The Assessment of the Older Adult with a Physical Disability: A Guide for Clinicians

The Assessment of the Older Adult with a

Physical Disability: A Guide for Clinicians

According to the United States census conducted in 2000, there are more than 33 million noninstitutionalized Americans older than 65. Of these older Americans, 28.8% reported living with a physical disability and 9.6% reported a self-care disability . According to the National Aging Information Center, 2,192,563 Americans have both a mobility and a self-care limitation. These numbers rise considerably in the 85-plus age group, with 49.8% of people reporting a self-care or a mobility limitation or both

Given these staggering numbers, it is imperative that clinicians caring for this older, frailer population be able to perform a comprehensive medical and psychosocial assessment that adequately addresses its needs and limitations.

Disability-related symptoms

Communication and swallowing

Pain

Fatigue

Falls

Sleep

Sexuality

Bowel and bladder

Spasticity

Mobility and adaptive equipment issues

Lower limb prosthetics

Lower limb orthotics

Ambulation aids

Wheelchair

Home adaptive equipment

Disability-related psychosocial issues

Depression

Aging caregivers

Gaps in care

Limited finances

The Role of Occupational Therapy in the

Care of the Older Adult

Occupational therapy (OT) is skilled treatment that helps individuals achieve independence in all areas of their lives . An OT is a board-certified licensed professional who may practice in a wide variety of settings for the geriatric population, including hospitals, nursing homes, skilled nursing facilities, and homes. Treatment involves providing people with the skills necessary for independent and satisfying lives. Services typically include

Customized treatment programs to improve the client's ability to perform daily activities

Comprehensive home and job-site evaluations with adaptation recommendations

Performance skills assessments and treatment

Adaptive equipment recommendations and usage training

Guidance to family members and caregivers

OT practitioners are skilled professionals whose education includes the study of human growth and development, with special emphasis on the social, emotional, and physiologic effects of illness and injury. The aging process often leads to a variety of illnesses and injuries that can greatly affect the ability of the elderly to complete their daily living activities. OTs therefore play a vital role in the provision of skilled health care services to the geriatric population.

A wide variety of OT services can benefit the geriatric population, including those with the following conditions:

Chronic back pain and repetitive stress injuries

Limitations following a stroke or heart attack

Arthritis, multiple sclerosis, or other serious chronic conditions

Burns, spinal cord injuries, or amputations

Broken bones or other injuries from falls, sports, or accidents

Vision or cognitive problems that threaten their ability to drive and/or perform home/community mobility

The OT plays an important role as a member of an interdisciplinary team.

This team typically includes a doctor, nurse, social worker, physical therapist, and speech therapist. OTs are able to provide pertinent feedback to the team on the problems and goals of the elderly from a unique perspective, one that

primarily focuses on the patient's functional level for performance of activities of daily living.

The OT therefore plays a vital role in the care of the geriatric population.

The OT is instrumental in determining the health care needs of the older population and providing the OT services that ultimately enhance the quality of living and health of the older population as well as the functional independence for daily living activities.

OTs also recommend alternative methods of performing daily life tasks, such as new techniques for performing ADL that promote energy conservation and protect fragile joints. OTs are instrumental in educating and prescribing adaptive

devices, as appropriate, to facilitate increased independent performance of ADL tasks with reduced pain and effort. Examples of adaptive devices include (1) reacher (Fig. 1) to extend the patient's reach for objects, (2) sock aid to

facilitate donning socks, (3) long shoe horn (Fig. 2) to facilitate donning and doffing shoes, (4) built-up-handled utensils to facilitate grip, (5) grab bars in the bathtub for transfer safety, (6) shower chairs for energy conservation and

compensation for reduced balance, (7) raised toilet seats to facilitate sit-to-stand transfers (Fig. 3), and (8) long-handled sponges (Fig. 4

Fig. 1. Reacher.

Fig. 2. Long shoe horn.

Fig. 3. Tub transfer bench and tub grab bar.

Fig. 4. Long-handled sponge.

A Geriatrician's Guide to the Use of the

Physical Modalities in the Treatment of Pain

and Dysfunction

The treatment of pain and dysfunction in the geriatric population is a challenge.

As Gerald Felsenthal eloquently concludes in his 1994 textbook Rehabilitation of the Aging and Elderly Patient: ''To simply ascribe pain in the elderly to arthritis and to merely prescribe medication without giving thought to the full impact that the pain may have on the patient's function is a disservice. An aggressive multidisciplinary approach may ultimately help the patient to continue or resume a productive and functional existence.'' A conclusion written today,

more than a decade since the book's publication, is an echo of his wisdom. This multimodal approach to the management of pain and dysfunction has since been broadcast by the American Pain Society and the Agency for Health Care Policy and Research. Its message is perhaps most applicable to the geriatrician. In this unique population, the physician has the opportunity to restore function and thus independence and sanctity. By learning and employing a multimodal approach to the management of pain and dysfunction with a concentration on the use of the physical modalities, the physician may restore, preserve, and perhaps even enhance functionality.