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Toni Talks about PT Today

Geriatrics are a Unique Population

Published December 29, 2009 12:08 PM by Toni Patt
Earlier this evening I reserved my seat to take the GCS (geriatric clinical specialist) examination for 2010. I thought I would be excited, or maybe relieved. I'm not. It hasn't even registered yet. When it does I don't think it'll change how I feel.  I've thought of it as that test for so long I've become immune to it. None of my co-workers or managers were overly excited either. The only comment I heard was a question of when I planned to take the NCS (neurologic specialist) exam. Isn't that interesting?

Somewhere along the way, the GCS has lost its luster. I've talked to several people who've taken it. All have told me it's hard but fair. I've also spoken with people who've taken the NCS exam. They tell me it was the hardest test they ever took. Over the course of the last 2 years, I've met many more GCSs than NCSs.  Is that a reflection of the difficulty of the test or trends in practice patterns? Does the greater number of GCSs mean the test is harder or that more people have taken it so therefore more have passed?  It's a matter of perspective.

It doesn't take an understanding of demographics to know our population is aging. The baby boomers are beginning to hit retirement age. Physical therapy will feel this in two ways. The increased population of older persons means increased demand for services. After all, the biggest consumers of PT are those 65+.  With that increased demand, practice patterns will also shift. There will be a greater need for those who treat older adults. 

It would seem more older adults would imply the need for more geriatric specialists. Based on my experience, I would say no. For some reason there is an unspoken belief that anyone can treat geriatric patients. There is no need for additional training except in a related area. Even though many people believe it, that doesn't make it so. Geriatrics are a unique population with specific therapeutic needs. The term "age-related changes" doesn't begin to cover the differences. 

That belief is part of the problem. Another piece is the unwillingness to work with patients who won't "get better." Older adults will improve but may never return to prior functional status. For an older person being able to go to the bathroom alone can be a huge goal. The majority of my older stroke patients just want to return home. Most of my younger stroke patients what to return to life as they knew it. Although some of my treatments for the two groups overlap, I anticipate completely different outcomes.

Possibly the value of the GCS could be setting related. The majority of the patients on the rehab unit could be considered older adults, but that's not why they're receiving therapy. In a SNF or home health setting, being older is part of the process. That doesn't mean all geriatric patients are treated the same. I've met several therapists who've told me they don't know what to do with older patients. I've met others who work with older people but don't excel at it. Especially in the home setting, there is much more to it than meets the eye.

Sadly, I think the real solution to this exists outside the world of PT. As a society, we don't put as much value on older people as we do younger ones. It's beyond me to even touch on the social issues involved with that statement. But the meaning is clear. If we don't value our older adults, we also don't value those who work with them. Orthopedics, neurology and pediatrics have an aura of excitement about them. PTs can "make" those patients better. That isn't necessarily so with the geriatric population. With a geriatric patient, my only gait goal may involve making it to a toilet. There's nothing wrong with that.  It's a matter of perspective.

posted by Toni Patt


Toni, your posts always make me think. Sometimes I agree with you and others I don't. That being said, all of them succeed because they inspire thought. As someone who also works with older adults, and I do so out of choice, I couldn't agree more with this post. I would love to say that I have discovered a greater reverence toward the older adult here in the UK, but that is not so. I am excited for you and your decision to take the GCS! There are not enough people who embrace our elders. I hope that your enthusiasm returns for this endeavor as it is a worthwhile one.

Cheers to you! Good luck and Happy New Year! Dean

Dean Metz December 30, 2009 1:55 PM

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