How Physical Therapists Can View Normal Versus Abnormal Aging

By Sean McFadden, PT, DPT
Physical Therapist

With people living longer than ever, physical therapists play a key role in providing the education necessary to maintain function as we age. There is a critical lack of knowledge: People don’t understand one can be medically well but functionally sick. That is how FOX Founder and CEO, Dr. Tim Fox, labels this issue. Picture someone doing fine medically but who has been constrained to a power wheelchair just because he or she got it as a gift.

While the aging process can be normal or abnormal, healthy or disease-ridden, it should be — above all else — optimally functional.

FUTURE DEMOGRAPHICS ARE CHANGING

My Grandfather is one of the wisest men I know…when it comes to automobiles that is. And for the record, he still handles himself well around those curves— let me be clear, in no way did he force me to say that! Ask him any question about your car, and he could likely tell you exactly what’s happening under the hood. He’s sort of an expert on the topic, and at the age of 89 years young, he is paving the road for the future.

As a physical therapist, if you were assessing him you wouldn’t give him a clean bill of health. He has his aches and pains. Arthritis limits his mobility, and over time his posture has become worse. But he is an example of what the older adult population is becoming. By 2050, projections indicate that those aged 80 and over will number 434 million worldwide, which is more than triple the amount we witnessed in 2015. People aren’t just naturally living longer, but are utilizing the advances through modern medicine to take a life like my Grandfather’s, riddled with comorbidities, to ages not seen in the past.

The number of people living longer is without a doubt changing, but how?

Modern medicine is rapidly improving, prolonging the lives of those with a disease, disorder, or other cause of early death. Despite an unhealthy lifestyle or emergence of predisposed disease, people are living well into their older adult years.

However, this is bringing forth its own set of problems.

While people are living longer due to medical advances, functionally they are not keeping up. There is a clear threat to this change catching the eye of the Center for Disease Control: fall-related injury. According to the CDC, “Fall death rates in the U.S. increased 30 percent from 2007 to 2016 in the older adult population” (those 65 and over). And the CDC projects that if numbers continue to rise, by 2030, there could be as many as seven deaths per hour caused by falls in the U.S.

Luckily, just as medicine has evolved to handle the disease, there is an answer to one of the aging population’s largest threats in falls. The answer is modern physical therapy.

WHAT DOES FUNCTION LOOK LIKE FOR NORMAL AGING?

There is a misconception out there that, as a person ages, it is normal to move around less. Perhaps this was true in the past, but society’s view on health should update itself just as modern medicine has evolved over time.

Example: Joel Jones, who is 76 years of age, gets some aches and pains, which go unaddressed, leading to greater periods of immobility. Mr. Jones’ daughter starts to see her father getting out of breath as he walks from the chair to the bathroom. A week later she notices he’s having a hard time getting up from his recliner. Because of this, Mr. Jones decides to limit his movement throughout his day. He stops drinking water at recommended amounts because he “doesn’t want to make extra trips to the bathroom.” One month later, Mr. Jones is having a hard time keeping his balance when standing, and because of this, his daughter buys him a rolling walker. However, he doesn’t like using it because it makes him hunch over. The Jones family is worried about their patriarch falling, so they hire someone to watch over him and help him in his home. Before he realizes what is happening, Mr. Jones becomes more and more reliant on that helper. He loses his independence.

In the therapy world, we see this “circular pattern of immobility” all too often.

While this story may sound familiar, it should no longer be considered normal in today’s world. The Jones family, like many others out there, really needs guidance. With FOX Rehabilitation, this is a concept that drives the minds of all our clinicians.

HOW PHYSICAL THERAPISTS CAN MAKE AN IMPACT IN THE AGING PROCESS

For Mr. Jones, and many people like him, there is a common thread: There is no mention of physical therapy until it is too late. It is not until after a fall occurs when anyone mentions physical therapy. At FOX Rehabilitation, we are trying to change that.

Medically speaking, there are in fact physiological changes that can impact the aging process.  These may involve cardiac health, bone metabolism, muscle fiber makeup, and cognitive strength to name a few. These are not new discoveries but have historically been accepted as normal as someone ages. While these are changes that can happen, we feel strongly that these changes do not have to be the norm. In fact, there is a simple fix! The good news is that a person can improve all these areas of their health through physical activity. A dedicated physical therapist experienced in Geriatric health can help to navigate these obstacles. These physiologic changes can be addressed as a person ages preventing an obstacle from even forming in the first place.

This is what we consider modern Physical Therapy.

Sometimes it takes exercise guidance, but more often than not it takes educational intervention. In a way, a FOX physical therapist becomes a healthy aging consultant, providing the tools to allow someone to live a functional life despite the normal or abnormal experiences life brings.

PHYSICAL THERAPY HELPS OLDER ADULTS FUNCTION

Oliver Goldsmith said, “Life is a journey that must be traveled no matter how bad the roads and accommodations.”

At times a person does not have control over what ailments affect him or her in life. A disease state is sometimes considered abnormal aging. But I’d argue that people who have their lives turned upside down by disease are just as deserving of a normal life.

Consider looking at the aging process not as being normal versus abnormal but rather functional versus nonfunctional. And, in health care as a whole, functional aging should become a model for everyone’s life. This is a concept that FOX Rehabilitation is spearheading across the healthcare industry and is portrayed perfectly through our Success Stories.

WHAT POSITIVE CAN PHYSICAL THERAPY REALLY BRING TO AGING?

As someone ages, it is important to recognize the need to feed the body. This, of course, includes maintaining physical activity levels but also considers healthy sleeping habits and adequate nutritional intake. FOX trains all of our physical therapists to facilitate the questions our patients are already curious about, but because of constraints on the healthcare system, never get to ask. I love to ask a patient, “How is your sleep hygiene?” During our sessions, we discuss regular eating habits. If a goal through physical therapy is to build muscle mass so that Mr. Jones can get up from the chair independently, but he does not have enough energy because he is not sleeping well and on top of that is not taking in enough protein to fuel his body, our treatment will be unsuccessful. Through bringing up these topics, we are able to treat the whole person, and more often than not, point our patients in the directions they need to get the answer to their questions.

In this way, FOX clinicians are strategically placed within the healthcare field in order to help older adults achieve what might be considered normal aging, or is better labeled as functional aging. Optimal aging for all is achieved by establishing a practice-wide belief in the best interventions. By ensuring the rapidly growing older adult population is achieving recommendations on strength training, especially task-specific strength training, we are not only maximizing potential but also quality of life.

In screening for fall risk, a physical therapist can most importantly keep an individual healthy, but the benefits don’t stop there. In 2015, the medical costs for fall-related injuries reached more than $50 billion. This begs the question of whether the healthcare industry needs to place a higher precedence on preventative services. This includes taking a special interest in community group programs and senior living facilities with the patient’s best interest in mind.

Because FOX physical therapists serve the community, we can work hand in hand with already established groups and organizations. Through teamwork, we can tackle the obstacles older adults face.

PHYSICAL THERAPISTS CAN CHANGE PEOPLES PERSPECTIVES

Too often we use a number–a person’s age–to define a who they are and what they can do. This is ageism. As physical therapists, we are positioned perfectly to be major movers in changing the healthcare landscape. We can and should help update societal perspectives on aging and independence. Our skills go beyond the physical, penetrating what is known as health literacy. Nine out of 10 adults struggle to understand and use health information when it is unfamiliar, complex, or jargon-filled.” Through patient-centered education, we can provide the tools necessary to maximize life potential and quality.

Like my Grandfather with cars, we have to strive for excellence when it comes to the aging process, which is never perfectly alike for two people. With modern physical therapy, aging in which someone accepts getting weaker and weaker over time, losing the ability to do the things he or she loves, is a thought of the past.

As physical therapists, each new patient we encounter provides his or her own unique puzzle, but as we treat the entire person, the pieces begin to fall into place. At FOX Rehabilitation, the very essence of what we do is put the pieces back together … making someone nonfunctional, functional yet again.