As people age, they are likely to find that balance issues, arthritis, neurological diseases, and other health problems become a threat to their quality of life. People facing these problems often find that being evaluated and treated by a physical therapist can be a significant step toward improvement in safety and mobility, or at least stabilization.
Caroline DeGroot, Master of Physical Therapy (MPT), is a physical therapist and the Vestibular Program Manager at Athletico Physical Therapy, an outpatient rehabilitation and fitness center operating across the midwest U.S. DeGroot answered questions from HealthCentral during a phone interview about how physical therapy can help our aging loved ones, or even caregivers, enjoy better quality of life.
HealthCentral (HC): Caroline, as a person who has a friend with vestibular (inner ear) issues, I’m particularly interested in the fact that you are the vestibular program manager at Athletico. How frequently do you see inner-ear problems diagnosed as a primary problem for vertigo in elders?
Caroline DeGroot: I would say that typically I’m the one to pick it up. I will get a referral for an elderly person with complaints of dizziness or balance issues and then, through an evaluation of their balance systems, we determine that something might be going on with their inner ear and then we determine if this person would be appropriate for a vestibular therapy program.
HC: I know, because of my friend, that PT can be very helpful with vestibular issues; however, some medications can also cause instability or dizziness. Should a patient see his or her primary physician for a checkup before looking at physical therapy?
DeGroot: Either way. Here at Athletico, we do free injury screenings or free screenings (for any reason). If the individual has questions or concerns, be it dizziness or balance issues, they can make an appointment for a screening and they will meet with a physical therapist who is trained in vestibular issues and balance issues, if that’s their primary complaint, and discuss what their concerns are.
We will discuss any new medications they may have started, and have a balance screening to determine how balance systems are functioning. If it is determined that the problem is probably due to a medication, they will be referred back to their physician to discuss any new medications that may have been placed on and the side effects that may be bothering them.
If it’s determined that we think that it’s something from their vestibular system or due to immobility in their spine, hips, or knees, then we would discuss with them what could be done in therapy to help improve the problem and improve their function. We’ll have them follow up with the appropriate physician to get a prescription in order to get the therapy in order to get treated. So, they can come in to get a screening, or they can always follow up with their primary care physician who can then refer them on to the appropriate channels.
HC: When it comes to mobility issues, what are the main things adult children should look for when visiting their aging parents?
DeGroot: Some of the main issues and easiest things to pick on up are when you notice that your loved one has difficulty getting up from a seated position or a chair that they used to stand up from without difficulty. You may see them rocking back and forth to try and get momentum to stand up, or grabbing for an external object to help pull them up. This could indicate some nuance or weakness in their legs that could be easily addressed in physical therapy, but the behaviors that they exhibit in order to transfer from these surfaces could put them at higher risk for an accident or falling.
Another is if you notice them walking around the home grabbing onto furniture to stabilize themselves. Sometimes, they may not even realize that they are doing this, but it could be really dangerous because the furniture can move or tip over, or they can be in an unfamiliar environment where there isn’t anything for them to grab onto and their balance may not be good enough to keep them steady. So this is somebody who might be appropriate for using an assistive device to get around their house more safely. So just understanding how to safely use that device to steady themselves might be important.
Another common thing that you might see is changes in the way they walk. If you notice that someone has started shuffling their feet more or if they take smaller steps, these can all contribute to an increased sense of tripping over things in the house and could lead to a fall. These could be addressed in therapy to increase their gate safety.
So, those are three things that could be addressed when visiting the house, and they could all be remedied with the right intervention
HC: Can physical therapy provide long-term benefits, or is this something that will only provide short-term relief?
DeGroot: It really depends on why you are seeing the individual. If this is somebody who is demonstrating increased weakness, possibly due to living a sedentary life and not standing up as much and walking around, physical therapy and strengthening exercises and getting somebody on a regular routine could have longer-term benefits, but it definitely is up to that individual or the caregiver to help them do regular exercises to maintain the gains they’ve made.
If the individual is someone who has some gait abnormalities and would benefit from an assistive device like a cane or a walker, once they’ve learned how to safely navigate with their assistive device that should give them a longer-term safety with their walking, and they will be able to get around more areas with less risk of falling. But it really depends on what the root cause of their immobility is. If it’s arthritis and there is immobility of the joints or weakness in the joints, those can be improved upon with therapy.
If it’s more of a neurological condition that’s progressive, a lot of times therapy is more of maintenance situation where we just try to maintain the function for as long as possible.
HC: Will Medicare cover physical therapy?
DeGroot: Medicare absolutely covers physical therapy, and Medicare has very good coverage for people who have balance issues and gait issues, as the alternative would be much more expensive if somebody were to fall and fracture a bone. So Medicare will pay for physical therapy interventions.
HC: Thanks so much, Caroline, for your helpful information. Your advice is likely to encourage caregivers and older readers to investigate physical therapy as a method of staying healthy and active for the longest time possible.
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Carol Bradley Bursack is a veteran family caregiver, having spent over two decades caring for a total of seven elders. She is a longtime newspaper columnist and the author of “Minding Our Elders: Caregivers Share Their Personal Stories,” as well as a contributor to several additional books on caregiving and dementia. Her websites can be accessed at www.mindingourelders.com. Follow Carol on Twitter at @mindingourelder_ and on Facebook at Minding Our Elders_.