Front Matter

Chapter 18 Rehabilitation for Geriatric Patients 463

Hyperadrenocorticism

Hyperadrenocorticism (Cushing’s disease) is
the result of pituitary‐dependent, adrenocorti­
cal, or iatrogenically induced excess cortisol in
the blood. Cushing’s patients can exhibit skin
changes such as hyperpigmentation and calci­
nosis cutis. They are predisposed to weight gait
and obesity, ascites, weakness, muscle wasting,
panting, and decreased pulmonary compliance
(Ettinger & Feldman, 2010). Respiratory distress
may be increased by excitement or exercise.

Hypoadrenocorticism

Hypoadrenocorticism (Addison’s disease) is
characterized by a lack of mineralocorticoid
and glucocorticoid secretion, and is often due
to an immune‐mediated destruction of the
adrenal gland. Lethargy, depression, and weak­
ness are the most common clinical signs affect­
ing the Addison’s patient. Weight loss, and
shaking or shivering may be additional clinical
signs, and seizures may occur from hypoglyce­
mia (Ettinger & Felman, 2010). If a geriatric
patient has underlying Addison’s disease, the
effects of Addison’s may, for example, com­
pound the weakness that they may experience
due to sarcopenia, so it presents an addi­
tional  challenge to the rehabilitation therapist.
Addison’s patients should be monitored for
response to stress during visits to the rehabilita­
tion facility and may need additional glucocor­
ticoid supplementation.

Diabetes mellitus

Patients with diabetes mellitus may present for
signs of peripheral neuropathy such as scuffing,
dropped tarsi (aplantigrade stance is more com­
mon in cats), or other issues related to weakness
(Figure 18.5). Diabetic neuropathy is less com­
mon in dogs than in cats, and usually is seen in
dogs that have been diabetic for 5 years or longer
(Ettinger & Feldman, 2010). Secondary compli­
cations of diabetes mellitus include cataracts and
poor wound healing. Adequate diabetic control is
necessary when treating these patients to ensure
that progress with therapy is not hindered.

Immune compromise

Immune compromise may be secondary to
diseases such as neoplasia, iatrogenic drug

suppression, or resistant infections. Routine

screening with lab work and urine cultures

should be pursued, and these patients

should receive appropriate antibiotic therapy if

warranted.

Neoplasia

In a 2011 study of canine mortality as recorded in

the Veterinary Medical Database (VMDB)

between 1984 and 2004, neoplastic processes

were the leading cause of death overall among

adult dogs (Fleming et  al., 2011). Monitoring for

rapid weight loss, muscle wasting, cachexia,

dyspnea, peripheral lymphadenopathy, or

enlargement of the abdomen is recommended.

Many of the modalities used in physical rehabili­

tation are contraindicated over areas of malig­

nant tumors as they increase regional blood flow.

Patients receiving chemotherapy should be mon­

itored for nadirs in white blood cell counts, which

may warrant postponing therapies such as

hydrotherapy until their blood counts stabilize.

Pain relating to cancer and its treatment has

been categorized for people in a three‐stage

analgesic pyramid by the World Health

Organization (Fox, 2012; WHO, 2017) This may

be helpful for the rehabilitation therapist in

determining appropriate pain management

measures to allow the cancer patient to regain

the best possible mobility.

Figure 18.5 Geriatric patient with muscular weakness

resulting in dropped tarsi.