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An Impairment and Disability Assessment and Treatment Protocol for Community-Living Elderly Persons

M Koch, PT, is Assistant Professor and Academic Coordinator of Clinical Education, Department of Physical Therapy, Quinnipiac College, Hamden, CT 06518.
M Gottschalk, PT, is Staff Physical Therapist, Department of Rehabilitative Services, Yale-New Haven Hospital, New Haven, CT 06504.
DI Baker, PhD, RNC, is Research Scientist, Yale University School of Nursing, New Haven, CT 06510.
S Palumbo, PT, is Clinical Education Coordinator-Staff Physical Therapist, Department of Rehabilitative Services, Yale-New Haven Hospital.
ME Tinetti, MD, is Associate Professor of Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar St, PO Box 3333, New Haven, CT 06510-8056 (USA).

Background and Purpose. Falls and immobility are common among community-living elderly persons and result from the accumulated effect of multiple impairments and disabilities as well as enviornmental hazards. We developed and tested a simple assesment and intervention protocol for use in prevention and treatment programs among community-living elderly persons. This article presents the components of the assessment; the criteria for intervening on diagnosed impairments contributing to falls and immobility; and the recommended treatments, environmental adaptations, training, and exercise programs targeting the diagnosed problems. Subjects. A convenience sample of 11 residents of a senior housing complex who were cognitively intact and ambulatory were chosen for reliability testing of the assessment protocol. A random sample of 20 of the 153 elderly subjects involved in a multiple risk factor trial for fall prevention then were chosen to test the reliability of the intervention recommendations. Methods. The assessment and intervention protocol was developed by a consensus approach among a group consisting of a geriatric physician, two nurses, and three physical therapists. The interrater reliability of both the assessment and the intervention components of the protocol was determined by comparing the results of two of the study physical therapists. Results. There was excellent agreement in assessment and intervention results by the two physical therapists. The assessment required approximately 45 minutes to complete, suggesting it is feasible for use in clinical practice. Conclusion and Discussion. A simple, standardized assessment and intervention protocol, such as the one described, could aid physical therapists in evaluating and treating community-living elderly persons by improving communication among care providers, providing better documentation for reimbursers, and ensuring a direct linkage between assessment and intervention, thus simplifying the development of a treatment plan for elderly persons with complicated or multiple impairments. The ultimate test of this assessment and intervention protocol will be ascertainment of the goal of the protocol, namely a reduction in falls and improvement in mobility among multiply and chronically ill elderly persons.

Key Words: Elderly • Falls and immobility • Home care • Physical therapy

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