb function after stroke and found some evidence for the
effectiveness of constraint-induced movement therapy, mental practice, mirror
therapy, and a high dose of repetitive task practice [23]. However, the review
identified insufficient high-quality studies to allow comparison of specific kinds of
interventions.

Evidence-based guidelines from the American Heart Association and the Veterans
Health Affairs address early stroke-related care and decision-making for
rehabilitation [24,25]. Stroke outcomes are affected by the underlying health
conditions that caused the stroke (eg, hypertension, atrial fibrillation) and by
comorbidity related to the stroke (eg, dysphagia causing malnutrition). Patients with
significant physical or functional impairment should receive intensive rehabilitation
if they are able to tolerate three hours per day of therapy. For patients who are
unable to tolerate intensive rehabilitation, the best location for providing
rehabilitation is determined individually and depends on the extent of their
functional impairment and available social support.

Additional guidance includes the following:

●Early patient assessment should be carried out using the National

Institutes of Health (NIH) Stroke Scale and should also include
assessment of risk factors for recurrent stroke (eg, hypertension,
hyperlipidemia, atrial fibrillation) and stroke-related complications (eg,
deep vein thrombosis [DVT], cognitive dysfunction, dysphagia and
malnutrition, mobility impairment).
●The patient and caregiver should be involved in decisions in all phases
of the rehabilitation process, in turn improving participation in the
rehabilitation processes and outcomes.
●Rehabilitation therapy should be initiated as soon as possible, starting in
the acute care setting, including early mobilization in the intensive care
unit, as tolerated.
●The selection of the post-acute setting for rehabilitative care is critical. It
should be based on the patient's degree of dependency in activities of
daily living (ADLs) (eg, patients with minimal functional impairment may
be managed at home with home health or outpatient follow-up, patients
with greater degrees of functional impairment benefit from inpatient
rehabilitation), ability to tolerate intensive rehabilitation (eg, patients must
be able to tolerate at least three hours per day of therapy to qualify for
intensive inpatient rehabilitation and other patients are best managed in
a skilled nursing facility), and ability to participate in rehabilitation and
overall prognosis (eg, patients whose condition limits participation in
rehabilitation or who have a poor prognosis for recovery may be best
cared for at home or in a skilled nursing facility with medical follow-up).
●Post-acute rehabilitation should be in a coordinated multidisciplinary
inpatient setting or with an organized team approach in the home health
or outpatient setting.
●Rehabilitation should be continued until the patient reaches a plateau,
but the optimal setting for care may change depending on the patient's
response to rehabilitation and neurologic recovery.

Evidence-based reviews pertaining to diverse aspects of stroke rehabilitation have

been developed by the Canadian Partnership for Stroke Recovery [26].
Tele-rehabilitation is a promising modality to deliver rehabilitation to patients with
residual impairment despite standard rehabilitation or for patients who lack access
to standard rehabilitation [27,28]. Further research on its effectiveness is needed.

Other neurologic conditions — Rehabilitation needs differ widely across the

spectrum of neurologic impairments related to conditions such as Parkinson
disease, spinal cord trauma, or traumatic brain injury. Rehabilitation may be
provided by a single discipline or multiple disciplines, typically in a post-acute
setting, with the amount and type of therapies tailored to the particular impairments
or tasks manifesting a decline in function.

Spinal cord injury — Rehabilitation for a patient with an acute spinal cord injury
resulting in paralysis likely would involve physical therapy (PT), occupational
therapy (OT), nursing, and medical rehabilitation specialists (ie, physiatry).
Comprehensive rehabilitation and a multidisciplinary team are needed to address
problems with weakness, mobility, self-care, and potential complex physiologic
effects of the injury [29]. The presence of comorbid conditions would determine the
aggressiveness of the therapies and their optimal delivery site, considering the
impact of comorbidity on the patient's probable functional outcomes and ability to
tolerate intensive therapy or cooperate with the therapists.

Parkinsonism — In contrast to an acute injury, Parkinsonism is slowly progressive

and response to PT is modest and short-lived [30]. Improvement in physical
function largely relates to treating concomitant deconditioning and/or use of
compensatory strategies; evidence on the effectiveness of speech therapy for
Parkinsonism is of insufficient quality to make definitive recommendations [31].
Typically, rehabilitation for Parkinsonism is provided by a single discipline and
focused on a particular problem, with interventions targeted towards compensatory
strategies and actions that the patient will be able to continue at home that may
help avert deconditioning (eg, home exercise programs).

Musculoskeletal conditions — A wide variety of musculoskeletal conditions are

treated with rehabilitation services. Typical treatment is by a single discipline and
as outpatient, but this may vary depending on comorbid conditions and patient
residence (eg, institutional residence, homebound). The number of visits provided
varies according to the nature of the condition (eg, severity) and other comorbid
conditions (eg, cognitive impairment).

Hip fracture — Specific guidelines are lacking for hip fracture rehabilitation.
Evidence shows that early and frequent PT helps improve outcomes [32], yet
prolonged PT may be required to reach maximal functional outcomes [33,34]. Post-
fracture rehabilitation is provided across the continuum of care, starting in the
acute hospital. After discharge from acute care, hip fracture rehabilitation is
commonly provided in skilled nursing facilities and inpatient rehabilitation facilities,
but there is little evidence to show greater benefit from one inpatient location or the
other, after accounting for length of stay [35]. Some evidence suggests that home
rehabilitation, compared with inpatient rehabilitation, may have greater benefit. The
choice of location largely depends on local availability and comorbid conditions.
Patients who have multiple comorbid conditions and/or who cannot participate in
intensive rehabilitation are best served in a skilled nursing facility, while patients
who can tolerate intensive rehabilitation may do well in an inpatient rehabilitation
facility or at home with a combination of home health followed by outpatient
rehabilitation.

Hip fractures predominantly affect mobility, but the impaired mobility affects self-
care activities that require mobility and lower extremity flexibility, such as dressing,
toilet transfers, and use of the tub/shower. While the predominant discipline
involved in hip fracture rehabilitation is PT, OT also is involved, albeit for a shorter
period of time. In a systematic review, there was a suggestion that multidisciplinary
inpatient rehabilitation for older patients improved short-term outcomes compared
with usual care, but results were not statistically significant [36].

Hip fractures in older adults are commonly associated with other common geriatric
problems:

●Cognitive impairment impacts recovery [37]. Nonetheless, hip fracture

patients with concomitant cognitive impairment benefit from rehabilitation
[38]. The rehabilitation goals and types of services may need to be
adapted according to the patient's ability to participate and with
consideration of his or her premorbid function.
●Frailty and sarcopenia also are common comorbid conditions. Little is
known about how to optimize outcomes after hip fracture in that
subpopulation, but close attention to ensuring adequate nutrition,
particularly protein, and use of resistive exercise is consistent with
beneficial strategies for frailty in general. (See 'Prevention of late-life
disability' below and "Frailty"and "Geriatric nutrition: Nutritional issues in
older adults" and "Physical activity and exercise in older adults".)

Elective joint replacement — Rehabilitation principles are similar for hip fracture
and joint replacement patients but, unlike a hip fracture, an elective joint
replacement allows the opportunity to carry out "prehab." There is some evidence
of benefit from PT-guided exercise in patients awaiting hip replacement,
particularly for pain and functional outcomes [39]. Even though persons getting an
elective joint replacement are younger and healthier than persons with a primary
hip fracture, there is fair evidence that early multidisciplinary rehabilitation can
reduce hospital stay and complications after a hip or knee replacement [40].
(See 'Early intervention' below.)

Effects of location for rehabilitation are similar to hip fracture, with intensive
rehabilitation facilities being more efficient for length of stay and skilled nursing
facilities being more cost-efficient [41]. Functional outcomes are marginally better
for patients treated in intensive rehabilitation facilities than in skilled facilities, but
may relate to the frequency of therapy, as skilled facilities that provide more
therapy visits achieve equivalent outcomes [42,43]. For patients who can tolerate
going home, in-home rehabilitation provides comparable or better outcomes than
conventional rehabilitation [40].
Knee arthritis — Osteoarthritis involving the knee is a common condition affecting
the geriatric population and serves as an example of the spectrum of services that
may be provided through rehabilitation [44,45].

●Rehabilitation clinicians may guide use of nonoperative medical

interventions (eg, injections with corticosteroids or hyaluronic acid, use of
topical creams or oral medications) and nonpharmacologic interventions
(eg, gait aid, brace).
●Physical therapists may recommend gait aids, braces, and orthotics and
provide fitting and training in use of such devices.
●Podiatrist may fit and provide orthotics.
●Physical therapists and/or occupational therapists provide education on
joint protection techniques, activity pacing, home exercise programs, and
in-person supervised exercise programs individualized according to the
patient's condition.

Multimorbidity — Many older adults have multiple medical conditions that can
affect functional outcomes. These conditions can interact with one another to
exacerbate adverse effects on function. In addition, comorbid conditions can
complicate the rehabilitation that might be typically provided for particular
conditions (eg, cognitive impairment requires adaptations in standard low vision
rehabilitation) [46]. (See "Managing multiple comorbidities".)

The most appropriate rehabilitation strategies need to be based on the specific

conditions that are believed to be causing and/orexacerbating specific functional
impairments, the acuity of the various conditions, and the patient's response to
prior efforts at rehabilitation.

PREVENTION OF LATE-LIFE DISABILITY Because of the

tremendous personal and societal burden of late-life disability, prevention is a

priority. Prevention strategies can be considered in three broad categories:
●Optimizing functional reserve
●Avoiding or minimizing exposure to common precipitants
●Early intervention

Optimizing functional reserve — Advancing age impairs the functional reserve,

or capacity to withstand and recover from stressors, for many organ systems
including the cardiovascular, renal, and immune systems. Loss of functional
reserve is thought to explain the observation that older adults experience more
complications (eg, delirium) and recover more slowly from an injury or illness than
younger persons. Frailty is the manifestation of decreased functional reserve that is
observed clinically [47]. (See "Frailty".)

Interventions to optimize functional reserve are attractive for preventing disability

arising from illness or injury. Exercise interventions are the best studied means of
improving functional reserve. In sedentary older adults at risk to develop the frailty
syndrome, a 12-month physical activity intervention reduced the risk of
development of frailty by nearly one-half, with 10 percent of subjects developing
frailty compared with 19 percent of controls randomized to health education alone
[48]. (See "Frailty", section on 'Exercise' and "Physical activity and exercise in older
adults".)

Evidence for benefit from other interventions is less robust.

●Nutrition interventions are theoretically attractive ways to improve

functional reserve, although, evidence that they improve or delay the
development of frailty is lacking. (See "Frailty", section on 'Nutritional
supplementation' and "Geriatric nutrition: Nutritional issues in older
adults".)
●Pharmacologic interventions have not proven beneficial, other than to
review medications and discontinue those that may no longer be needed.
(See "Frailty", section on 'Medication review' and "Frailty", section on
'Ineffective interventions'.)

Prevent common disability precipitants — Common preventable medical

conditions, which may precipitate or contribute to late-life disability, include
cardiovascular events, infections, falls, and fractures. Risks may be reduced with a
variety of medical interventions, including blood pressure management, smoking
cessation, fall prevention, osteoporosis screening, and vaccination against
influenza, pneumococcus, and herpes zoster. (See "Geriatric health
maintenance".)

Early intervention — Early intervention after an acute precipitating event may

prevent or ameliorate the development of disability. "Prehabilitation" programs
designed to improve exercise capacity and nutrition prior to an elective surgery
have been developed with variable and modest results [49-51]. In-hospital
programs to enhance mobility, such as early mobilization and walking programs,
may decrease length of stay and improve functional outcomes [52]. Models of care
of acutely ill older adults, which employ interprofessional assessment and
intervention (eg, Acute Care for the Elderly Unit, orthogeriatrics unit), have been
shown to improve functional outcomes, although programs are heterogeneous [53].

SUMMARY AND RECOMMENDATIONS

●Inyounger populations, disability frequently arises suddenly from a

catastrophic illness or accident. In older persons with limited functional
reserve, lesser stressors may precipitate disability or there may be
subacute onset with no clear precipitating event. Disability resulting from
multiple chronic conditions is dynamic, with patients' abilities and needs
changing over time. (See 'Epidemiology of disability' above.)
●A systematic approach to assessing late-life disability focuses on
identifying all contributing conditions, impairments, and contextual factors
 and addressing these factors with appropriate interventions. In this
assessment, the clinician(s) should describe the disability, including its
onset, time course, and impact on patient and caregivers; identify
associated symptoms; and identify contextual factors that may impact the
impairment. (See 'Approach to assessing late-life disability' above.)
●A practical management plan, developed with the patient and family,
identifies strategies to enhance functional abilities and decrease
functional demands. Maximizing capacity (functional ability) may include
initiating or discontinuing medication, nutritional and exercise
intervention, and providing prosthetics (eg, hearing aid). Decreasing
demands may involve assistive devices (eg, walkers), environmental
modification (eg, improved lighting), increasing human help, and adaptive
training. Implementing a plan to reduce late-life disability requires
coordination among multiple professionals, the patient, and caregivers.
(See 'Approach to the management of late-life disability' above.)
●Rehabilitation in the older population is made more challenging by the
common need to provide rehabilitation care across multiple settings, with
patients potentially transitioning from the acute hospital to intensive
inpatient rehabilitation, skilled nursing facility, home health, and
outpatient care over the course of recovery. Transitions across multiple
locations increase the risk of multiple problems, including errors in
medication orders, discontinuity in rehabilitation interventions, patient
confusion, and depression. The most appropriate rehabilitation strategies
need to be based on the specific conditions that are believed to be
causing and/or exacerbating specific functional impairments, the acuity of
the various conditions, and the patient's response to prior efforts at
rehabilitation. (See 'Rehabilitation for specific conditions' above.)
●Because of the tremendous personal and societal burden of late-life
disability, prevention is a priority. Prevention strategies can be
considered in three broad categories (see 'Prevention of late-life
disability' above):
•Optimizing functional reserve
•Avoiding or minimizing exposure to common precipitants
•Early intervention
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