© Springer International Publishing AG 2018 53
S. Masiero, U. Carraro (eds.), Rehabilitation Medicine for Elderly Patients, Practical Issues in Geriatrics, DOI 10.1007/978-3-319-57406-6_7
C. Federspiel, MD • J.-P. Steinmetz, PhD (*)
Centre for Memory and Mobility - ZithaSenior, Luxembourg City, Luxembourg e-mail: [email protected]; [email protected]
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[6], is a person’s belief in his or her capabilities to have control over or to influence a (personal) situation or an event. Previous research found that sense of control in people and their age is negatively related, with older persons experiencing generally less control [7, 8]. Beliefs in one’s own capabilities (i.e., self-efficacy) are thought to govern cognition, emotions, and behavior and are crucial to determine to what extent a patient feels motivated. In PRM it is thus important to identify potential sources of self-efficacy enhancing information to help strengthen those beliefs [9].
To enhance motivation and corresponding behaviors (i.e., participation in rehabili- tation activities), several factors are relevant: the patient’s personality, patient’s active participation in the development of the interdisciplinary rehabilitation pro- gram, definition of relevant goals to be achieved during rehabilitation, encourage- ment and support from the therapists, empowerment of the patient, and the rehabilitation environment in general [1, 10, 11]. Moreover, providing information about the necessity of certain exercises or therapies (i.e., patient education) may furthermore be beneficial in generating patient motivation to engage in rehabilita- tion [11]. Detrimental effects of lack of motivation have been discussed in the litera- ture. Findings suggest that if patients are perceived as unmotivated by the therapist, the clinician is less likely to support and encourage him/her. Thus, motivated patients are differently treated than unmotivated ones, especially if the unmotivated patient is old [11]. Therapists play a vital role in positively influencing their patients to actively participate in therapy. An interpersonal relationship characterized by respect and trust may easily be established between the therapist and the motivated patient but takes time and effort to be established with patients lacking motivation.
That is, therapists must develop an important amount of sensitivity toward their patients enabling the therapist to recognize cognitive and mood disorders threaten- ing positive rehabilitation outcomes in their patient [4]. As a positive consequence, rehabilitation interventions can promptly be adapted according to the mental and physical state of the patient.
After more than a decade of clinical practice in geriatric rehabilitation, our gen- eral experience is that the acquisition of knowledge of the patient’s preferences prior the critical health event and the patient’s personality (e.g., through contacts with the family) is beneficial in determining a tailored intervention program.
Tailored intervention programs are ideally developed by an interdisciplinary team composed of various healthcare professionals. A multidisciplinary team can be composed of a geriatrician and/or a specialist in rehabilitation medicine, an occupa- tional therapist, a physiotherapist, a psychologist, a speech therapist, a social worker, and a nursing staff. This interdisciplinary composition is an important key toward a better understanding, evaluation, adaptation, and scheduling of individualized reha- bilitation interventions. Monitoring physical and mental capacities and the social condition of the old patients helps us in approaching the very personal interests of each patient on different levels. Thus and, for example, assessing (e.g., through semi-structured interviews) and integrating systematically individual biographic elements in the development of tailored interventions is useful in enhancing compli- ance among patients as interventions may be better focused and adapted to the indi- vidual patient. Furthermore, spending time with the patient and trying to build up an
C. Federspiel and J.-P. Steinmetz
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empathetic relationship to make the patient feel comfortable and welcome may fur- thermore positively affect compliance and consequently, rehabilitation outcomes [12]. We conclude that exploring the construct of motivation is fundamental in the work with older adults and should hence be systematically considered in geriatric rehabilitation units as it figures as a key mediator of the success or the failure of a rehabilitation program.
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S. Masiero, U. Carraro (eds.), Rehabilitation Medicine for Elderly Patients, Practical Issues in Geriatrics, DOI 10.1007/978-3-319-57406-6_8
F. Scarponi
Neurorehabilitation Unit, USL Umbria 2, Foligno Hospital, Via. M. Arcamone, Foligno, Perugia 06034, Italy
M. Zampolini (*)
Department of Rehabilitation, USL UMBRIA 2, Foligno Hospital, Via M. Arcamone, Foligno, Perugia 006034, Italy
e-mail: [email protected]; [email protected]