A new generation of health

Long gone are the days when older adults were labelled as ‘the elderly’ and seen as an amorphous group of lonely, dependent, or disabled people, quietly deteriorating in an aged care institution.

Images of ageing are rapidly changing. With the baby-boomers now well into their fifties and sixties, a new generation of health conscious older Australians is taking responsibility for their own health and wellbeing. These days it is far more common for the media to depict retirees as healthy and energetic, enjoying participation in a range of physical activities and leisure pursuits. Images of walking sticks and nursing homes have been replaced with bicycles, tracksuits, and gymnasiums. Seventy-five year olds participating in walking groups, seniors riding in bicycle marathons, and grandmothers ‘pumping iron’ are now considered commonplace.

Physiotherapists play a key role in enabling older adults to optimise their health and minimise disability. Most Australians will enjoy 25–30 years as older adults and there are noticeable differences in the health needs of people aged 65 years compared to those 85 years or older. Most people just entering their sixth decade will be physically active and participating in a range of social roles at work, family life, or in the community. Many have just commenced roles as grandparents, others are still at work, and some are travelling or participating in leisure activities such as golf, tennis, and cycling. On average, one or two chronic conditions will be emerging, such as osteoarthritis, high blood pressure, low back pain, foot deformities, or relatively low-level impairments of vision or hearing. Physiotherapy has a major focus on health promotion and teaching people how to manage these emerging chronic conditions to minimise the impact of impairments on the ability to exercise and participate in physical activities.

Most people in their seventies will experience around 2–3 impairments, such as musculoskeletal pain, stiffness, reduced aerobic capacity, reduced muscle strength, or diminished lung capacity. The extent to which these arise from reduced levels of physical activity and a sedentary lifestyle compared to diseases is different for each individual. As pathologies such as Parkinson’s disease, stroke, arthritis, fractures, acute myocardial infarct, and cancer are more prevalent around this time, physiotherapists carefully evaluate the underlying factors contributing to the persons’ activity limitations and participation restrictions. When reduced levels of exercise and physical activity are the primary contributor to disability, the physiotherapist has the knowledge required to educate the person about how to change this. The physiotherapist can also devise a physical activity program, including targeted exercises, to increase the amount and scope of physical activity. This could include such things as progressive resistance strength training, a daily walking program, cycling, golf, tai chi, or hydrotherapy.

When the person has a pathology, such as a stroke or a broken hip, the physiotherapist is able to offer a range of therapeutic interventions that are matched to the diagnosis. For example, a person in the rehabilitation phase after a broken hip can be taught exercises to strengthen weak muscles and increase joint range of movement without disrupting fracture healing. They are also carefully guided on how and when to commence partial weight bearing and then full weight bearing through the affected leg. For people with Parkinson’s disease, the physiotherapist can teach a range of strategies to increase the size and speed of movements, as well as how to minimise the effects of disruptions (whereby the performance of a task such as talking interferes with a second task, such as walking). Stroke patients can be trained how to generate force in the muscles with the necessary force, timing, and pattern of activation to move more easily.

Once people reach their eighties, it is usual to have a combination of at least three impairments and at least one pathology. Physiotherapy is often recommended to assist people to maintain independence, safety, and to prevent falls, despite multiple pathologies, medications, and the deconditioning effects of a sedentary lifestyle. Around 29 per cent of people older than 65 years, and 40 per cent of those older than 80 years, fall every year. Physiotherapists have a key role in educating people about falls prevention, risk factors for falls, and how to modify the environment and the ways in which tasks are performed to minimise slips, trips, and falls. There are falls clinics in Australian public hospitals where older people can gain services from expert physiotherapists, geriatricians, occupational therapists, and other healthcare professionals.

The Australian public health system provides some additional examples of excellent physiotherapy services in gerontology. For example, in the Rehabilitation and Aged Care Program at Southern Health in Victoria, people with Parkinson’s disease have access to evidence-based physiotherapy delivered within a client-centred trans-disciplinary team. An onsite clinical research facility, including a gait laboratory, generates new knowledge as a basis for conceptualising the most effective models of care and evaluating therapy outcomes. Clinicians are trained to be effective consumers of clinical research, increasing the likelihood that research findings lead to changes in therapists’ behaviours so that therapy is more effective. Within the team environment goal setting is driven by the needs of the client and their family. This ensures that physiotherapy is well matched to the client’s requirements.

The physiotherapy profession recognises that older Australians are vibrant and diverse range of individuals, with wide individual differences in health, activity levels, and societal roles. Whilst respecting that older adults have the responsibility for their own health, physiotherapists can offer a range of diagnostic, assessment, and treatment services that enable people to minimise disability and to maintain their health, fitness, and activity levels well into old age.