Synopsis
Use comprehensive geriatric assessment to restore meaningful function after illness or injury through coordinated, goal-based rehabilitation that addresses medical stability, cognition, mood, nutrition, medicines, mobility, environment and caregiver capacity.
- Rehabilitation is an active treatment that aims to improve participation and independence; frailty, dementia or care-home residence must not be used as automatic exclusion criteria.
- First-line assessment compares current function with the stable pre-illness baseline across mobility, transfers, personal and instrumental activities, cognition, mood, continence, nutrition and social support.
- Use comprehensive geriatric assessment to produce one shared plan rather than separate medical, nursing and therapy lists with competing priorities.
- Start mobilisation and task practice as soon as medically safe, but investigate new pain, hypoxia, hypotension, delirium or focal weakness before labelling poor participation.
- Set goals in the person's own language, such as reaching the toilet or making tea, then translate them into measurable component skills and review dates.
- Progressive strength, balance, endurance and functional practice must be sufficiently challenging, repeated and adjusted; passive movement alone rarely reverses deconditioning.
- Treat barriers in parallel: analgesia, orthostatic symptoms, vision, hearing, footwear, depression, delirium, sleep, protein-energy intake, polypharmacy and fear of falling.
- Cognitive impairment changes teaching pace and cueing but does not remove rehabilitation potential; use routine, repetition, demonstration and familiar support.
- Assess home layout, equipment, transport and carer willingness before declaring a ward-level improvement safe for discharge.
- When decline is irreversible or the person prioritises comfort, rehabilitation can shift to supported transfers, positioning, pressure prevention and conserving energy for valued activity.
Key red flags
New unilateral weakness, aphasia, neglect or ataxia requires an acute stroke assessment.
Syncope, exertional chest pain, severe desaturation or a new arrhythmia needs urgent cardiorespiratory evaluation.
New inability to weight bear or severe focal bone pain after transfer can indicate occult fracture.
Fluctuating attention, altered arousal or abrupt functional loss suggests delirium and an underlying acute trigger.
Repeated aspiration, wet voice or respiratory change during meals requires swallow and chest assessment.
Pressure injury, unsafe manual handling or a carer unable to perform planned transfers makes the discharge goal unsafe.
A person declining therapy through pain, fear or inaccessible communication must not be labelled non-compliant without assessment.
Acute chest pain, hypoxia, hypotension, focal weakness, fever, delirium or severe movement pain requires immediate clinical reassessment before further therapy.
Investigation priorities
Integrate diagnoses, medicines, function, cognition, mood, nutrition, continence, falls, sensory status, environment and patient priorities.
Management branches
An older adult loses function during illness, injury, surgery or hospital admission.
- Establish pre-illness function and the person's priorities, then complete multidisciplinary medical, cognitive, nutritional, mobility and social assessment.
- Treat pain, delirium, postural symptoms, infection, hypoxia, medicine burden and missing sensory aids while beginning safe activity early.
- Agree measurable task-based goals, intensity, responsible professionals and a review date in one shared plan.
The person is medically stable enough for repeated active rehabilitation.
- Deliver progressive strength, balance, endurance and functional practice matched to the intended activities and monitor physiological response.
- Use nursing, therapy and willing carer opportunities across the day, with equipment and cueing that encourage safe participation rather than dependence.
- Review assistance level and valued function frequently and increase challenge, change technique or investigate non-progress from observed findings.