Physikalische Medizin in der Geriatrie
Abstract: In the treatment of geriatric patients it might be necessary to take into consideration chronic diseases which have been present for a longer period of time as well as their decompensation, longer confinement to bed or inadequate intake of fluids and nutrition. The reduction of the moveability of ajoint, mostly caused by the development of arthroses and tendons, which can no longer be extended optimally as well as shortened muscles belong to the most important physiological aging processes of the muscles and the skeleton. The muscle tone, the speed of contraction and the endurance are also reduced. In addition there is osteoporosis with a rarefaction of the bone architecture. The physiological aging processes of the cardiopulmonary system manifest themselves in a reduction of the cardiac output per minute and a vascular sclerosis, which often causes an increase of the average systolic blood pressure as a result of the related vascular rigidity. The rarefaction of the lung parenchyma and the associated capillary loss reduce the diffusion capacity and the arteriovenous O2 difference. The multiple changes of the cerebral metabolisrn and the vascular sclerosis of the cerebral vessels together with neurophysiological changes, as a reduction of the coordination, the reaction speed, the concentration power and other deficits concerning the cerebral function are clinically relevant for geriatrics. For patients, confined to bed, the pneumonia and thrombosis prophylaxis as well as the contracture prophylaxis by a passive or assisting full movement of the extremities belong to the general goals of physical medicine in geriatrics. After a confinement to bed for a longer period of time, a restorative training of the muscles, a training of the coordination and a training of the cardiovascular systems for the restoration and preservation of mobility are necessary. Among the special aims of physical medicine in geriatrics there are among others the training of the posture, walking training, preoperative and postoperative medical care as well as the training of the activities of everyday life within the scope of ergotherapy.