Seniors, risk and rehabilitation: broadening our thinking

Abstract

Purpose: Conceptualizations of risk in seniors’ rehabilitation emphasize potential physical injury, functional independence and cost containment, shifting rehabilitation from other considerations essential to promoting a satisfying life. In a two-day multidisciplinary planning meeting we critically examined and discussed alternatives to dominant conceptualizations.

Method: Invitees reflected on conceptualizations of risk in stroke rehabilitation and low vision rehabilitation, identified and explored positive and negative implications and generated alternative perspectives to support rehabilitation approaches related to living a good life.

Results: Current risk conceptualizations help focus rehabilitation teamwork and make this work publically recognizable and valued. However, they also lead to practice that is depersonalized, decontextualized and restrictive. Further research and practice development initiatives should include the voices of clinicians and seniors to more adequately support meaningfully living, and foster safe spaces for seniors and clinicians to speak candidly, comprehensively and respectfully about risk. To ensure that seniors’ rehabilitation targets a satisfying life as defined by seniors, increased focus on the environment and more explicit examination of how cost containment concerns are driving services is also necessary.

Conclusion: This work reinforced current concerns about conceptualizations of risk in seniors’ rehabilitation and generated ways forward that re-focus rehabilitation more on promoting a satisfying life.

Implications for rehabilitation

• In seniors’ rehabilitation, considerations of risk focus on physical injury, functional dependence and cost containment.

• Focus on provider-defined risk of physical injury limits examination of patient goals and patients’ histories of judging and dealing with risk.

• Focus on functional dependence and cost containment may lead to practice that is depersonalized and decontextualized.

• Abandonment of ableist and ageist thinking and an explicit focus on person-centered definitions of risk and a satisfying life are recommended.

Keywords:

• Low
• participation
• safety
• stroke
• vision

Acknowledgements

The authors acknowledge the valuable input of the meeting participants: Leah Bartlett, Hillel Finestone, Louise Gillis, Rachel Gorman, Amanda Grenier, Robin Hurst, Eleanor Larney, Susan Leat, Diane Lepage, Sally Plant, Carolyn Pullen, Sylvie Salley, Abe Schwartz, Beverly Shea, Vivian Welch, Meredith Wright, Patrick Duong, Kaylee Eady, Megan Rusciano, Katrine Sauvé-Schenk. We are also grateful to Stephen Katz for providing the group with questions for reflection.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding information

This work was funded through a Canadian Institutes of Health Research Planning Grant (Priority Announcement: Aging Grant #132277).