Introduction
Aging is a natural process of life. Getting old makes our body go through many physical changes. These changes usually lead to a decrease in muscle strength, bone density, body co-ordination, and even stiff joints, which sometimes can lead to falls and fractures. For elderly citizens, exercising may be the key for bringing back and sustaining the physical function required in daily living. Exercise programs designed by a physiotherapist can help in reducing body pain, enhancing the movement of joints, facilitating co-ordination, and boosting respiratory function.
Geriatric Physiotherapy covers a wide area of problems concerning the elderly. It aims to restore function or enhance residual functional capability and improving the quality of life in older people and particularly those with disabling impairments and/or frailty. [1]
Elderly people suffering from chronic diseases can also obtain benefits from physiotherapy. Though physiotherapy cannot stop the process of aging it can help to reduce the impact that it has on our bodies.
Current rehabilitation practice focuses on function and well-being, not exclusively on disease. [2] Rehabilitation of older adult patients can assist in preserving functional independence and improving the quality of life. [3]
One of the main goals of physical therapeutic procedures in the elderly is the restoration or maintenance of functional autonomy in daily living activities. Whilst necessity for care and assistance in an aged population rises dramatically with age, physiotherapy can efficiently reduce these needs. For an optimal therapeutic approach the therapists should take into account the particular characteristics of the ageing process as well as the predominant comorbidities, which should be correctly assessed in order to integrate those context factors into the rehabilitation program. This is only possible with a good functioning teamwork: The team should therefore include physicians, nurses, physiotherapists as well as social workers and other professionals.
Evidence based Geriatric Physiotherapy
Physiotherapists are trained professionals who can identify the factors that prevent elderly people from being active and independent. Exercising on regular basis can also help to reduce the risk and impact of illnesses that are more likely to affect older people.
There is reliable evidence for physiotherapy involvement for older people, especially those with falls, stroke, arthritis and frailty.
The Fundamental Principles of Geriatric Physiotherapy
- The effects of biological ageing reduce the efficiency of the body’s systems, but throughout life, optimum function is maintained in each individual by continuing to use these systems to their maximum capacity
- Physiotherapists have a key role in enabling older people to use a number of the body’s systems fully to enhance mobility and independence
- When neither improvement nor even maintenance of functional mobility is a reasonable goal, physiotherapists can contribute to helping older people to remain comfortable and pain-free
- Prevention of the development of problems in later life through health promotion
- Last but not the least; Disability is generally regarded as being due to a pathological process, or injury, not prima facie ‘old age’
Multidisciplinary Team
Ageing is characterized by decline in general physiologic function and this make chronic condition and multi-morbidity prevalent among older adults. These characteristics, among others, make recovery a challenging one among older adults; therefore, understanding principles of rehabilitation will facilitate delivery of effective therapeutic outcome to older adults.
The role of allied health professionals with specialized knowledge and skills in dealing with older people’s issues is essential, and a multidisciplinary team is required for the delivery of optimal care in response to the needs and aspirations of older people.
Geriatrics Rehabilitation Model
Geriatric rehabilitation models are embedded in those conceptual models for understanding disability. This will help to understand mechanisms of disability and how to achieve effective rehabilitation to improve or alleviate the disability defined. Among the notable models are: International Classification of Function, Disability, and Health (ICF); and International Classification of Impairments, Disabilities, and Handicaps (ICIDH-2) of the World Health Organization (WHO) [5]
Principles of Rehabilitation for Older adults
Three major principles to consider in geriatric rehabilitation are:
- Variation in older adults,
- Maximizing activity in older adults
- Concept that optimal health is directly related to optimal functional ability.
It is important to deal with an individual adult as a whole as variation in capacity of older adults of same age cadres greatly vary when compare to the variation noted within younger population cohort.[6] Rehabilitation goals should focus on improving older adults activity level because activity optimization is key in rehabilitation of older adults and many of the changes over time are attributable to disuse among aged. In acute setting , principles of rehabilitation may be geared to first stabilizing the primary problems , preventing secondary complications, e.g. contractures and pressure ulcers, and finally to restore lost functions. [6]
Conditions that can be intervened by a Physiotherapist
Geriatric conditions usually include musculoskeletal problems, mental illness, incontinence, and impaired senses, balance problems, chronic pain, and sleep deprivation. Physiotherapy treatments have been successful in resolving or managing each of these ailments. Here’s what physiotherapy has to offer to the field of geriatrics.
Pain from chronic conditions
Physiotherapy can help to decrease discomfort due to conditions like arthritis or osteoporosis. Usually, joint pain is caused by inflammation of the joints, injuries, arthritis, gout, etc. It can restrict mobility and lead to weakness or instability to perform normal activities if left untreated for a longer time. The goal of the physiotherapist is to restore the function of the muscles, bones, joints, tendons, and ligaments.
Improve strength and flexibility
Due to aging decreased strength and flexibility is one of the most common issues that almost every individual faces. Further, the condition can be worsened by the presence of other chronic conditions related to neurological issues, endocrine problems, and musculoskeletal issues. As a result of degenerative changes that occur due to old age, there is poor muscle tone and stiff joints, etc. A physiotherapist helps to alleviate pain and helps return to mobility. Some of the common causes of decreased strength are thyroid disease, anemia, and depression, lack of sleep, diabetes, congestive heart failure, and medication side effects. Physiotherapy helps to bring back strength and flexibility, and also improves patients’ quality of life.
Postural Instability and Balance Impairment
Balance impairment in the elderly is due to the loss of normal functioning of muscles and bones. It is most commonly caused due to arthritis and numbness in feet and legs, eye problems, blood circulation problems, and intake of multiple medicines. Physiotherapy treatment includes balance exercises to help improve the function of muscles & bones in individuals having neurological conditions such as Alzheimer’s disease, ALS, Parkinson’s disease, or suffered a brain injury.
Risk of injury
Physiotherapy helps to maintain stability. The physiotherapist teaches the patient to adapt to visual, mobility, balance, and muscle loss impairments to easily complete the activities of daily living. This awareness helps to reduce the risk of injuries and re-injury. Patients who have had a heart attack, or have other cardiovascular or pulmonary conditions such as pulmonary fibrosis or Chronic Obstructive Pulmonary Disease can benefit from physiotherapy by following a treatment regime that helps them to increase endurance and gain functional independence.
Prevention of risk of a fall
Falls are the leading cause of accidents among aged individuals, resulting in bone fractures and other injuries. A physiotherapist can train the individual in techniques to prevent a fall.
Maintaining an independent lifestyle
Recovery from pain due to an illness or injury allows the individual to lead an active and independent life for a longer period of time. Stretching and strengthening exercises are proven to be effective for older people. Patients with foot drop, spinal injury, and stroke are provided with walking aids to facilitate independent living and pelvic floor problems. The therapist works with the patient to ensure that he/she can remain as independent as possible.
What does Geriatric Physiotherapy include?
Physiotherapist aims to help and address the areas which require treatment. The therapist uses his/ her information to design a tailor-made program. The program includes strengthening exercises, range of movement (ROM), balance, and walking exercises.
Physiotherapy includes exercises, workouts, and the use of electric modalities such as Ultrasound, TENS, Shockwave therapy, Laser, etc
Muscle-strengthening exercises are done twice a week, one of the best treatments for osteoarthritis and bone health.
Moderate intensity activity like brisk walking is recommended.
Strengthening exercises for muscles can be done against resistance, by using stretchy bands.
Combination of moderate cardio, endurance, and balance exercises.
Conclusion
Geriatric Rehabilitation is the need of the hour. Physiotherapists must further develop geriatric rehabilitation in our jurisdiction and help to develop strategic alliances with other specialties, serving as a basis for a holistic approach towards Geriatric Population.
References:
- Van Balen R, Gordon AL, Schols JM, Drewes YM, Achterberg WP. What is geriatric rehabilitation and how should it be organized? A Delphi study aimed at reaching European consensus. European Geriatric Medicine. 2019 Dec;10(6):977-87.
- Khalid MT, Sarwar MF, Sarwar MH, Sarwar M. Current role of physiotherapy in response to changing healthcare needs of the society. International Journal of Education and Information Technology, 2015; 1 (3): 105. 2015;110.
- Silva A, Silva S, Fonseca CB, Garcia-Alonso J, Lopes M, Cardoso I, de Pinho LG. Promotion of Functional Independence in the Self-care Deficit of the Elderly Person with Orthopedic Disease and Technology. InGerontechnology III: Contributions to the Third International Workshop on Gerontechnology, IWoG 2020, October 5–6, 2020, Évora, Portugal 2021 (p. 149). Springer Nature.
- Kotsani M, Kravvariti E, Avgerinou C, Panagiotakis S, Bograkou Tzanetakou K, Antoniadou E, Karamanof G, Karampeazis A, Koutsouri A, Panagiotopoulou K, Soulis G. The Relevance and Added Value of Geriatric Medicine (GM): Introducing GM to Non-Geriatricians. Journal of Clinical Medicine. 2021 Jan;10(14):3018. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8304813/(accessed 11.9.2021)
- Hoenig H, Kortebein PM. Overview of geriatric rehabilitation: Program components and settings for rehabilitation. UpToDate, Waltham, MA. Accessed. 2019;3(24):20.
- da Silva MM, Curty BI, Duarte SD, Zepeda KG. Nursing safety management in onco-hematology pediatric wards. Rev Rene. 2014 Nov;15(6).