My grandmother often said, “You can see a fly on someone else’s back but you cannot see an elephant on yourself”. Today’s column is dedicated to illuminating our elephants and finding ways to liberate them. The elephant I am most apprehensive about is whether or not we recognize how many of our patients are truly geriatric and in turn take the time to appropriately modify the treatment programs given to these patients based on medical evidence and not hearsay or old wives tales. The past few Geriatric Function columns have been devoted to treatment techniques and adaptations for working with geriatric patients based on the most recent evidence-based treatment approaches for a variety of different diagnoses ranging from Parkinson’s disease, stroke, balance, and osteoarthritis. Yet I feel like a preacher preaching to an empty church. The more I seem to publish, the more I seem to see older persons coming into the office saying ‘Why don’t other therapists know this information’ or ‘Why don’t other therapists do these types of things’.

While running, I began to think that possibly therapists just don’t think that their patient population is geriatric. I am challenging you to look at who your patients really are. Recently, I received a fax on how to open an office or pursue new marketing ideas. In the fax, demographics were defined as the location, number of people in the surrounding area, and average income. A special comment said to look specifically at the number of individuals over the age of 65. I questioned this. Why would you want to know how many people are over 65? The reason is that these people are high-utilizers of health care services. In fact, they are the ones that will make up a stable percentage of your treatment population. They tend to be relatively compliant and relatively good about making their appointments when compared to other groups. 

This is an excellent group to market to and to provide appropriate treatment. However, this won’t happen unless therapists recognize that these people are different.  For example, low back pain in the elderly is much more commonly a manifestation of problems such as lumbar stenosis, and vertebral compression fracture. These types of problems need special attention and a special type of treatment. Manual techniques that would yield excellent results in someone 28 years old may cause a fracture in someone who is 80. With this information in mind, it is imperative that therapists read columns like this, take the information and see what are the appropriate treatment strategies for older persons and make the necessary modifications for your patient.

I frequently find therapists either do too much, exhausting their patients and not getting the optimal benefit or on the other hand, they do too little and patients don’t receive adequate benefits from the rehabilitation program. A perfect example of this is the years and years we’ve all spent putting one-and two-pound weights on our patients while researchers at Tufts and Yale had been performing 80% of the 1 repetition maximum with patients and helping them attain dramatic results. Therapists should have been doing this but because we treat older patients as someone so different that they can’t receive benefit or exactly the same as a younger person that we don’t give them the best program. That is why it is so important that we look at the literature and constantly update our knowledge base, so that we can provide the best benefits to our patients.

The point of this article is to encourage you to continue to read the geriatric function column where information will be provided with the most recent literature supporting different diagnoses. If you have a particular problem or diagnosis that you would like to be addressed, please send it or email it. The areas that have already been covered include Parkinson’s disease, stroke and osteoarthritis. Future diagnoses to be explored include lumbar stenosis, rotator cuff and total joint replacements. In addition, more protocols based on the literature will be incorporated into the column. I encourage you to read, attend continuing education courses and to research the area of geriatrics through evidence-based sources so that you are providing the most effective treatment.

In the future Medicare will be looking at how and what the outcomes are with these patients and if we don’t show that we are making a difference, the funding source will be cut. We all know that when Medicare makes a payment decision, many of the other payment sources follow suit. So please, let’s get rid of these heavy elephants and provide the best care