[Rehabilitation integrated in acute medical treatment]

Rehabilitation integrated in acute medical treatment is of great importance to patients with acute cerebral stroke and to frail elderly people admitted to hospital with acute medical conditions or fractures. We will focus on the latter group, which receives the least attention, but steadily increases.

MEDLINE-search for relevant literature published during the last 15 years, and own clinical experience.

Results from randomized clinical studies indicate that early geriatric rehabilitation, integrated in the acute treatment of elderly frail patients with acute diseases or hip fractures, is more effective than treatment in general medical or orthopedic wards. Geriatric intervention does not seem to increase costs. The beneficial effects consist of reduced incidence, duration and severity of delirium; fewer iatrogenic complications, better functional capacity and in some studies reduced mortality without increasing the need for institutionalization. Prerequisites for success are adequate patient selection and dedicated geriatric and rehabilitation units with full treatment responsibility. Up to 2050, there will be a dramatic increase in the number of elderly in Norway. Restructuring and reorganization of medical and orthopedic hospital departments are some of the measures required to meet this challenge.