Clinical problem-solving in geriatric medicine: obstacles to rehabilitation

This case illustrates how multifactorial medical, neurological and psychiatric conditions can synergistically effect the functional status of elderly individuals. This case also illustrates how iatrogenically induced illness, most commonly in the form of drug therapy, can significantly affect patients' conditions and their progress in rehabilitative therapies. This case also illustrates how the atypical presentation of disease in the elderly, as well as the medical ramifications of rehabilitative therapies, need to be strongly considered during trials at functional rehabilitation. More importantly, however, this case demonstrates how even a community-based geriatrician can be instrumental in recognizing the need of more appropriate evaluations in elderly patients with functional disabilities and how even in the setting of a multidisciplinary team there can still be a consulting relationship, with each person seeing the patient individually and communicating with other members of the team as necessary. Although each team member may have a specific area of expertise, there is still a very important role for the geriatrician to play in making sure that all the different components of the rehabilitation and the medical care proceed in a way that will provide the most favorable outcome for the patient.