Winter Edition: Top 5 Questions To Ask Your Older Adult Patients

By Megan Mitchell, PT, DPT

Physical therapist

Colder days, longer nights, fallen leaves, icy roads: As the seasons begin to change, older adults face new challenges. This population depends more heavily on their musculoskeletal, somatosensory, and vestibular systems as they adapt to the heavier clothing, a decrease in sunlight, and altered surfaces that come with colder weather.

With our shared goal of keeping individuals safe and independent, we have come up with five questions to ask during your patient’s next visit to determine winter’s impact on their physiological capacity.

HOW DID YOUR PATIENT GET TO THEIR APPOINTMENT TODAY?

Did they drive themselves?

Did a caregiver take them?

Did they use a car service?

Colder weather can be a difficult barrier for older adults, providing an increased load on their systems, making it more taxing to get to their appointments as well as other essentials such as grocery shopping and picking up medications. Finding out how they made it to your office can provide great insight into their independence and functional status, which can help determine if a referral to a FOX clinician is needed.

Although driving themselves offers more independence, fear of falling or driving in snow can create a sense of fear when getting behind the wheel. If your patient primarily drives, providing them with contact information for local transportation services can provide a temporary solution during inclement weather.

If your patient used public transit or a caregiver for travel, the patient has to have enough strength and power to transfer in and out of the vehicle. A FOX clinician can provide patients with a properly dosed progressive resistance training program to ensure they can safely transfer in and out of vehicles. We also provide caregiver education and training for safe transfers in and out of vehicles to help ensure they do not miss an important appointment or activities with someone they care about.

IS YOUR PATIENT AFRAID OF FALLING? DOES HE OR SHE HOLD ONTO A RAILING WHILE NAVIGATING STAIRS?

It is widely reported that fear of falling increases risk of falls in the older adult population. However, this fear of falling may come about gradually and subconsciously. Older adults may start to limit their activities without knowing specifically why. Using a railing to ascend or descend stairs can indicate a patient has a fear of falling. Winter, with its freezing temperatures, requires an increased level of strength, coordination, and balance to compensate for the icy conditions, heavier clothing, and footwear. Assistive devices that were once used to provide stability and balance can become the source of instability as one tries to navigate off an icy front step. If your patient is fearful of falling or concerned about getting in and out of their house now would be a good time for a FOX clinician to come out and evaluate their specific limitations and properly train stair navigation and dynamic balance before the weather sticks them indoors.

WHAT SHOES DOES YOUR OLDER ADULT PATIENT PREFER TO WEAR INSIDE?

As the temperature begins to drop, it is common for everyone to wear socks or slippers in the house. It is important for individuals to wear shoes that have backs on them and non-skid grip on the soles to reduce slipping. If your patient prefers socks, it is critical that they have non-skid pads on the bottom and are the appropriate size. By treating your patients in the home, in addition to balance and gait training, a FOX clinician can evaluate the patient and assess their footwear to ensure it is not a fall risk as well as train them to don and doff it safely and independently.

HOW MANY TIMES DOES YOUR PATIENT GET UP DURING THE NIGHT?

Getting up in the middle of the night poses a risk for falls, especially if they are rushing to the bathroom, regardless of the season. However, colder seasons offer the additional burdens of heavy blankets, robes, and slippers. Incontinence is in the scope of practice for both physical therapists and occupational therapists, who can help to decrease the number of times older adults are getting up in the middle of the night. This leads to improved quality of sleep and decreased risk of falls. FOX clinicians can also help modify the home set up to decrease the risk of falls for the necessary midnight trip to the bathroom.

HOW MANY TIMES A DAY IS YOUR PATIENT GOING OUTSIDE?

Shorter days and colder weather can increase the amount of time your patients stay in bed or inside the house. This often leads to a decrease in strength and power, which can make it more challenging for them to complete their activities of daily living independently and increase their risk of falls.

Additionally, a sedentary lifestyle often results in hypofunction of the vestibular system, creating increased challenges for patients to maintain their balance and exacerbate symptoms of dizziness.

Asking your patients how many times a day they go outside can help to get an overall gauge of their activity level.

Winter is a beautiful season and an opportunity to spend quality time with somone they care about. Asking these five quick questions can help ensure that your patients don’t miss out due to functional limitations that can be addressed by a skilled FOX clinician.