Rehabilitation of Older Patients with Mental Disorders

Abstract

The anatomical and histological changes that take place in the ageing brain can significantly impair the cognitive functions of elderly people, such as memory, learning and specific motor functions, affecting their autonomy and quality of life (QoL). Many factors appear to be involved in developing cognitive impairment in older people, including genetics, neuroendocrinology, lifestyle habits and nutrition, as well as social and cultural milieu. Mental disorders are psychiatric diseases due to breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling and behaviour producing either distress or impairment of functioning. Dementia, delirium and major depression are the most common psychiatric conditions affecting elderly people. The physiatric approach to elderly patients with mental disorders is holistic and patient centred, including the formulation of the individual rehabilitation plan (IRP) that has to be tailored to the cognitive (i.e. memory, attention, problem-solving, language) and non-cognitive impairments (i.e. neuropsychiatric symptoms), functional disability, social and cultural environment and quality of life. Caregiver or family members should be considered as members of the care team for patients with cognitive decline. Moreover, the chronic physical and mental burden on caregivers (caregiver stress) needs to be addressed in order to improve the quality of care for elderly patients with mental disorders.