What are the guidelines for elderly physiotherapy?

Guidelines for Elderly Physiotherapy

Elderly physiotherapy should include individualized assessment, tailored multicomponent exercise programs, and appropriate monitoring of vital functions to ensure both therapeutic benefit and safety. 1

Assessment and Monitoring

• Assessment prior to treatment should determine underlying problems amenable to physiotherapy and appropriate interventions 1
• Focus on deficiencies at physiological and functional level rather than medical diagnosis 1
• Use appropriate monitoring of vital functions during therapy to ensure interventions are both therapeutic and safe 1
• Utilize validated assessment tools when possible:
  • Short Physical Performance Battery
  • Walking speed test
  • Functional capacity evaluation 1
  • Risk of falling assessment 1

Exercise Prescription Components

Multicomponent Exercise Program

The Vivifrail multicomponent exercise program is recommended for elderly patients, tailored to their functional capacity level 1:

• Serious limitation: Focus on seated exercises, minimal weight-bearing
• Moderate limitation: Progressive resistance with support, short walking intervals
• Slight limitation: More advanced balance and strength training

Specific Exercise Types

1. Aerobic Exercise

   • 30-60 minutes, 3-7 days per week 1
   • Start with 10-minute sessions, gradually increasing by 5 minutes until reaching 30 minutes 2
   • Moderate intensity (able to talk but moderately hard work) 1
   • Examples: brisk walking, cycling, elliptical training 1

2. Progressive Resistance Training

   • 2-3 days per week 1, 2
   • Begin with 2-3 repetitions and work up to 10-12 repetitions 1
   • Use pain threshold as intensity guide for patients with arthritis 1
   • Focus on total body strength and range-of-motion training 1

3. Balance Training

   • T'ai chi classes with individual instruction are recommended for fall prevention 1
   • Core muscle training (abdominal curls and back extensions) 1
   • Balance exercises should be performed regularly 1

4. Flexibility Training

   • Daily stretching of major muscle groups 1
   • 5-10 minutes of stretching morning and evening 1
   • Focus on back, chest, hamstrings, gastrocnemius, and Achilles tendon 1

Special Considerations for Common Conditions

Arthritis

• Start with repeated short bouts of low-intensity exercise daily
• Exercise affected joints using pain-free range of motion
• Begin with as little as 2-3 repetitions, working up to 10-12 repetitions
• Consider hydrotherapy for non-weight bearing exercise 1

Hypertension

• Focus on aerobic activities using large muscle groups
• Exercise 30-60 minutes, 3-7 days per week
• Use 40-70% of 1-RM for resistance training
• Combine PRT with aerobic activity using lower resistance and more repetitions
• Avoid Valsalva maneuver
• Cool down gradually to prevent hypotension 1

Fall Prevention

• Individually tailored exercise programs administered by qualified professionals should be established for those over 80 years 1
• Exercise programs targeted at older people with mild deficits in strength, balance, and range of motion should be established 1
• T'ai chi classes with individual instruction should be offered to unselected older people living in the community 1
• Multifaceted interventions including exercise, home safety assessment, and medication review are most effective for high-risk patients 1

Implementation Strategies

• Create a specific exercise prescription with clear parameters:

  • Frequency: Number of days per week
  • Intensity: Using rate of perceived exertion (RPE) scale
  • Time: Duration of each session
  • Type: Specific exercises to perform 1

• Promote adherence through:

  • Group exercise settings when possible 2
  • Social support and regular follow-up 1
  • Including fun activities and time for social interaction 1
  • Regular telephone follow-up for home-based programs 1

Best Practice Principles

• Person-centered care that addresses individual needs and preferences 3
• Anti-ageist beliefs that avoid stereotyping older adults 3
• Holistic assessment using validated outcome measures 3
• Evidence-based interventions tailored to functional capacity 3
• Physical activity promotion for long-term health 3
• Interprofessional collaborative practice involving physicians, nurses, physiotherapists, and social workers 4

Cautions and Contraindications

• Patients with hemodynamic instability or high levels of ventilatory support are not candidates for aggressive mobilization 1
• Weigh the risk of moving a critically ill patient against the risks of immobility 1
• Medical clearance and appropriate follow-up are important parts of exercise programs for older adults 1
• Maximal exercise testing is recommended for older adults starting vigorous training programs 1

The ultimate goal of physiotherapy in elderly patients is to restore or maintain functional autonomy in daily living activities, reduce the need for care and assistance, and improve quality of life 4, 5.