How Physical Therapists Can Help Fight Ageism By Helping Older Adults Achieve Optimal Function

By Paige Grab, PT, DPT

physical therapist

Between 2006 and 2016, the population aged 65 or older in the U.S. increased by 33 percent. This trend is expected to continue as the baby boomer generation ages. With the number of older adults growing, healthcare professionals should expect an increase in older patients on their caseloads. Unfortunately, our aging society carries with it many ageist views of the 65+ population. When caring for the older adult population, it is important that we do not let age-related stereotypes influence our clinical decision making.

WHAT DOES AGEISM IN HEALTH CARE LOOK LIKE?

Ageism occurs when a healthcare professional discriminates against patient’s care as a result of their own personal bias against the elderly. This discrimination can be intentional or unintentional. It can include issues such as over-treating, under-treating, or improperly communicating.

As physical therapists, we are most at risk for unintentional under-treating. If a patient becomes fatigued during an exercise, we may be quick to give them a rest break even if they could actually push through for a few more repetitions. A patient may tell you that a certain weight feels too heavy so we decrease it by a pound or two to make it more comfortable for them. You may want to try a new activity with them but decide to defer because they are “just not ready for that.”

These may seem like simple modifications, and they can be appropriate if they are based on scientific or objective reasoning, but if an activity is modified by a physical therapist just because of a patient’s age, it could certainly end up hindering their progress through therapy.

PROVIDING PHYSICAL THERAPY TO THE PERSON, NOT THE POPULATION

Our responsibility as physical therapists is to maximize a patient’s functioning, safety, and independence. Our goal is for older adults to continue to live in whichever environment they so choose and participate in the activities they find fulfilling. Just because a person is 95 years old it does not mean that we should treat them as a frail individual who should live in a bubble.

I am currently working with a patient in her mid-80s and, even as an elderly patient, she performs cardiovascular exercise five days per week as well as strength training three days per week. Although this is atypical of a patient her age, I would be exacerbating the stigma by discouraging her from partaking in these activities. Instead, I recently visited the patient’s weight room to ensure that she is performing the activities in a way that permits effective and safe exercise.

Similarly, I also had a patient in her 80s who was preparing for a multi-state road trip in an RV with her son. Again, while some may not view this as a common activity for an older adult, I certainly was not going to discourage her. We spent the weeks prior to her trip practicing stairs so she could enter and exit the RV safely. She later reported that it was a great trip and she was able to perform the stairs with minimal assistance from her son.

Our job is not to determine which activities are appropriate for the older adults we treat. Our job is to listen to what activities are important to them and help them work to achieve those.

CONSIDER THE CLINICAL COMPLEXITIES OF AGING

Aside from limiting activities or decreasing repetitions, therapists may also under-treat in regard to patients’ symptoms. Complaints of fatigue may be disregarded as deconditioning when in reality that fatigue may be related to a cardiac episode, an abnormal blood sugar reading, or dehydration. It is essential that we utilize our skills to obtain an accurate medical history, assess vitals, and question patients so we can determine if their symptoms are a normal response to exercise or a more serious medical situation. In the event of a medical condition, their physicians should be notified to ensure that the necessary treatments can be initiated.

Our identification and correction of ageism do not stop with the direct treatment of the patient. To successfully carry this over into the daily lives of older adults, education should also be provided to their families and caregivers.

Just as we may accidentally exhibit ageist attitudes, family members are likely to do the same. In fact, I would argue that some family members and caregivers may even be more inclined to exhibit age bias because they feel they are just being helpful to their mother, brother, grandmother, etc. I am sure we have all seen this while working in older adults’ homes: An older adult goes to do an activity, such as walk to the kitchen for a snack, and their son stops them and tells them that he will grab it for them.

While this may seem like an innocent act, it is limiting the patient’s participation and hindering their progress toward improved mobility. We must educate patients’ families to encourage patient participation in simple daily activities and discourage the ageist attitude of doing various tasks for them.

OPTIMAL FUNCTION’S IMPACT THE HEALTHCARE SYSTEM

Not only can physical therapists help to improve the safety and mobility of older adults, but by identifying and correcting ageism we can also help to reduce their overall healthcare costs.

For example, by encouraging our older to participate in exercises and activities that are meaningful to them, we are discouraging the sedentary habits that often lead to pathologies, such as hypertension and diabetes. This could help reduce the need for expensive medications.

In another sense, improving an older adult’s strength and balance can translate to a decreased risk of falling. By preventing falls, we are preventing potential hospitalizations, which are an obvious cost-saving tactic and can also help maintain their quality of life.

Ageism is a prevalent problem in health care. It has negative effects on the treatments and outcomes of older adults. By identifying and preventing ageism in the care for older adults, we can help them maintain their safety and independence, thus allowing them to continue participating in meaningful activities.

As physical therapists, we need to be aware of any age bias and work to avoid this in order to maximize patient outcomes.

Addressing ageism does not stop at care for the individual. We also need to educate their families and caregivers to be aware of their own possible age bias so they can also help push the patients toward increased independence and functioning.

By working to address ageism, we can help improve the lives of our patients and also decrease their healthcare costs by preventing potential injuries or additional pathologies.