I am on a prac where I am mainly trying to improve deconditioned elderly patients strength, balance and endurance. We try to get the best possible outcome so we know whether to send them to high care, low care or home. I struggle when to know when they have reached their full potential, as my view is most old people are pretty weak, unsteady and not exactly marathon runners and compared to a lot of other elderly people in the community they seem relatively similar (in terms of acceptable level of functioning).
What I would accept as normal for an 86yr old is different to what experienced physios on the ward accept. I find it hard to know when to determine that physio is no longer helping. I have addressed this problem by reviewing the inpatient notes (particularly the social worker notes) on the patients previous mobility status. I try to aim to get them at least up to this point and if they are very slow to improve then make the decision that they are in fact deteriorating and therefore would benefit from higher level of care upon discharge. I have also found the old notes (previous admission notes) very helpful, as they state the reason for admission (i.e. admitted 3 times last year all related to falls), and therefore can direct my treatment and discharge planning accordingly.
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My point of view is that when treating the elderly patients, we always aim to maximise their functional independence rather than fitness, enhance their mobility and reduce the amount of assistance that they need to perform ADLs. To achieve this, we give strengthening, balance, endurance exercises. And understanding the aged care system in Australia and the wide range of services available out there will definitely be helpful for discharge planning. For example, if they are slow to progress, there are services like transitional care for patients who may benefit from slow rehabilitation instead of sending them to care facilities.
I think knowing how much patients will improve will come with experience. There are alot of services out there to help old people prevent falls. But it really comes to how interested the person is and how much effort they are willing to put in to prevent falls. We can only do so much while they are inpatients, and the service they get after d/c is only for a limited time. They must know the importance of keeping active themselves after d/c to maintain what we have done in hospital.
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