What medical conditions should be referred by a geriatrician to Physical Therapy (PT) services?

Medical Conditions for Geriatric Physical Therapy Referral

Geriatricians should refer patients to physical therapy services for fall risk, functional decline, peripheral artery disease, stroke rehabilitation, cancer-related impairments, and post-surgical recovery to improve mobility, reduce mortality, and enhance quality of life.

Fall Risk and Prevention

Fall risk is a primary indication for PT referral in geriatric patients:

• Patients who screen positive on fall risk assessments should be referred to PT 1, 2
• Key screening questions include: falls in the past year, unsteadiness when standing/walking, and worry about falling 2
• Patients with gait and balance abnormalities require PT evaluation and intervention 1, 2
• PT referral is strongly recommended for patients with recurrent falls 2

Assessment criteria indicating need for PT referral:

• Positive Timed Up and Go (TUG) test
• Impaired performance on 4-Stage Balance Test
• History of multiple falls
• Fear of falling affecting mobility

Peripheral Artery Disease (PAD)

Patients with PAD benefit significantly from PT referral:

• Supervised exercise programs are recommended for patients with symptomatic PAD 1
• PT should be initiated for patients with claudication symptoms to improve functional capacity
• Older patients (≥70 years) with dependent functional status and PAD have higher mortality rates and benefit from PT interventions 1
• Exercise therapy improves walking distance and reduces cardiovascular risk in PAD patients

Stroke Rehabilitation

Stroke patients require prompt PT referral:

• All stroke patients with rehabilitation needs should receive PT assessment 1
• PT referral should occur as soon as the patient is medically stable 1
• Multidisciplinary rehabilitation assessment using standardized procedures is recommended for all stroke patients 1
• PT interventions focus on mobility, balance, strength, and activities of daily living

Cancer-Related Rehabilitation

Cancer patients benefit from PT throughout treatment and survivorship:

• PT referral is indicated for cancer patients experiencing treatment-related symptoms that impair function 1
• Colorectal cancer patients with treatment-related symptoms or advanced disease should be referred to rehabilitation specialists 1
• Sarcoma patients at all disease stages benefit from PT for symptom management 1
• Brain tumor patients should receive PT consultation upon diagnosis and at every stage of follow-up 1

Post-Surgical Rehabilitation

Surgical patients, particularly those undergoing high-risk procedures, benefit from PT:

• Enhanced Recovery After Surgery protocols include PT implementation preoperatively and within 24 hours after surgery 1
• High-risk surgical patients should be referred to rehabilitation for general symptom management 1
• Older patients (≥65 years) undergoing surgery should have preoperative PT evaluation 1
• Prehabilitation programs should be considered for frail elderly patients prior to major surgery 1

Frailty and Functional Decline

Frail elderly patients require specialized PT approaches:

• Frailty assessment should be conducted in all elderly patients, with PT referral for those showing signs of physical frailty 1
• Patients with decreased functional status compared to baseline should receive rehabilitation services 1
• PT interventions should address strength, balance, and mobility limitations
• Home safety evaluation and modification are essential components of PT intervention 2

Palliative Care Needs

Patients with advanced disease benefit from PT for symptom management:

• Patients with high symptom burden or unmet physical needs should be referred to rehabilitation 1
• PT can improve quality of life even in patients with limited life expectancy
• PT interventions can address pain, fatigue, and functional limitations in palliative care patients

Implementation Considerations

When referring to PT, geriatricians should:

1. Specify the primary impairments requiring intervention
2. Provide relevant medical history and precautions
3. Establish clear functional goals for the intervention
4. Consider the patient's cognitive status and ability to participate
5. Evaluate the need for home-based versus outpatient services

PT referral should be considered early in the course of functional decline rather than waiting until significant disability has occurred. Early intervention is associated with better outcomes and reduced mortality in many conditions affecting older adults.