Clinical issues - setting appropriate treatment or rehabilitation goals for individual patients

Overview

Setting appropriate treatment and rehabilitation goals for older patients requires goals that are realistic, functionally meaningful to the patient, and time-framed - rather than defaulting to either maximal intervention or premature limitation of care
Rehabilitation potential varies enormously between individuals of the same age and diagnosis - chronological age alone is a poor predictor and should not itself determine the intensity of rehabilitation offered

Goals set without the patient's input, or based on generic assumptions about what an older person "should" be able to achieve, are less likely to be met and less likely to reflect what actually matters to that individual

Goal-setting is most effective when done collaboratively with the patient (and family/carers where relevant), specific and functionally meaningful (e.g. "walk to the bathroom independently" rather than "improve mobility"), and reviewed/revised regularly as progress (or its absence) becomes apparent
Baseline (pre-morbid) function is the key reference point - the realistic goal is usually return toward baseline, not an arbitrary external standard

Multidisciplinary team input (physiotherapy, occupational therapy, nursing, medical) ensures goals are coordinated and consistent across disciplines, rather than each discipline pursuing its own independent target
Reassess and adjust goals as new information emerges (e.g. slower-than-expected progress, a new complication, or a change in the patient's own priorities) - initial goals are a starting point, not a fixed contract

Rehabilitation potential, functional trajectory, discharge planning, patient-centred care

Goals that are too ambitious risk setting the patient up for a sense of failure and can delay appropriate discharge planning; goals that are too conservative risk under-treating genuine rehabilitation potential and unnecessarily accelerating functional decline or premature residential care placement

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