Geriatric MedicineTier 2Topic

Patient-centred care and multidisciplinary issues - potential disadvantages arising from disability or ageing and how to assist persons in achieving their full rights in society

The paradox of over-assistance

Over-assisting an older person - doing tasks for them that they could do (with more time or support) themselves - can actively undermine their ability to achieve their full functional potential, a phenomenon sometimes termed "excess disability"
Well-intentioned carers, family, and even healthcare staff commonly over-assist, particularly under time pressure (it is faster to do a task for a patient than to support them doing it themselves)

Learned helplessness

Learned helplessness and deconditioning - a patient who is consistently assisted with a task they could partially perform loses confidence and physical capacity for that task over time, compounding rather than compensating for their underlying impairment
This is a particular risk in hospital, where efficiency pressures favour staff completing tasks quickly over allowing patients the time to do them independently or with minimal support

Assessment

Assess what a patient can do (not just what they cannot), and structure care to support and encourage that capacity rather than routinely bypassing it

Restorative care

"Restorative care" approaches (encouraging maximum patient participation in ADLs, allowing extra time rather than taking over) preserve and can even improve function, in contrast to a purely custodial approach
This principle applies across settings - hospital, rehabilitation, and residential/home care - and is a recognised quality marker distinguishing good from merely safe care

Related concepts

Excess disability, deconditioning, hospital-acquired functional decline, residential care culture

Key point

The well-intentioned instinct to help can, paradoxically, accelerate the very functional decline it is trying to prevent - recognising this tension is central to good rehabilitation-oriented care

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