I think the first thing you have to do is look and listen. Look at the person as they walk across the room, shake their hand. Do they have a good grip? Can they squeeze your hand back? Do they have trouble getting out of the chair in the waiting room? As a therapist going into someone’s home, I mean we really do have to be proactive. It’s our responsibility it’s our duty to pick up these signs and symptoms them, to address frailty or even pre-frailty. If we don’t dose them properly and if we don’t rehabilitate them forcefully you know they may fall into frailty.
Welcome to FOXcast Physical Therapy. A podcast for clinicians made by clinicians. It’s brought to you by Fox Rehabilitation. Find out more at foxrehab. org.
Jimmy McKay, PT, DPT: Alright on the show right now is physical therapist Stephanie long Stephanie welcome to the show.
Stephanie Long, PT, DPT, GCS: Thanks for having me.
Jimmy: Stephanie where do you practice geographically where are you calling from today?
Stephanie: Well I practice on New Jersey South, so Southern New Jersey. I am also the regional quality assurance liaison for New Jersey. So I’m a bit all over the place.
Jimmy: Yeah a little bit it, I like that but you get to dip your toes into a bunch of different things. Treating clients and also helping clinicians maximize their potential.
Stephanie: Exactly I love it.
Jimmy: So I reached out to you because I wanted to get you on the show get some insight from you and we wanted to talk about frailty today and I guess the first step is pretty much define it right? So what would be the proper official definition of frailty?
Stephanie: Frailty in general. It’s really multi-dimensional. Multifactorial coupled a decline in function and physical status but it also throws in things like physiological, social and emotional changes. Overall frailty is going to negatively impact a person’s ability to appropriately function or bounce back from life’s curveballs. Indicators that we commonly see in the field are going to be things like weight loss. That’s usually defined by about 10 pounds of unintentional weight loss in a year. But we’re also going to see things like it decreasing grip strength, decreasing gait or walking speed. As well as the self report of exhaustion or low energy expenditure.
Jimmy: So I’m sure we deal with this when treating our older adult clients. I feel like you summed it up nicely where I think some people might identify frailty as just weakness you bring in more than one dimension that we need to pay attention to and some signs to focus on.
Stephanie: Definitely I mean nothing drives me more nuts when you hear people even health care professionals say or even assume that just because they’re older or there’s an older adult they’re working with that they’re frail. That’s just not true. Everyone who ages is not frail. It doesn’t have to go hand in hand.
Jimmy: And we love that that’s one of our steps to fight against ageism is not just assume because someone has been around for many years that they have an inability to do anything.
Stephanie: Exactly.
Jimmy: So now that we’ve got the definition of frailty out of the way, why do we concern ourselves with it? What Could frailty lead to with our older adult clients?
Stephanie: When we see signs and symptoms associated with frailty. We need to be careful because many times predictive worsening mobility worsening ADL tolerance and increased risk of falls the hospitalization even potentially death. So there are things that we definitely don’t want to overlook. The problem is a lot of time primary care practitioners or other health care providers, they might miss these signs and symptoms when they’re treating these clients in a 10 minute visit. They’re not seeing the big picture.
Jimmy: If you’re in front of another health care provider outside of physical occupational speech therapy what would you tell them to look for if you if you had 10 seconds of their attention what would you tell them to focus on before sending them to see a physical occupational speech therapist?
Stephanie: I think the first thing you have to do is look and listen. Look at the person as they walk across the room and shake their hand. Do they have a good grip? Can they squeeze your hand back? Do they have trouble getting out of the chair in the waiting room? And the look of them asked them the question how are they moving? How are they getting out of there how to visit them in the office today? Was that a big task? And if so that should really triggers some thoughts to go ahead and get or PT, OT or speech involved.
Jimmy: I love that it’s so simple and yet it can’t be said enough is to make sure other health care providers know where physical therapists can actually help in a very very big way with these older adults.
Stephanie: Exactly. As a therapist going into someone’s home I mean we really do have to be proactive it’s our responsibility it’s our duty to pick up the signs and symptoms to address frailty or even pre frailty. I mean maybe they’re not there yet but if we don’t dose them properly and if we don’t rehabilitate them forcefully you know they may fall into frailty. So we have a good opportunity to also be proactive for this group.
Jimmy: Yeah I love that Stephanie you mentioned that term pre frailty and the American Physical Therapy Association on its web site actually identifies that about 47 percent of older adults have signs of pre frailty. Definitely something we can look forward to as we’re looking in the homes of our older adults and that we can seek out and make sure we’re paying attention to properly ID.
Stephanie: Agreed.
Jimmy: Importance of advocating for these clients who show either pre frailty or frailty symptoms. Why is it important to you?
Stephanie: It’s completely important. I mean I think not only are we working with the older adult that may or may not understand what we’re saying but we’re also dealing with their caregivers and their families and other health care providers that if they don’t understand the bigger picture then there’s a limited capability for us to be successful in our plans of care. So we have to advocate for these folks. We have to educate our clients and their loved ones so that we can really help them achieve their own maximal functional potential.
Jimmy: Love that. And Proper dosage that comes up a lot on this show. I feel like with a population if you’ve identified someone who is having these symptoms of frailty proper dosage is even more important.
Stephanie: Yeah and a physical therapist as well as my OT counterparts we we can’t be afraid to work with these people we have to monitor them and make sure we’re working them out as much as they can and are willing to do because I’m telling you they surprise me every day of what they actually can do once we push them hard enough.
Jimmy: Love that. Other things you’d push for besides proper therapy with a trained professional. What else do you trying to leave those clients with after your episode of care.
Stephanie: Knowing that there’s resources out there you know it’s opening up lines of conversation and communication. Sometimes letting the person know that it’s okay to talk to their son and daughter about how they’re feeling or talk to their physician or be proactive themselves. Maybe getting involved in different work groups or silver sneakers programs or just other programs to get them out of there house back to the community or back doing the things that they want love to do.
Jimmy: That’s a great point. One thing we like to say that we’re good at with this profession of physical therapy is education and advocating for wellness for that up to 47 percent of older adults who might have pre frailty symptoms advocating and educating and how you can prevent some of those frailty symptoms down the road.
Stephanie: Yes.
Jimmy: OK Stephanie a tradition we have here on the show is your FOXtale. Why did you decide to work with older adults?
Stephanie: You know I have to have an aha moment and look at the bigger picture. And you know I wanted to make a difference. I wanted to help the person that thought that they were too old to do something and that they couldn’t do something anymore. And I want them to feel empowered about what they could do. Because I know when I’m 95 years old, I still want to be out there doing basically anything I want to do.
Jimmy: I love that that’s a great reason. Stephanie Long physical therapist in New Jersey for Fox Rehabilitation. Thanks for letting us take a peek into your brain on the other topic of frailty and how you work with older adults.
Stephanie: Thanks for having me.
Thanks for listening to FOXcast physical therapy. A clinically excellent podcast is brought to you by FOX Rehabilitation. Listen to other episodes or read articles and position papers at foxrehab.org.
