Physiotherapy and Older People

Introduction

‘Working with older people can present the physiotherapist with a set of challenges unparalleled in other areas of practice. The caseload is very mixed; patients with musculoskeletal, neurological, and cardiovascular problems may all be found in a single caseload and often in the same patient. Interlinking between medical, psychological, rehabilitative, economic and social problems that all need attention is the norm, rather than the exception. Add to these the differences in presentation of disease, the unique pattern of ageing in each individual, and the varying responses that older people may demonstrate, and the complexity of the challenge is obvious.’ Pickles (1995) 

Physiotherapy settings and onward referral
Many initiatives have been set up to provide better systems of health and social services for older people. In the UK, most of these involve physiotherapy with the more common areas of work for physiotherapists with older people  listed below: 

  • In health promotion and disability prevention programmes
  • In hospital – either acutely ill on the general wards or on a specialised older person's unit; or a specialised rehabilitation ward.
  • Ambulatory clinics or Day Assessment and Rehabilitation Units – where individuals classically require input from more than one profession and spend a day in a centre where rehabilitation is provided
  • Community – a term that encompasses settings such as:

o Community physiotherapy in a person’s own home or at the doctor's clinic.

o Regional and local outreach services, often for specific conditions, e.g. neurological or respiratory conditions to provide a monitoring service with rapid response capabilities should the therapist detect a decline in the person’s condition.
o Intermediate Care, with the provision of jointly funded health and social services set up through a multi-disciplinary team for an average of 2–6 weeks to prevent (re)admission of older people into hospital. This can take place either in the person’s own home or in beds set aside for rehabilitation at a Care Home.
o Community Rehabilitation Teams, with a longer remit of up to 12 weeks, historically funded to promote the early discharge of people post-stroke, but who now take those with orthopaedic and general rehabilitation needs

  • Physiotherapists in mental health teams, who can be called upon for specialist advice.
  • In research institutes looking into age-related conditions and issues

A physiotherapist working with older people can be considered a ‘Jack of all trades’. Far from being a term of belittlement, the phrase should be regarded with respected for the skills necessary to apply all aspects of the bio-psycho-social model to ensure a holistic, patient-centred approach. All over the UK advanced practice posts like Clinical Specialist and Consultant posts are emerging for physiotherapists in this clinical field. Knowledge, therefore, in respiratory care, orthopaedics, neurology, medicine together with awareness of psycho-social aspects are essential.

{{subst:Key point}}