Case studies are utilized as a way for students to learn the principles of geriatric assessment including physical, cognitive, social, psychological, and environmental assessments. Goals are to promote wellness, independence, and successfully maintain or improve the quality of life for the patients who we see. As physical therapists we focus on movement, function, and mobility performance (gait, balance, and transfers). In today’s payment situation, we must be efficient in our ability to perform rapid screens to identify target areas for examination and then intervention. But in the older population we must at the same time be vigilant so that complications from comorbidities, “yellow” or “red” flags, do not escape us. The use of Clinical Practice Guidelines (CPGs) is incorporated into the cases wherever applicable. The American Physical Therapy Association (APTA) and the various academies associated with APTA encourage the creation of CPGs for physical therapy management of patients with physical impairments and functional limitations described in the World Health Organization’s International Classification of Functioning, Disability and Health (ICF).
EXAMINATION OF THE GERIATRIC PATIENT
The core to determining what interventions need to be performed is first performing a comprehensive evaluation and examination. This is necessary for all patients. This chapter is not a guideline about how to perform an evaluation but some special thoughts to consider with older individuals. As we age, the incidence of chronic diseases and wear-and-tear injuries add to the normal aging changes, requiring in-depth questioning and use of functional tests and outcome measures. As people age, it becomes more difficult to adapt to stresses placed on the body, our organ system’s capacity decreases, function decreases, and impairments and disabilities increase. The geriatric physical therapy examination must consider all biopsychosocial realms of the patient, both internal and external, that may not affect the outcomes in the same way as most younger individuals. The older individual who comes to physical therapy can have concerns about many physical, social, and psychological issues. Environmental factors including housing, home safety, and transportation will affect how the older clients’ needs will be addressed. As an example, think about the patient seen by a physical therapist who may be under a great deal of stress and is justifiably concerned about the illness of a spouse or the potential of becoming institutionalized themselves. When teaching treatment techniques in physical therapy school, students are often taught in silos, meaning they learn range of motion (ROM), manual muscle testing (MMT), sensation, transfers, etc, without adequate synthesis of these procedures into older adults. For instance, measuring ROM and performing MMT on fellow students may translate into the students believing that all older adults are not “normal.”
How does the evaluation of a geriatric client differ from a middle-aged adult? The middle-aged patient may come to physical therapy for a specific problem, perhaps carpal tunnel. The therapist would try to determine the mechanism of injury and then determine how ...