In my clinical experience there are actually two age groups which present problems of rehabilitation.
The first group is the comparatively young (e.g. ages 30-40) males in manual labor positions who often have (or came from) families with one or more disabled family members *and* who themselves have no alternate skills for non-labor intensive occupations. Within a year of injury, these individuals acclimate to a sedentary lifestyle of watching television, gaining weight and inactivity aside from doctor visits and physical therapy visits. Dependency upon medication arises. These individuals can be readily identified and assisted if referred soon after injury.
The second group is comprised of two subgroups, but they share in common their age ranges. This group is the age range of ~48-60 years of age. The first of these subgroups are those who are working to offset boredom and have no financial need to be in the workforce. Their motivation to confront their injury-related problems in order to return to productivity is very low. Vigorous efforts to mobilize them will ultimately fail, and such patients need to be early identified so that care is more targeted to a decision they have already made.
The other subgroup of these middle aged individuals is comprised of those who have had a long, productive and effortful career. In effect, they are simply tired. They feel they have made their contribution to their family and the workforce. While they obviously would prefer not to have been injured, the injury provides the secondary gain of early _retirement_ and justification for seeking social security benefits which they have funded for decades. Once again, early identification of these patients enables assisting them in realizing that this is the decision that they are making and how best for them to communicate this to their families._