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Physiotherapy Works for Healthy Aging

Physiotherapy enables individuals to maximize their quality of life and optimize their health and well-being. Physiotherapists work with other health-care providers (home care staff, personal support aides, and health-care aides) to increase the individual’s ability to live independently and participate fully in their community, countering the risk of social isolation.

The 5 Rs

Reversal

Increasing care needs are not inevitable. Physiotherapists are experts in rehabilitation and reablement, which can reverse deterioration of ability. Following a crisis or hospital admission that results in loss of function or mobility, physiotherapy teams work to motivate and enable individuals to return to their previous level of function, to meet their goals, achieve their potential and continue to live independently. This includes people living with dementia or other cognitive impairments.

Resilience

Physiotherapists consider all the surrounding factors and the individual’s personal resources (health, financial, social) to maintain and sustain their health and well-being.

Physiotherapy builds resilience for the long term by supporting self-management and teaching families, carers and care professionals to deliver care safely and effectively and facilitate reintegration into the community. Physiotherapists and physiotherapist assistants work to prevent ill health and crisis events, avoiding or minimizing periods of high health and social care need, through:

  • Utilization of risk stratification tools
  • Care co-ordination
  • Early intervention
  • Admission avoidance
  • Provision of a single point of access
  • Education in self-management
  • Health promotion
  • Rehabilitation
  • Early reablement

Results

Physiotherapy focuses on outcomes, not activity. It empowers people to be independent, contribute to society and get back to full employment. Physiotherapists and physiotherapist assistants consider people’s personal preferences and goals, delivering better outcomes for individuals and their caregivers.

Responsive

Physiotherapists respond to a person’s everyday needs as they change over time but have the skills to react quickly to a crisis event. They enable a coordinated approach to meet an individual’s personal needs.

Resources

Physiotherapy is cost effective and delivers value within available resources.

Physiotherapists employ available resources within a community environment to support a long-term focus on health and well-being, as well as contribute to the avoidance of hospital admission or readmission, and the delay or prevention of the need for complex or residential care. Physiotherapists also ensure the best use of resources to deliver a personal care plan that meets the individual’s situation.

Physiotherapists collaborate with community-based health-care providers to deliver services that prevent deterioration, promote and improve physical function, mental health and well-being, encourage directed self-management, and build people’s confidence, independence, and opportunities.

Why Physiotherapy

Including physiotherapy within community care settings can deliver significant savings by reducing the need for ongoing care and support, including residential placements.  For example, the Stroke Action Plan has implemented early supported discharge in 14 small centres across Alberta. Early results show the average length of hospital stay is reduced by half and the improved access to rehabilitation, including physiotherapy, has improved stroke outcomes overall in the over 1,300 patients reached between 2012 and 2015.1

Innovative new programs, such as the Alberta Cancer Exercise (ACE) program, will help cancer survivors throughout Alberta make the transition from hospital rehabilitation to exercise in the community.  The program is a partnership between the Faculty of Rehabilitation Medicine at the University of Alberta (U of A), the Faculty of Kinesiology at the University of Calgary (UC), Alberta Health Services, and the YMCA. The initial pilot study, led by U of A physiotherapist researcher Dr. M. McNeely, will “examine the benefit and specific outcomes of a community-based exercise program that is designed to address the needs of individuals who are receiving or recovering from cancer treatment.”2  

Physiotherapists use a patient-centered approach, which takes each individual’s  physical, emotional and social needs into consideration. They are autonomous practitioners with the skills and ability to assess, diagnose, treat, and discharge their patients. They are able to access a wide range  of resources and consult other professionals, such as referring a patient to a pharmacist with prescribing rights as necessary, allowing the provision of   streamlined, cost efficient, and effective care.  

Physiotherapists practice in many community care settings, including general practitioner clinics, health centres, residential homes, workplaces, gyms,and day centres. They are members of interprofessional teams, contributing to personalized programs for each individual’s needs. The focus of their rehabilitative approach for the individual is to secure independence and social integration.

Physiotherapy can help prevent hospital admissions and readmissions,6 as well as reduce bed days and the dependence on complex care packages.7

Health and social care services can work together more effectively to improve outcomes for individuals by developing new models of integrated care to transform the service user’s experience and optimize the use of limited resources.

Aging Population

  • In Canada, women 65 years of age have an average life expectancy of an additional 22 years, while the projection for men is an additional 19 years.3
  • In 2017, almost 6,200,000 Canadians (16.9%) were over 65 years old. Forty-one percent were baby boomers, an increase of almost 5% in one year. In Alberta there were about 550,000 seniors over 65.4
  • By 2031, it is estimated that one in four Canadians will be over 65, with 93,8000 living in Alberta.2  
  • In 2012, 26% of adults over 65 reported an activity-limiting disability; pain, mobility or flexibility were the most commonly reported.5

Increasing care costs

  • Annual health-care spending increases with age – e.g., $6,298 for those 65-69 to over $20,000 for those age 80 an older.14
  • In 2014, cost of long-term care in Canada was approximately $69 billion. It is projected to increase to $188 billion by 2050.14
  • The Conference Board of Canada has estimated 2.4 million Canadians 65 years and older will need continuing care, both formal and informal, by 2026.14

Older People

  • Every year, one in three people over 65 experience a fall: 85% of all seniors’ injury-related hospitalizations in Canada are due to a fall.8 Eight percent of these individuals will die as a result of the fall.9 In Alberta on average, over 100 seniors die every year as a result of a fall.10 One third of seniors’ falls result in a hip fracture and may result in significant disability that requires continuing care.8   
  • Physiotherapy-led falls prevention programs, with tailored exercise and education, improve outcomes, keep people living independently and reduces the number of falls and fractures, hospital admissions and medical appointments.
  • Alberta’s Bone and Joint Health Institute reports that avoiding a single hip fracture can save $21,000 in treatment the first year, which can increase to $44,000 if the patient requires long-term care.13

Dementia

  • By 2016, an estimated 564,000 Canadians were living with dementia, and about 25,000 new cases are diagnosed every year. That number is expected to increase to 937,000 or 66%, by 2031.12
  • Physiotherapists undertake detailed, individual assessments of impairments, activity restrictions and participatory limitations faced by people with dementia or intellectual disabilities. They deliver high-quality, effective care and rehabilitation to promote and maintain independence for individuals in this population.
  • Physiotherapy interventions can help reduce the risk of developing dementia15 and delay the progression of both cognitive and functional decline.15,16

Long-term conditions

  • According to a report by the Public Health Agency of Canada, more than one in five Canadians live with one of the following chronic diseases: cardiovascular disease (CVD), cancer, chronic respiratory disease (CRD) or diabetes. One in 25 Canadians 20 years or older report having a mood and anxiety disorder and at least one of the four major chronic diseases.15
  • Physiotherapy is an effective intervention for a range of long-term conditions, such as stroke, mental health, multiple sclerosis, motor neuron disease, Parkinson’s disease, arthritis and rheumatology conditions, osteoporosis, acute and chronic pain, chronic heart disease, and respiratory conditions such as chronic obstructive pulmonary disease (COPD), bronchiectasis, asthma and cystic fibrosis.
  • Using therapeutic exercise alongside education and social integration, physiotherapists support and empower individuals to return to their previous level of functioning.

Conclusion

With the aging population and increasing numbers of people with long-term conditions, demand for health and social care services will continue to rise. Expenditure is not keeping pace with demand and people’s independence and well-being are at risk. Physiotherapy can deliver cost effective change to more integrated, co-ordinated and effective community services, focused on prevention, early intervention, and rehabilitation. All of which enable people to live well for longer with reduced need for care and support.

Ackowledgement  

Adapted and used with permission of the Chartered Society of Physiotherapy.

References

  1. Noseworthy T, Wasylak T, O’Neill B. Strategic clinical networks in Alberta: Structures, processes, and early outcomes. Health Manage Forum. 2015 Nov; 28(6) doi: 10.1177/0840470415600130 Epub 2015 Sep 7.
  2. McNeely M. Alberta Cancer Exercise Pilot Randomized Trial 2015 https://clinicaltrials.gov/ct2/show/NCT02330575
  3. Statistics Canada. CANSIM Table  053-0003 -  Life expectancy and other elements of the life table, Canada, provinces and territories, 2017 http://www5.statcan.gc.ca/cansim/a26?lang=eng&id=530003
  4. Statistics Canada. Annual demographic estimated: Canada, provinces and territories, 2017. http://www.statcan.gc.ca/pub/91-215-x/91-215-x2017000-eng.htm
  5. Statistics Canada. Disability in Canada: initial findings from the Canadian survey on disability. 2012. http://www.statcan.gc.ca/pub/89-654-x/89-654-x2013002-eng.htm
  6. Courtney M, Edwards H, Chang A, Parker A, Finlayson K, Hamilton K. Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program. J Am Geriatr Soc 2009 Mar ;57(3):395-402. doi: 10.1111/j.1532-5415.2009.02138.x. Epub 2009 Feb 23.
  7. Courtney M, Edwards H, Chang A, Parker A, , Finlayson K, Bradbury C et al. Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial. J Eval Clin Pract. 2012 Feb;18(1):128-34. doi: 10.1111/j.1365-2753.2010.01547.x. Epub 2011 Apr 1.
  8. Accreditation Canada, CIHI and CPSI. Joint Report, Preventing Falls: from Evidence to Improvement in Canadian Health Care, 2014. http://www.patientsafetyinstitute.ca/en/toolsResources/Documents/Interventions/Reducing%20Falls%20and%20Injury%20from%20Falls/FallsJointReport_2014_EN.pdf
  9. Public Health Agency of Canada. Seniors’ Falls in Canada: Second Report. 2014 http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/assets/pdf/seniors_falls-chutes_aines-eng.pdf
  10. Health Trends Alberta, Fall related mortality among Alberta seniors, 2015 Jan 20. https://open.alberta.ca/dataset/73729d77-eac4-4d11-ac23-849ad42c2cbb/resource/e7ef0e49-3f95-42c2-9c8e-e29ef90cf663/download/HTA-2015-01-20-Seniors-Deaths-due-to-Falls.pdf
  11. Alberta Bone and Joint Health Institute. Projects. Hip Fracture. n.d. https://albertaboneandjoint.com/projects/hip-fracture
  12. Alzheimer society of Canada - HPCDP. Prevalence and monetary costs of dementia in Canada. 2016 Oct;36(10). https://www.canada.ca/en/public-health/services/reports-publications/health-promotion-chronic-disease-prevention-canada-research-policy-practice/vol-36-no-10-2016/report-summary-prevalence-monetary-costs-dementia-canada-2016-report-alzheimer-society-canada.html
  13. Kaur J, Sharma S, Mittal J, Physiotherapy in Dementia. Delhi Psychiatry Journal 2012; 15(1). http://medind.nic.in/daa/t12/i1/daat12i1p200.pdf
  14. Christofoletti G, Oliani MM, Gobbi S, Stella F, Bucken Gobbi LT, et al. A controlled clinical trial on the effects of motor intervention on balance and cognition in institutionalized elderly patients with dementia. Clin Rehabil. 2008 Jul;22(7):618-26. doi: 10.1177/0269215507086239.
  15. Public Health Agency of Canada. How healthy are Canadians: A trend analysis of the health of Canadians from a healthy living and chronic disease perspective, 2016. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/healthy-living/how-healthy-canadians/pub1-eng.pdf
  16. Canadian Medical Association, The state of seniors’ health care in Canada. 2016, Sept. https://www.cma.ca/En/Lists/Medias/the-state-of-seniors-health-care-in-canada-september-2016.pdf