Physiotherapists have a vital and important role in working with elderly people. They are involved in preventing disease and disability, treating current conditions, managing inpatient care and following up in the community.
Physiotherapists have a wide range of skills that can benefit many conditions suffered by elderly people. Elderly care physiotherapists specialise in the assessment, treatment and long-term management of older people in their homes, in hospitals and in care homes.
By 2030 one in five people in the UK will be over 65 and the number of older people continues to grow as a proportion of the total population. Many elderly people continue to be independent and healthy but as time goes on are likely to develop complex conditions and become more frail and disabled.
Over 65 year olds make up 80% of bed stays in hospital that last over two weeks.
Elderly people have specialised needs and often have more than one presenting medical condition at any one time, complicating the assessment and management of their problem.
Many physiotherapists specialising in working with elderly people belong to AGILE, the professional network of chartered physiotherapists working with older people. They continually develop the necessary skills to manage the complex needs of older people.
Where Will An Elderly Person See A Physiotherapist?
An elderly person might encounter a physiotherapist in a number of settings. In hospital for treatment or for diagnosis, they may be seen by a physio in that service such as a cardiac clinic, pulmonary rehabilitation, a neurological or stroke unit or an outpatient clinic.
Private physiotherapy clinics see a large number of elderly people, mostly with musculoskeletal conditions, and can often arrange a home physiotherapy visit if attending the clinic is too difficult.
What Happens On The First Appointment With The Physiotherapist?
The initial assessment is split into two parts, the subjective examination (mostly talking) and the objective examination (testing the person’s abilities).
The subjective examination goes through the problems the person is having, how they started, how long they have existed and what makes them better and worse. It also covers the medical history of other conditions that the person may be suffering from, as this is very common in working with older people.
Once the physio understands the problem and the general health status of the person, they can start examining the area concerned. This may be a general approach concerning balance and muscle power or could be more focussed such as looking at the shoulder joint’s movement and testing its ability to move normally and do functional activities.
In cases where joints such as the hip, knee, shoulder, neck or back are examined, it is useful for the person to take off enough clothing so the physio can get a clear view and test the area accurately.
What Treatments May A Physiotherapist Provide?
Much of the skill that a physio can provide to an elderly person is in the clear and precise assessment of the physical problems the person is suffering from. An explanation of the situation can then be given and an individual treatment plan formulated.
Most treatment plans involve altering the way someone is doing something and giving them an exercise regime to practise regularly. Improving balance, strength and mobility are often major aims. If the person is suffering from pain then this may be addressed with exercises, massage, heat or cold treatments, TENS machines, hydrotherapy in a pool and advice.
A physiotherapist can also give advice on gait correction and the safe use of walking aids such as a stick, crutches or a frame.
Elderly people can suffer from a wide range of medical conditions and these may include:
- Neurological conditions such as stroke and Parkinson’s disease
Cardiovascular conditions such as heart disease and angina
- Dementia and frailty
Which? Elderly Care is a useful resource and gives free, independent and practical advice about caring for older people in the UK, including information to support independent living and financing care.
A stroke occurs over 150,000 times each year in the UK and there are over 1.2 million people who have survived a stroke. It is the fourth largest cause of death and a significant cause of disability.
Specialist neurological physiotherapists undergo advanced training to assess, treat and manage stroke patients. They can help with:
- Weakness or paralysis (hemiplegia) of the muscles on one side of the body. The ability to direct movements easily may be lost.
- Spasticity, a continual increased spasm in the muscles, may interfere with normal movement.
- Loss of feeling or the presence of unusual sensations.
- Loss of postural and balance reflexes may mean difficulty in maintaining a sitting or standing position safely and limit walking ability.
- Joints of the affected side may stiffen up due to disuse and become stiff, painful and tight.
Neurophysiotherapists direct treatment at encouraging the brain’s ability to re-organise its pathways to make up for the damage from the stroke.
They position patients to minimise spasticity, make a mobility plan, practice sitting or standing balance, maintain joint ranges of movement, practice limb movements and functional tasks and advise on how patients should be handled to minimise injury and encourage recovery.
Respiratory physiotherapy may also be required due to weakness of the chest muscles and the forced immobility in a hospital bed.
Guidelines recommend at least 45 minutes of physiotherapy every day when in a stroke unit or in a rehabilitation unit. Specialist community rehabilitation teams in some areas may help continue progress after discharge.
Parkinson’s disease is a degenerative condition caused by the loss of cells in a part of the brain that controls automatic movements. Typical symptoms are tremor, difficulty initiating movement, rigidity of muscles, slowness of movement and loss of facial expression.
Physiotherapy for this condition focuses on improving posture, arm function, walking, balance and training on safely managing transfers from one position to another. Physios use exercise and strategies to help initiating movement to improve independence and safety.
Falls are the most common cause of death due to injury in people over 65, with head injuries and fractures being the most common results. In people aged over 65, one in three fall each year and in people over 80, around one in two suffer a fall each year.
This works out at three million falls per year and of these, half will fall again within the next 12 months, with 10-25% suffering a serious injury. The leading cause of death in over 75-year-old persons in the UK is injury from a fall. Repeated falls lead to increased hospital stays, higher rates of long-term care and increased mortality.
Community care costs after a fall requiring hospital admission are very considerable. After a hip fracture around half of sufferers are no longer able to live independently and fractures are increasing in number.
Programmes to improve balance and strength have been shown to reduce the risk of falls by up to 55%. Physiotherapists can assess physical problems that may contribute to falls risks, looking at muscle strength, balance, stability and mobility, and develop a programme of strengthening and balance improvement.
A multi-agency and multi-professional approach has been found to be the most effective way of tackling falls prevention. This may include acute hospitals, falls prevention teams, care homes, community and social services, housing teams and others. Interventions planned in this way have shown significant reductions in falls incidence.
An occupational therapist or OT assessment may also be useful as they take a wider view of the person, their activities and their environment. They can see the broader picture of how a person is coping within their home and advise on changes in activities, the use of products and the provision of equipment that may be useful.
Which? Elderly Care provides important information about falls prevention, common causes of falls, a checklist to prevent falls in the home and useful organisations and website for dealing with a fall.
Osteoporosis is the loss of more than 30% of bone mineral density or BMD. Bone density falls steadily with age, particularly after menopause in women.
A smaller loss is known as osteopoenia and may progress to osteoporosis over time. Over 300,000 people attend UK hospitals with fractures due to this condition every year. Hip fracture from falling is a very common osteoporotic fracture and only around 30% of people fully recover from this.
Physiotherapists can help by devising exercise programmes to strengthen back muscles, encourage functional ability and increase bone density by promoting weight-bearing and balance activities.
Osteoarthritis is the most common degenerative joint condition in the world and affects hundreds of millions of people. OA increases in frequency the older a person becomes and healthcare costs run into billions from disability costs and hip and knee replacements.
Physiotherapists can advise on maintaining joint ranges of motion, increasing muscle strength, gait correction, the use of sticks and crutches, pacing activity and weight control.
Dementia and Frailty
With the increasing proportion of elderly people in the population over the next twenty to thirty years, the number of older people who are frail or have dementia will also rise. Physiotherapists can work with people with dementia to improve functional ability and teach relatives how to manage activity and transfers.
Physiotherapists also work in health promotion, cardiac rehabilitation, incontinence and pulmonary rehabilitation with older people.
- AGILE. Chartered Physiotherapists working with older people. http://agile.csp.org.uk/
- Preventing falls. Which? Elderly Care. http://www.which.co.uk/elderly-care/your-relatives-needs/dealing-with-a-fall/342494-preventing-falls
- State of the Nation. Stroke statistics January 2016. Stroke Association. https://www.stroke.org.uk/sites/default/files/state_of_the_nation_2016_110116_0.pdf
- Physiotherapy after stroke. Stroke Association April 2012. https://www.stroke.org.uk/sites/default/files/physiotherapy_after_stroke.pdf