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Geriatric Treatment

Biomechanical Stimulation

Abstract

Women 65 years of age and older are the fastest growing segment of the population. As women age, physical inactivity is the leading cause of morbidity and mortality due to coronary heart disease, diabetes mellitus, and hypertension. There is also a loss of both physiologic and psychological capabities that contributes to an overall reduction in function and independent living. Regular physical activity in geriatric women has been shown to reduce cardiovascular morbidity and all-cause mortality. Further research needs to be done to evaluate the role of regular physical activity in the management of diabetes and hyperlipidemia.
Introduction

As we enter the twenty-first century, we are faced with the reality that the fastest-growing segment of the population is women aged 65 and older. Within this age group, women significantly outnumber men,[1] with the average woman living to 76.7 years of age.[2] As women age, physical inactivity is recognized as contributing to the increases in morbidity and mortality due to coronary heart disease (CHD), diabetes mellitus, hypertension, and obesity.[3,4]

Inherent in the natural aging process is the loss of both physiologic and psychological capabilities, which contributes to a reduction in overall function and independent living.[5,6] During the past 30 years, studies have shown that exercise and physical activity improve functional capacity,[7,8] reduce risk of illness,[9,10] improve health, and ultimately enhance quality of life.[11] However, much of the literature in support of regular physical activity has been obtained from studies in young and middle-aged men.

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Geriatric Treatment

Biomechanical Stimulation

Chapters 8 through 11 present a variety of management issues; the issue of working with patients with cognitive impairments and depression is explored from both psychotherapeutic and general staff perspectives. The value of psychotherapy with older clients is covered in chapter 11. The final chapter explores the role and problems of the caregiver and provides suggestions for ways that the staff of a rehabilitation center can help caregivers cope with the stress of the role.

Throughout the book, research findings and management suggestions are provided to form a comprehensive picture of the psychological aspects of rehabilitation with elderly individuals. This book is quite readable, with minimal duplication among chapters. A detailed reference list follows each chapter.

The book is designed for use by all rehabilitation personnel, and general staff concerns are consistently addressed. Though not a text for students, the book would be useful to all practitioners working with elderly clients, regardless of setting, and would make a useful reference for entry-level or graduate students interested in geriatric care.

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Geriatric Treatment

Biomechanical Stimulation

The first three chapters provide an overview of the topic, with chapter 1 differentiating briefly between the needs of younger and older rehabilitation clients, chapter 2 providing an overview of normal physiological aging, and chapter 3 reviewing normal psychological aging. Chapter 4 focuses on how the older individual adapts to the rehabilitation setting. Problems related to loss of independence, to loss of peer support, and to the youth orientation prevalent in many rehabilitation centers are addressed. Several individual and group interventions are suggested.

The next three chapters focus on assessment of cognitive factors Noun 1. cognitive factor – something immaterial (as a circumstance or influence) that contributes to producing a result
cognition, knowledge, noesis – the psychological result of perception and learning and reasoning , emotional factors, and dementia. One author, Rentz, reviews a number of studies on the effect of cognitive dysfunction on rehabilitation outcomes and concludes that diminished cognition.

Act or process of knowing. Cognition includes every mental process that may be described as an experience of knowing (including perceiving, recognizing, conceiving, and reasoning), as distinguished from an experience of feeling or of willing. , in and of itself, does not mitigate against rehabilitation potential. She emphasized the value of a knowledgeable staff and programs aimed at the client’s cognitive level. Trezona, another author, explores the effects of anxiety on learning and makes recommendations for improving the client’s emotional state. An overview of dementia associated with physical disabilities is presented, and several evaluative forms are addressed.

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Geriatric Treatment

Biomechanical Stimulation

When gathering information for this article, I looked at the “numbers” over the years. We often hear that women outlive men – from my very tiny study, this is true. Females make up 76 per cent of all the residents I have treated. The average age is in the over 85 category – 58 per cent. The average number of treatments per resident came out to 28. Residents like to have and also need their massage on a regular basis.

For best results, a minimum of once a week is recommended.

If you are considering approaching a personal care home about setting up a massage therapy program I believe there are two key criteria.

1) The massage therapy program must be self-sufficient. The board of the personal care home will not
be able to approve a program that will cost them money!

2) In the referral process, all caregivers should be able to refer the resident for massage, as well as the resident them self.

Of course, there are aspects of working in this field which cannot be ignored. Of all of the residents who have received massage treatment since December of 1998, 47 per cent have passed away. I would have to say that this is the hardest part of my job. The residents do become a part of my extended family. You hear talk of professional detachment, this is very difficult in the setting of a personal care home. Home is the key word, and home means family. I was able to attend a course offered here by Hospice and Palliative Care Manitoba – “A Friend in Hand.”

This 8-week course explores attitudes toward death and dying. I would advise anyone who is thinking of working in the geriatric field to consider a course of this nature.

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Geriatric Treatment

Biomechanical Stimulation

Therapists are required to report observed concerns to the health care professional on duty – e.g. increase in edema, skin discolorations, changes in moles, changes in personality/ mood, increase/decrease in rigidity/ tremor etc. These observations should be documented in clients’ charts as well. Be conscientious in thought, place yourself in the resident’s position and be aware of their comfort and care before during and after the massage treatment.

Hypertension, congestive heart failure, osteoarthritis, diabetes, dementia, declining tissue integrity, and paralysis are some of the many conditions that are seen when working with the elderly. Contraindications are dealt with somewhat differently than in the younger population.

It requires weighing the benefits against the possible negative effects. Being familiar with these, as well as a host of other conditions, will make your treatment more effective.

Understanding the medical abbreviations will also speed things up when charting, these are used with frightening regularity!

Incontinence pads are a fact of life working in a personal care home. Pads come in many forms, depending on the type of incontinence. Often, when performing a massage, they will become soiled. This now becomes a matter of choice for the therapist.

You may halt the massage at this point and have a health care aide attend the resident, or, continue if at all possible. It is key to remember at this point that constipation is a far too common and painful condition among the elderly and a bowel movement during a massage is a small price to pay for the relief of it.

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Geriatric Treatment

Biomechanical Stimulation

The daily working environment is much different than working in my massage therapy clinic. Working at a personal care home requires adaptability, to say the least. Everything from scheduling appointments to the application of the treatment has to be adapted to fit the needs of the resident. Massage therapy should enrich their weekly routine, not replace something else they enjoy because it fits into the therapist’s schedule.

As they say, “timing is everything.” If the resident is in a wheelchair, scheduling should include the time necessary to have one or two health care aides to assist them into their bed for massage. Health care aides are necessary for lifting and assisting the residents as they have the full coverage necessary with the personal care home’s insurance for this task.

You must also consider that appointments will be cancelled at the last minute for a variety of reasons. For this reason, I schedule appointments quite close together.

Often, residents have given power of attorney to a loved one. This requires the contact of this person, usually the son or daughter, regarding the massage therapy program. They will then approve treatment and arrange for payment. Most residents have trust accounts with the personal care home and, once approval has been obtained, the accounts may be billed directly. Talking with families is one of the bonuses of my job – they love to hear how mom/dad/grandma/grandpa is doing.

There are specific responsibilities one must carry out when working at the personal care home. There should be open communication with family members and staff, and flexibility with scheduling, as mentioned above.

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Geriatric Treatment

Biomechanical Stimulation

by Sheila Savary
The population is aging. The baby boomer generation, the largest of its kind, is now entering its “golden” years. The number of people age 65 and over is expected to double from nearly 4 million in 2000 to almost 8 million by 2026. The population is aging. The baby boomer generation, the largest of its kind, is now entering its “golden” years. The number of people age 65 and over is expected to double from nearly 4 million in 2000 to almost 8 million by 2026.

This could lead to the conclusion a career in geriatric massage therapy would be lucrative. However, careful consideration is required before entering into this specialized field.

Since December 1998, I have had the good fortune to have a contract with The Middlechurch Home of Winnipeg, a personal care home north of Winnipeg.

Working with the elderly has many advantages. If you love physiology and pathology (as I do), the opportunities to explore and understand are enormous. Every moment of every day that I’m working with the aged, I learn more about the human body, the human condition, and myself, than I had ever thought possible.

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Geriatric Physical Therapy

Biomechanical Stimulation

Physical therapists evaluate and develop specifically designed, therapeutic exercise programs. Physical therapy intervention can prevent life-long disability, restoring the person’s level of functioning to its highest level. A physical therapist uses things such as treatments with modalities, exercises, educational information, and screening programs to accomplish a number of goals with the person they are working with, such as:

* Reduce pain
* Improve sensation, joint proprioception
* Increase overall fitness through exercise programs
* Suggest assistive devices to promote independence
* Recommend adaptations to make the person’s home accessible and safe
* Prevent further decline in functional abilities through education, energy conservation techniques, joint protection
* Increase, restore or maintain range of motion, physical strength, flexibility, coordination, balance and endurance
* Teach positioning, transfers, and walking skills to promote maximum function and independence within the person’s capability

There are various common conditions that can be effectively treated through physical therapy. Among the specific diseases and conditions that might affect older adults which can be improved with physical therapy are arthritis, osteoarthritis, stroke, Parkinson’s disease, cancer, amputations, urinary and fecal incontinence, and cardiac and pulmonary diseases. Conditions such as Alzheimer’s disease, dementia’s, coordination and balance disorders, joint replacements, hip fractures, functional limitations related to mobility, orthopedic or sports injuries can also be improved through geriatric physical therapy.

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Geriatric Physical Therapy

Biomechanical Stimulation

Physical Therapists

Physical therapists provide people with a variety of services. They work with people individually, evaluating their physical capabilities and designing specific programs of exercise, education and wellness for them. Physical therapists also work with other health care providers to coordinate the person’s care.

Physical therapists must have completed their coursework in the biological, medical, psychological and physical sciences. They must have graduated from an accredited education program, and have completed a bachelors, masters, or doctoral degree with specialty clinical experience in physical therapy. Many physical therapists choose to seek additional expertise in clinical specialties, although every physical therapist must meet licensure requirements in their state.

The potential for age-related bodily changes to be misunderstood can lead to limitations of daily activities. The usual process of aging does not need to result in pain, or decreased physical mobility. A physical therapist can be a source of information for understanding changes in the body, they can offer assistance for regaining lost abilities, or for development of new ones. A physical therapist can work with older adults to help them understand the physiological and anatomical changes that occur with the aging process.

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Geriatric Massage

Biomechanical Stimulation

Forms of Geriatric Physical Therapy

Exercise: Exercise is defined as any form of physical activity that is beyond what the person does while performing their daily tasks. Exercise is something that is designed to both maintain and improve a person’s coordination, muscle strength, flexibility and physical endurance, as well as their balance. It is meant to increase their mobility and lessen their chance of injury through falling. Exercise in relation to geriatric therapy might include activities such as stretching, walking, weight lifting, aquatic therapy, and specific exercises that are geared towards a particular injury or limitation. A physical therapist works with the person, teaching them to exercise on their own, so they may continue their exercise program at home.

Manual Therapy: Manual therapy is applied with the goals of improving the person’s circulation and restoring mobility they may have lost due to an injury or lack of use. This form of therapy is also used to reduce pain. Manual therapy can include manipulation of the person’s joints and muscles, as well as massage.

Education: Education is important to the success and effectiveness of geriatric physical therapy. People are taught ways of performing daily tasks safely. Physical therapists also teach people how to use assistive devices, as well as how to protect themselves from further injury. Older adults can utilize physical therapy as a means for regaining their independence. Physical therapy can help seniors to feel better, as well as to enjoy a higher quality of life.

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