Nursing Homes Abuse Blog - By Jonathan Rosenfeld

Before I began representing seniors who had suffered an injury in a long-term care settings, I considered physical as a tool for young people who had sustained some type of sports-related injury.

I had visions in my head of the time I spent working with an extremely helpful (and aggressive) physical therapist after I dislocated my shoulder swimming in college.  Little did I know how valuable physical therapy can be for elderly nursing home patients in terms of helping them improve physical conditioning and improve the quality of their life. 

Physical therapy and rehabilitation are used to treat patients suffering from illness, disease or injury.  Therapy can improve their mobility, strength, flexibility, coordination, endurance, and even reduce pain.  The goal of physical therapy is to restore, maintain, or promote optimal physical function.  Physicians and physical therapists create individualized therapy plans to address each patient’s needs.   

Geriatric physical therapy is a specialty area that focuses on older adults and aims to restore mobility, reduce pain, and increase fitness level.  It is important that older nursing home residents receive physical therapy from skilled physical therapists in order to ensure that dangerous accidents or injuries do not occur.  As the population of older adults increases, there will be an increased demand for physical therapists who specialize in or are educated in geriatrics.  Currently, 37% of physical therapy practice involves elderly people, and almost 50% of the physical therapists who treat older adults (age 65 and older) practice in nursing homes. 

Physical therapy is a useful tool for helping treat older people.  One of the most common reasons an older person requires physical therapy is that they suffer from a fall.  Physical therapy can help ease pain from injuries and improve balance.  Many conditions that often plague older adults are well-suited for physical therapy treatment including: arthritis, osteoporosis, pain associated with cancer, strokes, dementia, Alzheimer’s, and incontinence.  One of the best improvements gained by physical therapy is improved independence. 

Many nursing home residents receive physical therapy in order to achieve, restore, or maintain the best possible physical well-being.  One study that looked at the benefits of physical therapy for nursing home residents revealed that physical therapy was frequently used to the benefit of most residents.  However, the likelihood of benefit from physical therapy decreased with cognitive impairment, very advanced age, and very advanced age. 

Another study acknowledged the importance of executing a comprehensive physical assessment of nursing home residents before starting physical therapy because many residents suffer from multiple injuries and diseases.  The standard protocol for physical assessment includes measuring range of motion, muscle force, muscle reflex activity, sensation, soft tissue status, balance/coordination, and posture.  This assessment helps physical therapists plan and prioritize treatment, identify when goals have been met, and recognize when there is a need for treatment modification. 

By the age of 65, most people suffer from arthritis in the spine.  Physical therapy can help improve strength, balance and motion with the use of aquatic therapy, hot packs, electrical stimulation, and ice to reduce swelling.  Osteoporosis can be treated with balance exercises and extension exercises to help improve posture and prevent dangerous falls (exercises for osteoporosis).  People suffering from cancer often have associated pain which can be treated with physical therapy exercises to reduce swelling and improve range of motion.  One condition that plagues many older adults is incontinence (loss of bladder control), which physical therapists can treat by helping the patient locate the muscles that control the urinary tract. 

For older adults, physical therapy can be just one more treatment method to try, when their bodies cannot withstand surgery or more dangerous treatment options.  An added bonus of physical therapy is that it does not bring along with it the unwanted side effects of drug treatments or surgery.  However, that is not to say that physical therapy is not without risks (see accompanying article - Physical Therapy: Injury). 

Resources:

FindArticles.com: Challenges Associated with Providing Physical Therapy for Elderly People: Implications for graduate education

Illinois Physical Therapy Association

MedicineNet.com: Physical Therapy a Boon for Seniors

PT Journal: The Impact of Physical Therapy on Nursing Home Patient Outcomes

PT Journal: Physical Therapy Assessment and Treatment Protocol for Nursing Home Residents

Department of Health and Human Services: Office of Inspector General: Physical and Occupational Therapy in Nursing Homes Cost of Improper Billings to Medicare