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Geriatric rehabilitation is an interdisciplinary offer of rehabilitation services for elderly persons who often have several impairments and, in some cases, an already existing need for nursing care. It aims at maintaining their self-determined participation in everyday life to the greatest possible extent as well as at avoiding or reducing their needs for nursing care. Characteristic features of geriatric patients are high vulnerability due to an age-related reduction of reserves and often multiple chronic diseases. This is why the geriatric assessment and the multi-professional geriatric team present a correspondingly broad base.As a result of the vulnerability of geriatric patients, early rehabilitation that already starts during acute treatment in hospital is of great importance for their rehabilitative care. Of total German geriatric-rehabilitative care 75 % is inpatient- and 8 % day-care in hospital. These kinds of care are largely provided nationwide. Unfortunately, they often cannot make use of the entire rehabilitation potential of geriatric patients. Independent geriatric rehabilitation facilities, however, are not available in all federal states yet and mainly focus on inpatients. They account for 17 % of geriatric-rehabilitative care - for more than 95 % in connection with a previous hospitalization. Up to now, there has not been an adequate focus on the utilization of out-patient and mobile geriatric rehabilitation as well as on the use of geriatric rehabilitation in case of a slowly progressing deterioration of activities and participation without any acute event. Especially, mobile rehabilitation that is directly performed at the patient's home constitutes a particularly suitable rehabilitation setting mainly for persons who will still need nursery care despite reaching their rehabilitation targets. But this kind of rehabilitation care is still little known.The article provides decision-making aids to physicians in hospitals and doctor's offices as well as information on how to gain access to geriatric-rehabilitative care services, including new regulations to facilitate this access, which are planned for 01 July 2022., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Geriatric rehabilitation care serves to maintain the self-determined participation of elderly people. It contributes to reduce dependency on care, which is one of society's major challenges. The focus of its work lies on elderly patients, mostly with multiple impairments and limited reserves. These people consequently face a high risk of developing further activity limitations and participation restrictions in the context of any acute illness. This justifies the large proportion of early rehabilitation already in hospital, which forms an essential part of geriatric rehabilitation care in Germany. Its goal is to reduce or prevent any associated setbacks regarding independent living as soon and as far as possible. However, early rehabilitation cannot replace a potentially necessary further medical rehabilitation - particularly under the conditions of lump-sum compensation in the context of the DRG system. But institutions for further medical rehabilitation exist only in some of the federal states in Germany.In addition, geriatric rehabilitation services are largely provided in inpatient settings in Germany. This system to date only rarely takes advantage of the benefits of other forms of rehabilitation. For instance, outpatient geriatric rehabilitation could already be used more frequently to prevent dependency on care in cases of slowly increasing deterioration of functional health. Mobile rehabilitation, where rehabilitation patients are visited in their residential environment, could be more efficient and more sustainable for patients whose rehabilitation and participation goals can be achieved less by means of restitution of lost functions rather than by the adaptation of contextual factors and the improvement of support arrangements., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; BezahlterBerater/ interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Nicht-Sponsor der Veranstaltung): nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Sponsor der Veranstaltung): nein. Erklärung zu nichtfinanziellen Interessen Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The Barthel Index (BI) is firmly established as an assessment instrument in geriatrics. It is a proven, clear and easy-to-use instrument for the recording of basic daily functions. However it is increasingly finding new applications beyond its original, clinically orientated use. It has been applied as a quality parameter, as an instrument for the management of service delivery provision and as an instrument to record treatment efforts relevant to care or costs. This study considers the basic suitability prerequisites of the Barthel Index for these applications.With the Hamburg Classification Manual for the BI, German geriatrics has made a contribution to the standardized operationalization of the items and to the standardized evaluation of aids. An evaluation was performed on a total of 5262 Barthel classifications at seven geriatric hospitals according to existing classification practice by comparison with 5483 classifications after introduction of the Hamburg Classification Manual. No significant differences were found in Barthel Index total scores either on admission or on discharge. With respect to further applications it is essential to be aware that the usability of the total score (including its changes over the course of time) is limited because of the ordinal scaling of the BI. Studies have been carried out which show how important this is, although they have so far received little attention. As a grading criterion the BI takes account not only of the "functional status" but also of the "extent of support effort". This can lead to positive changes in one focus -- especially with the use of aids -- without associated improvements in the other focus. Whether the BI in this form is meaningful for a specific application must be tested separately for each individual context. There is no justification for assuming that the BI has general validity irrespective of application. The results of a systematic literature survey on the testing quality criteria of the BI indicate an astonishingly generous approach to the question of the validity of the BI. Contrary to widespread opinion, cognitive-psychological components do influence the classification result of the BI. As an addition to the Hamburg Classification Manual we recommend that the extent of this influencing factor should also be more clearly operationalized and that "stimulation required" for the carrying out of an activity be included in the evaluation equivalent to the factor "supervision required" already introduced by Barthel and Mahoney. The BI has shown itself to be an efficient but nonetheless multidimensional global parameter in clinical practice, whose meaningfulness is on the level of the individual item and whose validity, particularly as total score and course parameter, needs to be proven for each new application. The Hamburg Classification Manual, as a standardized and consensus-based operationalization of the BI, provides an important basis for this.