Welcome to FOXcast Physical Therapy podcast for clinicians made by clinicians. It’s brought to you by Fox rehabilitation. Find out more at FOXRehab.org.
Jimmy McKay, PT, DPT: Welcome to FOXcast PT. I’m your host physical therapist Jimmy McKay on the program. Margaret Danlovich, Margaret. Welcome to the show. Thanks for having me. A professor of geriatrics at Northwestern University everything about her is purple always. That’s that’s one thing I know about you.
Margaret Danilovich, PT, PhD, GCS: That is true. Now we bleed purple Northwestern.
Jimmy: And they always like to tell you about it. It’s a great school. We had a chance to go out there a couple of months ago and and kind of go through your facilities everything’s gorgeous out there. But on top of just being a professor you’re also a PhD, GCS you do research you do dance competitions you do lots of things.
Margaret: That’s right. You know I like to kind of be a renaissance women here.
Jimmy: Before we go any further I did mention dance competition. So describe briefly dance the worldwide dance competition that you won.
Margaret: Yeah thanks. And so every year “Science” puts on the dance your PhD competition. Really with the whole idea of saying like we need to get findings from science out to communities and get people excited about science understand careers in science and maybe more importantly disseminate our results to communities otherwise it doesn’t matter. So they put on this competition every year dance your PhD and it is what it sounds like. You have to dance the methods and results of your PhD. And so I won their social science category dancing my dissertation work which was an exercise program in which we trained home care aides these formal caregivers to do exercise with their clients.
Jimmy: It’s brilliant. It’s just a great idea. People can check it out go to YouTube type in dance your PhD and Margaret and you’ll and you’ll see it and it’s just it’s a great idea because yes research is fantastic in everybody in physical therapy loves the fact that we’re doing more of it but if it’s just printed on paper it if a couple people read it. Where does it go? And that’s why I love the fact that science said Hey dance your PhD have fun with it. Get it out there put it on something like YouTube where research normally isn’t put it out there so what was that. What was the title of that that particular piece of research that you danced to?
Margaret: Sure. So our exercise program was a program that Allen Jette actually developed strong for life. We have a home care aides when they’re strong for Life program. And then if you tune in we are dancing to Kanye West Stronger.
Jimmy: Yeah it’s pretty cool mashing up you know pop culture and pop science right there.
Margaret: That’s right.
Jimmy: And Allen Jette the editor of PTJ. I’ll actually be I’ll be talking to him in a couple of months. Maybe I’ll have him dance. I’ll be I’ll be live on say he’ll be onstage. You think he would he would dance your PhD.
Margaret: I would love to see that. If you can make that happen that would be earth shattering.
Jimmy: All right. So a different way to disseminate research is to get it into the ears of clinicians working with older adults and that’s what this episode is is about. You worked on a paper called evaluating frailty in Medicaid home and community based services clients of feasibility and comparison study between the share fi and SBPPB SBPPB. Yeah I got it right. That’s a lot of words and it’s got them all right. First off where can people find this? While we’re talking about we’re gonna go through it. And then if you want to find out more where can people take a look at it?
Margaret: Yeah this paper is open access if you just google that title you Google my name Margaret Danilovich it pops right up perfect.
Jimmy: I love what it’s easy like that. Now what was the purpose. You know what were the aims of the study where we trying to do.
Margaret: Sure. So I’m just a little bit of background because I think this work is really outside of PT a little bit. But a lot of my work has been with home and community based services which is this Medicaid program that provides services that each individual state can kind of determine what they want to offer to people who are at risk or deemed eligible for long term care. So if someone in Illinois where I am and actually needs to go into a nursing home if they are Medicaid eligible they have the opportunity to participate in home and community based services as an alternative to being in a nursing home. And so what Illinois provides are home care aides these formal caregivers who do things that you would get in a nursing home bathing dressing meal preparation et cetera. They also provide things like life alert or adult day services for individuals. Although my work has really worked on these individuals and how do we enhance the care that’s provided in this service so that people can keep living at home and stay out of nursing homes?
Jimmy: We love that.
Margaret: Yeah for sure. Cause I mean nobody wants that and a nursing home. I think PT have a huge role to play in preventing that from happening. So my research focuses solely on individuals with frailty. Many of whom are older and frailty is this medical geriatric syndrome that we’re thinking about. People have fatigue. They’re weak. They have low levels of physical activity. They don’t walk very fast and they actually start to lose weight and have unintentional weight loss. So there’s been a huge sort of boom and evidence in frailty and the populate interest in this population. And there’s been some groups that they really for anyone over the age of 70. They should be evaluated for frailty each year because it can help us provide information about what interventions they might need. But it also kind of gives us some information on like you know what services should this person get a surgery or not if they’re more frail they may have more complications and so it’s a really great sort of prognostic factor for a lot of things. Despite this recommendation that people should be evaluated for frailty it doesn’t really happen often in clinical practice and it particularly doesn’t happen in this Medicaid home and community based services group because this is a population that is highly medical complex but they don’t actually have a lot of medical supervision. So these home care aides are individuals many of whom don’t have a high school education and they’re managing really complicated participants. And so what I really wanted to do is you know this is the recommendation that everyone gets evaluated our first step is to see how well this could happen and can we actually evaluate frailty in the home of these individuals receiving Medicaid versus being evaluated out in like a clinic in more medical setting?
Jimmy: OK. So how did you do it?
Margaret: I had a grant from the Retirement Research Foundation. We hired a lay person no medical training no PT training no nothing. And we trained him on how to evaluate frailty using two measures the share FI and the SBBP. Be looked at those two measures because they are kind of SBBP is a very functional objective measure and it’s something that is like the most highly cited outcome measure for older adults. And then the share FI is this newer tool that’s for self report questions and a measure of group strength.
Jimmy: And that stands for the survey of health among retired Europeans frailty instruments. I do my homework.
Margaret: You did. That’s totally correct. All right.
Jimmy: So you trained out this guy with no previous background with these two tools. Then what happened?
Margaret: He went out and went to every single person’s home that was enrolled in this study measured the share FI measured the SBBP and then we primarily looked at was this feasible? Did it work in the home and what kind of things people would need to consider if they were going to do this on a wider scale. And then we actually took those frailty scores and started to look at like how well do these frailty measures actually relate since the SBBP is a very objective measure of physical performance. And the share F have these four self report questions. And so we would think that there would be a good correlation between self report and the objective.
Jimmy: OK. And what happened.
Margaret: We found that it really was feasible. The share FI is much more practical given that it’s for self report questions. It only takes like less than five minutes to administer. You don’t have many equipment needs. All you need is a grip dynamometer the S P P B because you’re getting people up there is that sort of element of arrest and safety because you’re checking people’s balance to little longer of a tool. But the good news was there is actually a statistically significant fair agreement between these measures. So potentially like this might be a way that these Medicaid home and community based service providers could actually use the share FI reasonably well as a sort of screening tool to evaluate frailty among their clients.
Jimmy: Anything that surprised you while you were doing this.
Margaret: You know I think one of the interesting things we found in this study and in a lot of other work is that this concept of frailty even when we talked about it. They don’t necessarily understand what it is and they sort of made the equivalent of frailty with old age which it’s not you shouldn’t get frail as you get older. And so I think there’s a huge opportunity to look at how we educate individuals on frailty what’s normal aging what’s pathologic aging. And then we actually use some of that data and got funding from the foundation for PT research to actually develop an educational program for older adults to help inform them about what Frailty is and what’s normal and what’s more pathologic aging loved ones wrapping that study up right now.
Jimmy: Love when you bring in the foundation for physical therapy research also known as the foundation. I’ll actually be hosting we’ll talk about this before we recorded I’ll be actually hosting their gala fundraiser at the NEXT conference in Chicago in June. So loving that is coming full circle. What do you think this this study really highlighted for clinicians who are working with older adults right now can put into practice?
Margaret: I think the first thing is if you’re working with anyone over 65 you need to be evaluating frailty. It doesn’t matter what setting your and we should be looking at frailty because if you’re in acute care it’s going to help you make a more informed assessment of whether this person should go home with home house or a ethnic or whether they’re at risk for a 30 day re hospitalization. If you’re an outpatient it really helps to think about what’s the trajectory of this person and how can we maybe provide information interventions broader social services beyond PT to help them age as optimal as possible.
Jimmy: And that’s what we love especially with the with the clinicians that I get to work with at FOXRehab.org and that’s that’s that’s what we do what you want when you’re working with older adults share. Margaret Have you ever done your FOXtale you’ve done that before when you’re on a show now or FOXtale you’ve got to tell us why you decided to work with older adults why do you decide to make that your focus of your career?
Margaret: That’s a great question in retrospect. I just spent a lot of time with older adults growing up and I always just kind of gravitated towards this population. And now I see that this is an area where you know PT students don’t necessarily want to work with that this group are like they’re not coming into PT school thinking that this is their career but this is a population that is so in need of quality intervention that you can make a dramatic improvement in their life. And to me that’s so rewarding that they’re really underserved group and am a group that really benefits from having PT is who care about giving them evidence based interventions.
Jimmy: How many’s PT students do you get to flip per per year in terms of walking into your geriatrics course at Northwestern saying I would never work in geriatrics to at least leaving and saying Oh I’d be open to that.
Margaret: You know actually a fair number one of my advisees now is doing a geriatrics residency at Mayo Clinic and came in as you know very much athlete sports etc. So you know I like to think that I’m incentivizing them into geriatrics a little bit.
Jimmy: Perfect just kind of give giving them a nudge nudge in a particular direction and seeing if they like it.
Margaret: Yeah I mean I think it’s great because we have a lot of experiences that are very hands on at Northwestern going out into the community going in and nursing homes working with older adults and that makes a huge difference because if you have those experiences while you’re a student and you’re exposed to the population you can see just how rewarding it is love.
Jimmy: Evaluating frailty in Medicaid home and community based services clients a feasibility and comparison study between the share Fi and S P P B. Look it up it is open access right there you can learn about what Margaret did with with frailty assessments appreciate your time for not only doing this but also talking to us about it here.
Margaret: thanks for having me.
Thanks for listening to FOXcast PT.
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