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Geriatric rehab program focuses on research, training and service.

Nearly 50% of all persons over 70 have at least one chronic illness severe enough to interfere with their activities of daily living.

Chronic, disabling illness is the major health problem of older persons. Nearly 50% of aU persons over the age of 70 have at least one chronic illness severe enough to interfere with their activities of daily living. Although acute medical problems of most people, young and old, are generally well cared for by our technologically-based health care system, the treatment of chronic health problems, such as arthritis, stroke and Alzheimer's disease, has not been a national priority. However, this is beginning to change as a result of the aging of our society. There is now a growing interest in the treatment of chronic illness which focuses on improving function rather than cure.

The goal of this practical approach is to maintain the independence of older people in the community. If disabled elderly are able to preserve their independence, they will have enhanced overall health, have a greater sense of life satisfaction, avoid inappropriate institutionalization and be less of an economic cost to society. The emphasis on maximizing functional abilities is the core of geriatric rehabilitation.

The Geriatric Health Education and Research Center (GHERC) at Rancho Los Amigos Medical Center (Rancho) in Downey, California has utilized the geriatric rehabilitation model since 1979. Rancho is a 500-bed county-owned rehabilitation center and teaching hospital for the University of Southern California (USC) School of Medicine. The GHERC program includes clinical, research and training activities that deal with practical problems of older disabled persons from medical, psychological, and social perspectives. Historical Background

The initial geriatrics program has its roots in three areas. First is the Medical Center itself. Starting as Los Angeles County's "Poor Farm" in the late 1880s, Rancho first became involved in rehabilitation through treatment of persons with polio. Following the acute illness period, there was a need to address the multiple after-effects of polio. This meant that professionals were needed to address the daily living, mobility, educational and psychological consequences of the illness. Hence, one of the earliest multidisciplinary approaches to the treatment of chronic illness in the country developed here. What worked for polio was extended to other conditions such as stroke, arthritis, head trauma, amputations, spinal cord injury and pulmonary disease. Rancho soon became well known as a rehabilitation center for chronic illnesses. Since geriatrics is often the treatment of multiple chronic diseases, its development at Rancho was only natural. The hospital was experienced in interdisciplinary care, a functional approach to treatment, and the treatment of severe disabilities. In addition, USC was looking for a clinical teaching site to train medical students as part of a new thrust into geriatrics.

Finally, the force of aging demographics played a major role. By 1978 several things had become clear: * the explosion of the older population

was beginning to create tremendous

health, economic and political

problems that were not being adequately

addressed; * traditional acute-oriented approaches

to health care could not

solve the problems; * the future of health care and funding would revolve around the aging population to a great extent; and * rehabilitation was the most logical approach to the health care of older persons. Philosophical Underpinnings

Several philosophical principles underlying the geriatric programs at Rancho are important and have helped lead to its success. First, equal weight has been given to clinical practice, research and training activities under a single banner. The development and integration of these three activities is difficult because each has its own values, methods and outcomes. However, their integration provides a synergy for excellence. Good applied research comes from good clinical care; the best clinical care comes from staying abreast of practice developments and research fundings; and the best clinical teaching comes from providing the best care and conducting problem-oriented research. Thus, an integrated program gains from each of its parts, sometimes to a greater extent than simply a sum of those parts.

Second, linking rehabilitation and geriatrics is a main focus of the program. Because the major health problem of the older population is chronic disabling illness, rehabilitation cannot be viewed as an adjunctive service to geriatric health care; rather, it is the mainstay. Similarly, the best geriatric rehabilitation treatment requires special skills and knowledge in order to assess and treat older persons most effectively.

Third, multiple sources are necessary to pay for the entire range of clinical, research and training activities needed to prepare the country for the next century or even for today's needs. The program utilizes a wide range of funding resources for this program, including public, private, federal, state and local government support. Unless and until a national health system emerges, geriatric health care will continue to need the support of a combination of funders. Program Description

The Geriatric Health, Education and Research Center consists of 1) the Rehabilitation Research and Training Center on Aging, 2) the Clinical Gerontology Service, 3) the Independent Living Services Program, 4) the Southern California Alzheimer's Disease Diagnostic and Treatment Center and 5) the Rancho Family Resource Center.

The Rehabilitation Research and Training Center on Aging (R&T Center) is funded by the National Institute of Disability and Rehabilitation Research. The goals of the R&T Center are very practical: to improve patient care through research and demonstrations; to train others in the best principles of geriatric care; and to disseminate state-of-the-art knowledge to a national audience. In keeping with this applied nature, the research program is aimed at developing new treatment techniques, assessment tools, delivery systems and improved access to rehabilitation services for older persons. It has conducted or is currently conducting research on topics such as mobility impairments, incontinence, depression, chronic illness in minority populations, the effects of aging on early life disabilities, attitudes toward older disabled persons, motivation and rehabilitation, service outcomes, legislative policies that affect rehabilitation, and technological improvements to assist older disabled persons.

The training program of the R&T Center is directed toward improving health care of older persons by emphasizing a rehabilitation approach in geriatrics and encouraging more knowledge of geriatrics in rehabilitation. A variety of training programs are utilized, including fellowships, residencies and student rotations for physicians; internships and classroom teaching for allied health students; conferences for professional and lay audiences; and lectures and courses at national conferences.

The Clinical Gerontology Service is an outpatient and inpatient rehabilitation-oriented interdisciplinary health service. It includes an in-home assessment unit, a comprehensive geriatric assessment clinic, follow-up clinics, outpatient therapies, group treatment programs, family services, community services and a 12-bed inpatient unit for intensive rehabilitation services. The main goals of the Service are to provide state-of-the-art geriatric care and rehabilitation for common and complex disabling conditions and to serve as a training and research site for the field of geriatrics and rehabilitation.

The Independent Living Services program complements the other clinical services. It is designed to provide preventive services and education in order to help disabled older persons maintain their independence. Services include in-home assessment, case-management, assistance in finding community services, patient advocacy, transportation and a home health training program.

The Southern California Alzheimer's Disease Diagnostic and Treatment Center provides diagnosis of cognitive impairments, treatment and on-going care for demented patients, and educational programs for professionals and families. In addition, the Center conducts rF,search on the basic causes of Alzheimer's disease, behavioral consequences of the disease, caregiver stress, and drug therapies to improve memory and reduce behavioral problems. The Center is sponsored by the California State Department of Health Services.

The Family Resource Center provides health and social services to older persons with physical or cognitive impairments (including Alzheimer's disease) who are having difficulty managing independently in their own homes. Participants receive ongoing supervision, assessment and treatment by the multidisciplinary staff. The activities at the Center are specifically designed to enhance the quality of fife of this impaired population. A major goal of the program is to provide support for families of the most severely disabled older persons. In many instances, the assistance provided to the family by the Center prevents institutionalization of the elderly person, which greatly reduces the stress on the family,

In conclusion, the model of geriatric rehabilitation used by the Geriatric Health, Education and Research Center is one that can be developed elsewhere using the guiding principles of the Center: 1) integration of service, research and training; 2) treatment of disabled older persons that utilizes a bio-psycho-social perspective; 3) a multidisciplinary team approach; and 4) a goal of m g functional abilities. The end result of these activities will be the enhancement of health care and maintenance of independence of older persons.


One of the goals of the Geriatric Health, Education and Research Center is dissemination of state-of-the-art information on geriatric rehabilitation. The following publications are available: * A quarterly newsletter, "Geriatric

Rehabilitation Preview," available at

no charge by writing to: Newsletter,

7600 Consuelo Street, Downey, CA,

90242 * A new clinically-oriented text,

"Geriatric Rehabilitation," published

by College-Hill Press. The book

contains chapters on assessing

rehabilitation potential, rehabilitating

persons with specific impairments,

improving function, organizing

geriatric rehabilitation programs,

and ethical issues in geriatric care.

For information, call (800) 343-9204.
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Title Annotation:Rancho Los Amigos Medical Center Geriatric Health Education and Research Center
Author:Plowman, Vicki J.
Publication:The Journal of Rehabilitation
Date:Oct 1, 1989
Previous Article:Aging and disability: toward a unified agenda.
Next Article:Persons with disabilities and the aging factor.

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