Physiotherapy and Older People

Introduction

Geriatric medicine word cloud

There is solid evidence that older adults, especially those with falls, stroke, arthritis, and frailty, need physical therapy.

1. There is strong evidence for the effectiveness of primary care/community-based falls prevention interventions for older adults, eg. Otago Exercise Program under Physiotherapy Supervision. International evidence exists that exercise interventions are beneficial for frail older adults Mainly physical therapy led or supervised.
2. Physiotherapy is a core component of Comprehensive Geriatric Assessment (CGA) and is known to improve outcomes in older adults, especially the frail. The CGA approach is part of successful geriatric orthopedic care and a new frontier in perioperative surgical care of the elderly.
3. Together with specialist aged care ward physiotherapists, core members of the Stroke Unit Multidisciplinary Team provide care to patients in the Acute Stroke Unit Stroke Rehabilitation Unit and the Community Stroke Team. Multidisciplinary stroke care has been found to be highly effective Improve results. [1]

Fundamentals of Physical Therapy for the Elderly

Disability is often considered to be due to pathological processes or injuries rather than ostensible “old age”. The effects of biological aging reduce the efficiency of body systems, but each individual can maintain optimal function by continuing to use these systems throughout life Maximum capacity of the system. Physiotherapists play a key role in enabling older adults to take full advantage of some of the body’s systems to enhance mobility and independence. When improving or even maintaining functional mobility is not a reasonable goal a physiotherapist can contribute. Helping seniors stay comfortable and pain-free Preventing the development of problems in later life by promoting health

This Physiopedia article describes the common setting of physical therapy for older adults and the assessment and treatment of older adults with subsequent discharge planning and outcome measurement.

Physiotherapy Settings

Geriatric Care

In the UK, a number of schemes have been developed to provide better health and social services systems for older people. Much of this involves physical therapy, and the following are some of the more common areas of work for physical therapists working with older adults:

• Health Promotion and Disability Prevention Program
• Hospitals: Seriously ill patients in general wards or specialized geriatric wards or specialized rehabilitation wards.
• Outpatient Clinic or Day Assessment and Rehabilitation Unit: Individuals often require the input of multiple specialties and spend a day at a center that provides rehabilitation.

Elder in day care unit

Community:

• Community physical therapy in an individual’s home or a doctor’s office. This can be provided by a private physiotherapy company or a government-funded health service.
• Regional and local outreach services often target specific conditions. For example, a neurological or respiratory disease monitoring service with rapid response capabilities if a therapist detects a decline in a patient’s condition.
• Intermediate care, where care is co-funded by health and social services. This care is established by a multidisciplinary team and lasts an average of two to six weeks to prevent (re)admissions in older adults. This can take place in the person’s own home or A bed reserved for rehabilitation in a residential care facility.
• CBR teams can last up to 12 weeks. Historically, funding for such teams has been to facilitate early discharge of patients following a stroke, but now they accept patients with orthopedic and general rehabilitation needs
• Physiotherapists on the mental health team can be called on to give expert advice.
• In research institutions that study age-related conditions and issues.

Essential Skills for Geriatric Physiotherapists

Elderly care is complex because it comes with multiple conditions and requires many expertise. Older adults often present with musculoskeletal cardiovascular and neurological disorders. [2] These categories may overlap because older adults often have many diseases. Because of the impact of aging on the health status of older adults and their patterns of disease manifestations, it is recommended that physical therapists of older adults should be trained in musculoskeletal neurological and cardiovascular assessment and management of older adults. basic Therefore, the skills of a physical therapist specializing in geriatric care should include a thorough knowledge of these three categories of physical therapy practice, with an emphasis on the care of older adults.

Assessment

Treatment assessment and principles for older adults should follow recommended national protocols and guidelines. The assessment of the elderly differs from that of the young by taking into account the physical differences that occur with age. have different models The most common and inclusive model of rehabilitation is the World Health Organization (WHO) International Classification of Disability and Health [3]. Often referred to as the ICF, the framework provides a model by which healthcare professionals can examine multiple injuries and correlate Relate them to relevant areas of an individual’s life to guide assessment goal setting and treatment planning.

License granted by the World Health Organization. Source: International Classification of Functional Independence and Health in short booklet (WHO 2001), p. 26. HTTP://WWW.WHO.INT/CLASSIFICATIONS/ICF/EN/; ISBN / WHO Ref. No. 92 4 154544 5

The ICF is valuable to clinicians because it can guide a comprehensive assessment of older adults. The ICF helps clinicians assess how impairment typically affects activities of daily living and how people engage in social roles later in life [4]. ICF also considers the following persons context. Examples include environmental factors (physical location and social attitudes) and personal factors (drug factors, social support). These can act as barriers or facilitators in the analysis and subsequent planning of appropriate nursing interventions and supports. as a Points of Interest Many hospitals in the UK now use the related International Classification of Diseases and Related Health Problems (ICD-10) to code questions on patient admission, which complements the ICF.

Medical history: It is important to obtain a complete medical/surgical history and supporting drug history

• Medications, in particular, can have a major impact on older adults and can lead to reduced mobility and falls. See Medications and Older Adults
• Individuals may not report significant medical conditions (e.g. cardiovascular disease)

Social history: Significant older adults often rely on formal or informal (family and friends) support. For example, how does a physical therapist (and other related health disciplines) guide rehabilitation for an older person who is being discharged from the hospital alone but cannot stand safely Cook a meal or walk to the store to buy food.

The ICF can guide the clinician in the assessment and act as a checklist to ensure that all relevant history and assessments are included.

Treatment

Older persons exercise class

The nature of physical therapy means that assessment and treatment often focus on the physical nature of a person’s condition. For older adults, physical activity in daily life is an important starting point for treatment. Intervention should include (re)assessing a person’s the abilities and challenges of getting on/off functional tasks such as a chair or bed as well as overall movement.

After assessing older adults performing tasks such as chair transfers, physical therapists then identify potential impairments affecting the task. Examples include strength and balance deficits or psychological impairments, such as a fear of falling. Physiotherapists use few techniques Whether using manual techniques in a clinic setting (although mechanical changes to the human skeleton may require us to modify treatment positions) or performing functional interventions in an individual’s home, this differs from what is taught for all age groups.

Some healing techniques must be given due attention and more time allowed to learn and practice skills and exercises. For example, for an acute sprain, history taking is no different, but treatment takes more account of past history and state before injury. Treatment may still initially include rest ice compression and elevation, but the therapist must also assess the condition of the skin to allow safe application of the ice or compression effects. For example, if treatment with ice elevation and rest is for Ankles that are already swollen, you must consider assessing the length of the hamstring muscles to ensure that the person has adequate length. This will confirm that the patient can sit comfortably with the hips bent to 90 degrees or more during treatment.

Goals

Goals are important to keep treatment person-centred and coordinate care.

• The goal should be more towards managing and improving the condition, rather than passively “caring” for the elderly.
• Sometimes, whether in a hospital or community setting, it is appropriate to work with another team member, not only to learn from each other, but also to ensure that you are working towards the same goals for your own personal benefit [5].

The goal may be to improve function in older adults or to maintain current function and prevent decline.

• The therapist must know what are acceptable “norms” for this age group, such as age-related changes in gait and posture.
• Sometimes there can be a conflict between the patient’s goals and the therapist’s ideas about what might be safe. The task of the physical therapist is to emphasize the risks and minimize them as much as possible, not to completely stop a person from functioning.

Discharge Planning

Discharge planning requires careful consideration and is an important element in preventing adverse events after discharge. Adverse events occurred within 30 days of discharge in nearly 20% of patients. Research shows that 75% of these could have been prevented or improved. [6] See more links

Outcome Measures

Outcome measures are measures of change (usually from pre-intervention to post-intervention). What you measure depends on your definition of “outcome of interest”, i.e. who wants the data and for what purpose. Physiotherapists may be interested in how a person’s functioning has changed; managers and buyers in the cost of bringing about this change; and individuals in their day-to-day performance.

See Category: Geriatrics/Geriatrics – Outcome Measures