Category Archives: population health

Aging and Population Health

2910912489_bf07d7809b_mI’ve been thinking for some time now (starting during PT school, because of my father and grandfather getting older) about the aging population – including illness, chronic illness, health and wellness, the changing of demographics in the communities and what is needed, or better yet, what might be expected and how to get ahead of the changes.  It was one of the reasons I did the residency and earned my GCS, and with continued changes to healthcare I’m realizing that instead of responding to just a major or minor illness (in my daily practice), I also need to get ahead and do something to help address population health.  From what I’ve seen communities are becoming more aware of this as well as their population ages, including Washington County and the Twin Cities overall.

Dr. Michael Riley has written a great challenging blog post Can We Jump the Fence? which I encourage you to read as a starting point.  One thing he writes is “Given the current health climate we are not seizing the opportunity to work as the entry point to better health. People change for two reasons, desperation or inspiration… I have been inspired to change the way I think about the future of this profession and the value we possess.”

Practice Level:  How can we do this at a provider level?  For PT’s working with older adults, we need to be inspired to be the entry point, and to view our position as a both-and (prehab/wellness, rehab, and post-hab/ wellness so to speak), not as either-or (PT or personal trainer, for lack of a better term).  The issues I see for those working with older adults is that Medicare won’t pay for wellness, there is an annual limit for MedB (and a rather tight scrutiny if you go over), and the limited fixed income most seniors are on create limits in some way.  Even if all these were answered to our patients’ benefit, there is a significant issue with adherence to exercise in the older adult population.  So how can we jump the fence and be “the entry point to better health”? We can advocate on our own, but having the support of other providers and current and former patients will be important.

  • Get buy-in from other providers.  They need to know what we can do, both for injuries and to address chronic diseases.  We need to show we know what we are doing by challenging our patients (which we don’t do often enough) to demonstrate good results.  Two PT’s who stick out in my mind in challenging the strength of their older patients or clients are Dustin Jones of the Senior Rehab Project and Christina Nowak of STAVE Off.
  • Get buy-in from our patients (the customer) that we are THEIR therapist, not just for this POC but anytime the need arises.  How can we do this?  Practice at our best, every, single, time; don’t give out a generic HEP, but target it to the patient’s most significant impairments (and emphasize this); and provide home assessments if they are interested.

Community LevelThis will largely be a pro-bono effort initially (though some customers may come your way through your interactions), but it is greatly needed, though others have found a way for it to work for the general population (see the link below for Pro-Activity Associates).  Having the support of providers and older adults may help you get a program started or give you ideas for promoting healthy aging in your communities.

  • For older adults:  support or even teach programs for falls prevention and strengthening; teach a class at your community center or local gym on a wellness topic or recovery from [x]; make or find and promote low cost technology to encourage physical activity in the older adult population.  An example of a good community program for overall health is Mike Eisenhart’s Pro-Activity Associates (What might a geriatric version of this look like? I’m intrigued and excited by the idea).
  • For their families: advertise how your program or classes can help their loved one function better; offer home assessments to help them age in place.
  • For communities and businesses: first, ask older adults what they see that they will need as they age!  Second, you can provide input at city, county or state meetings (zoning, transportation, and parks are a few areas that come to mind) where issues may come up that relate to older adults.  You can also provide comments to businesses on how to be senior friendly, and offer input to senior centers and ALF’s on design changes and fitness facilities.  Eagan, MN is redesigning their town (which is great for those who can move), maybe your community will redesign a part or all of it to accommodate older adults.  If you aren’t sure where to get started, contact your community’s public health department, and help out where your community may note needs (Washington County seems to have a good grasp of where the needs are and what they have in place already).

With a new baby I’m not taking on anything new at the moment, but I’m mulling all this over in my mind.  How can I help position physical therapy as “an entry point to better health”?  Can we therapists network with each other and with other disciplines and organizations to elevate the health and wellness of our aging population?  I think the answer is yes.  I’d love to hear your ideas either in the comments below, on social media, or via email.

Picture by Mendhak