Improvements in Balance in Older Adults Engaged in a Specialized Home Care Falls Prevention Program

Whitney, Susan L.; Marchetti, Gregory F.; Ellis, Jennifer L.; Otis, Laurie

doi:10.1519/jpt.0b013e3182550ea5

Cited by 16 publications

(16 citation statements)

References 54 publications

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“…Physical and occupational therapists can help patients like Mrs L to implement individualized home-based treatment programs. 97 Although Mrs L stated that prior physical therapy courses were not helpful, home-based 98 services directed at improving her safety and mobility could potentially facilitate involvement in out-of-home activities; these services might indirectly yield dividends such as more time spent socializing with family and friends. In support of this approach, a recent clinical review highlights the critical role physical therapists can play in developing “function-enhancing interventions” in older adults with mobility limitations.…”

Section: Methodsmentioning

confidence: 99%

Management of Persistent Pain in the Older Patient

Makris

Abrams

Gurland

et al. 2014

JAMA

267

201

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Importance Persistent pain is highly prevalent, costly, and frequently disabling in later life. Objective To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult. Evidence Acquisition Search of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults. Findings Of the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended–emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong therapeutic alliance between the older patient and the physician. Conclusions and Relevance Treatment planning for persistent pain in later life requires a clear understanding of the patient's treatment goals and expectations, comorbidities, and cognitive and functional status, as well as coordinating community resources and family support when available. A combination of pharmacologic, nonpharmacologic, and rehabilitative approaches in addition to a strong therapeutic alliance between the patient and physician is essential in setting, adjusting, and achieving realistic goals of therapy.

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Section: Methodsmentioning

confidence: 99%

Management of Persistent Pain in the Older Patient

Makris

Abrams

Gurland

et al. 2014

JAMA

267

201

View full text Add to dashboard Cite

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“…Findings from our study have implications for the improvement of the safety of hospitalized older adults and the subsequent consequences for rehabilitation units of acute care hospitals. Overall, efforts should be channeled into improving fall-prevention strategies 26 – 29 as well as in developing early interventions for any potential AE with the aim of identifying individuals at a higher risk of not improving their disability level between admission and discharge. Concerning these participants, interventions could potentially lower the risk of subsequent high disability and even the economic costs linked to longer hospital stays.…”

Section: Discussionmentioning

confidence: 99%

Changes in Disability Levels Among Older Adults Experiencing Adverse Events in Postacute Rehabilitation Care

et al. 2015

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This study aimed to assess the relationship between adverse events (AEs) and changes in the levels of disability from admission to discharge during inpatient rehabilitation programs.A prospective cohort study was conducted among a cohort of inpatients (216 older adults) admitted to a rehabilitation unit. The occurrences of any AE were reported. The level of disability regarding mobility activities was estimated using the disability qualifiers from the International Classification of Functioning, Disability, and Health. Changes in the levels of disability between admission and discharge were assessed. Baseline-measured covariates were also selected.Regarding all 4 disability levels (“no limitation,” “mild,” “moderate,” “severe,” and “complete disability”), a total of 159 participants experienced an improvement at discharge (126 participants progressed 1 level, whereas 33 improved 2 disability levels), 56 made no change, and no participants experienced a decline.The occurrence of fall-related events and the diagnostic group (musculoskeletal system) are specific predictive factors of change in the level of disability. The odds of undergoing a change in any disability level between admission and discharge decreases by 68% (1–0.32) when patients experience fall-related events (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.11–0.97, P = 0.041) and increases for individuals with musculoskeletal conditions (OR = 3.91, 95% CI = 1.34–11.38, P = 0.012).Our findings suggest that increased efforts to prevent the occurrence of these AEs, together with early interventions suited to the diagnosis of the affected system, may have a positive influence on the improvement of disability. Further studies should evaluate disability over time after discharge to obtain a better sense of how transient or permanent the associated disability may be.

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“…A minimal detectable change at the 95 percent CI for the POMA and the DGI has been reported as a 3-and a 2-point change, respectively [27]. The mean difference between the POMA scores of those who were independent and those who required considerable assistance was 1.9 (minimal detectable change is 3).…”

Section: Discussionmentioning

confidence: 99%

Relationship between cognition and gait performance in older adults receiving physical therapy interventions in the home

Whitney

Marchetti

Ellis³

et al. 2013

J Rehabil Res Dev

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Abstract-Persons undergoing physical therapy home services often have difficulty with mobility and gait. The purpose of this study was to determine whether there was a relationship between gait and a rating of cognitive functioning in persons undergoing home-care physical therapy services. Patients over the age of 65 (n = 11,601) seen by a home-care agency between 2007 and 2008 were included in the retrospective analysis, and 10,953 (mean +/-standard deviation age 83.2 +/-7.1; 31%) met the criteria of being able to ambulate independently or with an assistive device. All patients attempted to perform the modified Clinical Test of Sensory Integration and Balance plus either the Performance Oriented Measurement Assessment (POMA) or the Dynamic Gait Index (DGI). Mental function was scored as part of the Outcome and Assessment Information Set. A multivariate model with adjustment for age and sex identified gait performance as measured by the DGI to be independently associated with the likelihood that a patient required cognitive prompting (p = 0.03). Both the DGI and POMA scores were independently associated with requiring assistance/dependence with cognitive tasks. There was a strong relationship between cognition and gait performance in persons undergoing physical therapy interventions in the home. Changes in gait may be related to cognitive decline.

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Improvements in Balance in Older Adults Engaged in a Specialized Home Care Falls Prevention Program

Cited by 16 publications

References 54 publications

Management of Persistent Pain in the Older Patient

Management of Persistent Pain in the Older Patient

Changes in Disability Levels Among Older Adults Experiencing Adverse Events in Postacute Rehabilitation Care

Relationship between cognition and gait performance in older adults receiving physical therapy interventions in the home

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