Think of your age. If you’re in your 30s, think of yourself as “middle-aged.” If you’re in your 40s, think of yourself as “an older adult.” If you’re in your 50s, think of yourself as “geriatric.” If you’re in your 60s, think of yourself as “in the final chapter.”

If you don’t consider those thoughts to be pleasant, be thankful you live in the present versus a century ago.

In the beginning of this century, only 25 percent of people in the United States lived beyond 65 years, according to the Geriatrics Education and Research Institute at the University of North Texas Health Science Center in Fort Worth, Texas.

Currently, close to half of the population is expected to live 80 years or longer. But there’s a downside: The added years of life may involve declining health, loss of physical and mental capabilities as well as increased social stress. These problems contribute to loss of productivity, increased dependence and reduction in quality of life.

In response to this challenge, experts are striving to better understand the biological processes involved in aging and age-associated diseases and discover effective methods of therapy, technologic adaptations and prevention.

I've fallen and I can't get up!

This line – now a recognized, universal punchline etched in pop culture history – was originally spoken in a television commercial for a medical alarm and protection company called LifeCall that featured an elderly lady named “Mrs. Fletcher” who had fallen, with her walker, in the bathroom. Despite the comedic reasons it’s remembered, the commercial illustrates a serious situation that happens all too often: An independently living senior falls in his or her home and is left lying on the floor for hours or even days, unable to get help.

According to the National Institutes of Health, falls are the leading cause of fatal and non-fatal injuries in persons over 65, and about half of those falls can be attributed to some sort of balance disorder.

The Association for the Advancement of Retired Persons (AARP) Public Policy Institute estimates the direct cost of falls in 2000 alone, in the 65 and older age range, was $16.4 billion. By 2020, it is estimated that the annual cost of all fall injuries to Americans 65 and older will reach $43.8 billion.

But it doesn’t have to pan out that way. “Falls are absolutely preventable if you address it up front,” says Lee Anne Fein, senior vice president of Innovative Senior Care for the American Retirement Corporation (ARC). With 125 clinics in 19 states, ARC provides senior living housing, independent living, assisted living and a few skilled-nursing facilities.

Fein says screenings, such as balance testing, are offered to the residents at her communities. “These tests give us an information baseline where we can track issues before they become a big problem,” she explains. “For example, if we see someone developing a balance issue, we can send them to one of our Tai Chi classes to work on their balance.”

Balance disorders can be caused by a variety of reasons to include hearing disorders because hearing and balance are closely tied together, says Jeff Singer, an audiologist and vice president of West Palm Beach, Fla.-based HearUSA.

Meniere’s inner ear disorder is a common hearing disorder affecting balance as it is characterized by recurring attacks of disabling vertigo (a whirling sensation), hearing loss and tinnitus. Several procedures are available for people who are disabled by this disorder. However, severe hearing loss can result from this treatment.

Hearing aids on the market today are quite advanced, says Singer. Some have a directional microphone to focus on sounds in front of the patient, and a back microphone that can be shut off with the touch of a button to cancel out background noise. This helps the patient focus on the sounds they need to be well acclimated to their surroundings, thus preventing falls.

“Seniors have come to expect physical problems with age. They think it’s a normal part of the aging process. So, when a problem like a balance disorder does arise, they don’t think it’s a big deal,” Fein says. But she hopes seniors will soon realize there’s a new way to think about the aging process.
 
“What we try to engrain into our programs is that you don’t have to expect these problems; you can have a higher quality of life than that,” Fein says. “The once accepted ‘norms’ for the geriatric population are changing.”

To learn more about evaluating and treating geriatric balance issues, there are many continuing education courses available to do so. Live seminar-based courses are readily available, and as a more convenient option, video-based and DVD-based courses are becoming available through companies such as Keep Pace Education Opportunities.

Active Aging

If a patient begins falling or develops gait instability, physical therapy may help provide balance training, provide therapeutic exercises or assess the patient’s need for orthotic devices, according to the American Medical Directors Association (AMDA).

One therapeutic exercise that many therapists are integrating into geriatric patients’ care plans is aquatic therapy.

“Recent studies show that aquatics can slow down the onset of Alzheimer’s and Parkinson’s disease,” says Dianne Rothhammer, owner of San Luis Obispo, Calif.-based Aquatics by Sprint. “It can’t prevent it if you’re destined to get it, but you can slow it down anywhere from five to 10 years.”

Rothhammer says a routine of two to three times a week, for a duration of 20 to 30 minutes, can achieve the results tested in the study.

“I don’t think therapists use pools enough,” says Rothhammer. “It’s truly a great way to ease the geriatric patient into a better quality of life.”

There are a few special considerations to take when mixing a senior with water. For those afraid of water, Rothhammer suggests aquatic equipment that heavily supports the patient such as a water walker assistant.

Also, Rothhammer says, always require the senior to wear shoes in the water. “It can be specialized aquatic shoes or their old tennis shoes,” she says. “They just need to wear shoes because there are too many diseases affecting this population that result in a loss of feeling in the feet. Diabetes is a big one.”

If you can help the senior patient conquer their fear of water, and keep them safe in the water, aquatic exercise is a great tool in any physical or occupational therapist’s toolbelt. But, many other types of exercises – such as walking, yoga and Tai Chi – are beneficial as well.

For people with Alzheimer’s disease, physical activity should be continued for as long as possible to help prevent muscle weakness and health complications associated with inactivity. And because Parkinson’s disease affects the ability to move, exercise helps to keep muscles strong and improve flexibility and mobility, according to WebMD.

The AMDA encourages exercise because of different reasons as it could help dissipate feelings of depression or isolation.

The Changing Face of Nursing Homes

“Industry wide, the nursing home resident is changing,” says Margaret Calta, BSN, associate director of Nursing at The Valley View Center for Nursing Care and Rehabilitation in Goshen, N.Y.

Years ago, says Calta, the nursing home was considered the last resort. It was where someone went at the end of their life after they had been kept in the home as long as possible. “People thought they came to the nursing home to die,” says Calta.

But not anymore. Today, nursing homes are welcoming in many more sub-acute residents. “They don’t really qualify for a hospital setting,” explains Calta, “but they come to the facility to get things like intravenous therapy, advanced respiratory therapy or short-term rehab after a hip replacement.”

Innovative Senior Care’s Therapy and Wellness Program includes screenings, health issue-related education courses and exercise courses tailored to each resident’s individual needs. With this program, Fein says her facilities are taking a proactive approach to keeping seniors healthier, longer.

“In the past, you received therapy after you fell and broke your hip or after you suffered a stroke,” she explains. “What we’re trying to do is develop a continuous screen so that we pick up on a condition as soon as it presents. The idea being: If you treat it before they fall, they are less likely to have to go to the hospital in a skilled nursing facility.”

Getting Smarter

For many seniors living independently, life can be somewhat of an obstacle course, with a new challenge at every turn.

An activity that once took mere moments now requires an hour of careful effort. But new “smart technologies,” are making everyday tasks easier and the home safer so these seniors can continue to get by on their own.

For those struggling with short-term memory loss, an automatic pill dispenser beeps when it’s time to take medication. There are nail clippers with magnifying lenses for those with dimming vision, long-handled hairbrushes helpful for someone with an arthritic shoulder, telephones that ring loudly and flash a red light for the hard of hearing, alarms that can literally shake someone out of the bed in the case of an emergency and forks and spoons with heavier handles designed to steady hands shaking because of Parkinson’s disease or other neurological disorders.

“Most of the problems happen in the bathroom, in areas of high traffic or areas with great risks. We talk about the sensory and cognitive impairments this population has, and then we develop strategies to make it better,” says Eric Tangalos, MD, geriatrician at the Mayo Clinic in Rochester, Minn.

The smart technologies, Tangalos says, will continue to get even smarter. For example, you can purchase a motion detector for approximately $10 and put in the place of a light socket. Taking away the need to search for a light switch in the dark also takes away a risk of falling. In the future, technologically advanced bracelets will monitor the patient’s directional values and will serve as something similar to a global positioning system device.

The best thing to do in a senior’s home is simplify, “and make sure you’ve provided all the sensory opportunities you can for these people,” says Tangalos. “Most occupational therapists are familiar with grab bars, loose rugs, but what they aren’t going to be familiar with is how color contrasts, the appropriate ballast in the bathroom and light switches can make a big difference.”

Because a lot of the therapists do make home visits, Tangalos says it’s important to be thinking about patient safety in a new way: A smart technology way. He says therapists need to be aware that smart technologies and smart homes are currently available and making those types of recommendations can truly make a difference.

Amy Storer is the editor of Therapy Times. Questions or comments can be directed to editorial@TherapyTimes.com.