A recent article described how physical therapists can use a comprehensive geriatric assessment (CGA) to create personalized interventions to help older people stay healthy and live at home despite certain limitations and barriers.
A CGA is intended to avoid hospitalization and nursing home care for frail older adults and prevent problems from arising, and to promote Safe Aging in Place (SAIP). The main obstacle to SAIP is falls, which are associated with high costs and a risk of disability. In addition, falling can lead to more falls due to increased fear of falling and decreased confidence in performing usual activities.
The authors said research suggests that a third of people aged 65 and over fall annually; Nearly 40% of falls require medical attention, with costs ranging from $3,038 for an emergency department visit to $38,412 for hospitalizations.
A CGA examines 9 areas of functional status: Mental, Physical Environment, Medical, Socioeconomic, Quality of Life, Physical, Gait/Balance, Cognitive, and Behavior.
registered mail Archives of Physiotherapythe authors outlined some benefits and potential shortcomings of outcome measurements and interventions that were most aware of time and resource limitations and straightforward to administer in the community. An overall list of all the assessments that a physical therapist could possibly do could take nearly 3.5 hours, with dozens of items to review, according to a table accompanying the study.
For the treatment of physical function, the authors cited the Short Physical Performance Battery, the Timed-Up-and-Go, the 30-second chair-rising test, and the four-test balance scale.
They also recommended using health-related measures, such as the Functional Comorbidity Index, and environmental measures, such as Home FAST.
There are also limits to the measures available. For example, neither the Functional Comorbidity Index (FCI) nor the Charlson Comorbidity Index (CCI) include hypertension in their score; Given the relationship of high blood pressure to other health problems, a physical therapist should include blood pressure in the assessment, the researchers said.
The CCI predicts 10-year survival in someone with multiple comorbidities (19 are included), with a severity weighting from 1 to 6. The FCI, a list of 18 common diagnoses, does not take into account the severity of an illness.
To assess polypharmacy, the authors note that physiologists may have differing knowledge of the effects of 5 or more drugs on a patient. They suggested two sources to consult: the CDC guide Stopping Elderly Accidental Death and Injury (STEADI) Medications Linked to Falls and the American Geriatrics Society’s Beers Criteria.
Physical therapists should also assess cognition and mood, since mental state affects the person’s ability to perform recommended physical activities and exercises. The authors highlighted 3 cognition assessments and 2 depression screens. For cognition, the Mini Mental State Exam (MMSE), the Mini-Cog, and the Trail Making Test (TMT) all have good reliability and validity.
Another assessment, the Physical Therapy Healthy Lifestyle Appraisal, asks people to describe their typical behaviors related to healthy eating, physical activity (aerobic), sleep, stress management, and tobacco use. Their statement is linked to stages of behavior change and gives the physiotherapist an idea of the person’s willingness to change.
Most commonly used to measure frailty is the Fried Frailty Index, which includes 5 criteria: self-selected walking speed over 4.6 m (15 ft); frequency and duration of regular physical activity; handle strength; self-perceived feeling of exhaustion; and unintentional weight loss of more than 4.5 kg (10 lb) in the past year.
Regarding home security assessments, “there is a striking lack of valid, reliable, and objective measures of home security risk,” the authors said. There is the Home Falls and Accident Tool (Home FAST) which comes in two versions, one self-managed and one managed by a professional. What is remarkable, however, is that when comparing the two versions, there was only a 52% agreement on the rating points.
Wilson CM, Arena SK, Boright LE. State-of-the-art physiotherapist-led approaches to safe aging are in place. Arch Physiother. Published online August 1, 2022. doi:10.1186/s40945-022-00142-5