Me in 50 years
I knew I would be changing venues and patient populations roughly one year ago. I knew I worked in a physical therapy dream world (for those who like sports medicine) back in Boston where my typical patient was a high school or college aged athlete who wanted to get better. The biggest challenge with these patients was their over-eagerness to get better too soon. I calculated the average age of my patients the other day; 78.4 years old. 78! I know that the 65+ age group is the fastest growing sector of the population but this was not what I was used to, or developed my skill set on. Then I began to think….I shouldn’t treat these patients any different than my sports medicine patients. And, more importantly, I was quick to realize that treating these patients differently just doesn’t work. Below I have listed my top 5 misconceptions that PTs have about treating older adults.
1. They are fragile: Only about 55% of the people we treat over the age of 50 have osteoporosis. There is no reason to assume that every older adult we treat cannot handle heavy loads. If done properly, it’ll help increase their bone strength. (Random fact – While weight bearing exercise does not increase the density of the bone, it DOES makes it get thicker; therefore adding to the bone’s strength).
2. They are not strong: I’m not talking manual muscle testing strong. I’ve got 94-year-old female osteoporotic patient that can throw down a 5/5 manual muscle test on her quads. I’m talking STRONG. Like let me bust out 3 sets of 10 squats. Once again, many of us are guilty of “taking it easy” on our older adult population (more likely the 75+ range), but how can we truly know how strong any patient is if we do not push them. Sorry guys, the SAID principle applies to older adults too. Just because they love prune juice doesn’t mean they can’t do a weighted deadlift. And yes of course you have to take movement quality into account.
3. They don’t want to try “alternative” methods of rehabilitation: I routinely use yoga, Pilates, and kinesiotape on my younger patients because they are typically more accepting to these newer ideas of rehab. It’s hard enough to get older adults to even want to do a straight leg raise! FALSE. This is the stuff I hear or have seen. Absurd I say. Mildred and Gertrude love telling their fellow book club mates about the fancy blue tape I put on their back, or that they can now “perform a really good upward frog, or downward dog, or some tomfoolery pose” with excellent form.
4. They do not want to work hard: Older adults have had a tough life. Either they worked their asses off recovering from the Great Depression, or they fought for this country in any one of the foreign conflicts over the past 40-50 years. So why the hell would they want to perform a plank or farmer’s walk. If you look around my clinic, and I am not the only one to notice this, I can guarantee that the hardest working patients I have are 80+. It is sad to say, but this generation of people knows that to get results you have to work your ass off. You have to put the work in to get things to work out for you. They do not rely on a magic cure, or pill. They put in effort.
5. They will not listen to younger health care professionals: I am 27 but look like I am about to graduate from high school. I get these comments all the time, but I also know what I am talking about when it comes to rehab; and although these patients usually bring their own ideas to the table (thanks WebMD) it is because they just want to get better. They are willing to listen to a health care professional regardless of their age, because they know that we know more than them (hopefully) about their medical situation.
It’s funny that our true respect for our elders has decreased in this country to the point where many rehab professionals consider this patient population unable to perform like their younger counterparts, or too fragile to work hard. I think if we push the limits of our older patients we will all see what hard work is.
In closing, watch this. He is 72 years-old, and that is 100 pounds in each hand.
Always Evolve (even when you’re old),
Mike
Mike Scott, DPT 
Appreciate how you talked about SAID. If you’re alive, you can always grow. Most trainers don’t push their clients in healthy ways. Keep these coming!
Chris,
We both know that as long as your body is still kicking it, it’s possible to grow. Unfortunately because of these 5 misconceptions many practitioners are hesitant to push their older clients. As long as we are safe and take their other medical history into account, there should be nothing stopping us from using advanced training and rehab techniques with this patient population. Thanks for not backing off your clients!
I have 4 cases of stroke patients ages, 29, 38, 47 and 64. It kinda frustrates me sometimes that I cant advanced our rehab treatment with my older patients because of lots of restrictions unlike with my 29 year old patient who had stroke with no clear cause. No other concern to consider moving forward and pushing the patient to execute our PT. As much as I try to do the same thing with the other 3, your list of misconception applies to them That is why I think most PT sometimes come up with alternative treatments and exercises. I think that I aside from not backing off from our patients, we have to be creative and really lots of patience and love for our job. 🙂
Jaq, thanks for stopping by. You’re absolutely right that many times we are forced to use some creativity in our treatments, but this is what makes PT somewhat of an art form as well as science. Even when we see patients such as those who have suffered a stroke, we need to push them as much as we possibly can. Neuro conditions can be very frustrating d/t their complexity and the nervous system’s control over everything else. Regardless of age, i will almost always take them through PT based on developmental sequencing and find their true functional and developmental restrictions. Every stroke is different and so are everyone’s past medical histories, so people reactions to the same treatment may be way different, as you have clearly seen! Thanks for pushing your patients even though it can be frustrating and difficult.
Mike
PS – to those interested in motor learning, check out my motor learning posts from last October