It is possible, however, that at the contemplation stage Mr. Rogers will decide he does not wish to acquire any type of assistive technology. In this case, the physical therapist will likely suggest another strategy such as a caregiver who will help; in this instance, the patient demonstrates engagement in the Setting and reimbursement Schell and Cervero (1993) introduced the term pragmatic reasoning to describe the current realities of healthcare service delivery. Practical issues that may impact the provision of physical therapy include payment guidelines, availability of equipment, scheduling options, and even the skill set of the practitioner. Pragmatic reasoning may contribute to the type and length of functional assessment considered for practice with older adults but should not deter physical therapy practitioners from employing other types of professional reasoning in determining the course of care for their clients. Often, insurance Caregiver needs Caregiving is a common practice among the older population. Older caregivers commonly care for spouses, but may also care for aging parents, disabled children, or grandchildren. Research suggests that caregiving is associated with a range of adverse health consequences, including depression (Perkins et al., 2012). Because caregivers are a core element of an older adult’s health, it is important to recognize, respect, and assess caregivers’ needs and capacity to provide care. The benefits of caregiving for the caregiver are now being explored and can include the positive aspects of caring for a loved one. The Family Caregiver Alliance National Center on Caregiving (2006) has prepared guidelines to assess the health of caregivers. A caregiving assessment is a systematic process of gathering information that describes a family caregiving situation and identifies the particular problems, needs, resources, and strengths of the family caregiver. It approaches issues from the caregiver’s perspective and culture, focuses on what assistance the family caregiver may need and the outcomes the family member wants, and seeks to maintain the caregiver’s own health Conclusion As the 65-and-older population continues to grow, use of a multidimensional functional assessment in physical therapy and other rehabilitation services becomes critical. The older adult population constitutes a hetero-geneous mix of individuals with distinct issues and needs, and older adults in need of physical therapy services often present with multiple chronic and acute medical conditions that affect their independence and participation. In addition to basic ADL needs, older adults are likely to have IADL needs in areas such as driving, financial management, and homemaking. Some may continue to work or volunteer and many may serve as a primary or secondary caregiver for others. Successful aging has shifted away from a medical focus to a perspective that considers well-being and life participation as outcome measures of choice. Function and participation should be assessed by the consideration of performance in a broad range of daily life. Physical therapists should consider activities that clients want, need, and are
preparation stage by identifying a caregiver who will assist, while strengthening exercises are focused on improving this skill. If Mr. Rogers decides to make no changes, the therapist will consider modifying the goal of safety and independence with toilet transfers despite the current safety risk of the activity. coverage (or lack thereof) can determine a client’s length of stay or promote the transition from acute care services to skilled nursing. To improve functional outcomes, physical therapists need to be aware of outside factors that may affect the health care received by older adults in various settings. Staying abreast of current evidence-based practice and legislative changes can maximize effectiveness of interventions. The therapist must also recognize that group activities and using community resources may help the older adult maintain optimal wellness. and well-being. The guidelines suggest that caregivers be identified for all older adults, and that they be assessed when the need for caregiving arises. While specific measurement practices will differ across settings of care (such as hospital or home), the following seven domains should be assessed: 1. Context. 2. Caregiver’s perception of health and functional status of care recipient. 3. Caregiver’s values and preferences. 4. Caregiver’s well-being. 5. Consequences of caregiving. 6. Skills, abilities, and knowledge to provide care recipient with needed care. 7. Potential resources that a caregiver could choose to use. (Family Caregiver Alliance National Center on Caregiving, 2012) The caregiver interview and assessment should be done at multiple points throughout the caregiving process, and the intent of the assessment should be explicitly communicated to the caregiver. expected to perform as they relate to the demands of their personal life and environment. Clinicians must understand the difference between expected age-related changes in physical, cognitive, and psychosocial domains and changes in function resulting from the effects of acute and chronic illness. Such knowledge will aid clinicians in determining whether restoration of function, compensation, or an adaptive approach will facilitate goal achievement. In addition to understanding client factors, practitioners must be conscious of the delicate interplay of the dimensions of the environment on the function. Pragmatic issues, including reimbursement and the client’s own readiness to change are also key elements for consideration in treatment planning and service delivery. Combined, this knowledge allows for an efficient, best-practice approach that maximizes the potential and well-being of older adults.
EliteLearning.com/Physical-Therapy
Page 52
Powered by FlippingBook