PTAT-2330: GERIATRIC PHYSICAL THERAPY

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1 PTAT-2330: Geriatric Physical Therapy 1 PTAT-2330: GERIATRIC PHYSICAL THERAPY Cuyahoga Community College Viewing:PTAT-2330 : Geriatric Physical Therapy Board of Trustees: Academic Term: Subject Code PTAT - Physical Therapist Assist Course Number: 2330 Title: Geriatric Physical Therapy Catalog Description: Course is designed to highlight special considerations of physical therapy approaches, role, and procedures regarding the older adult Statistics, myths, and legislation regarding aging population are presented and reviewed, as well as, typical aging and its implications for treatment and wellness. Credit Hour(s): 2 Lecture Hour(s): 2 Lab Hour(s): 0 Other Hour(s): 0 Requisites Prerequisite and Corequisite PTAT-1401 Clinical Pathophysiology, and PTAT-1420 Therapeutic Exercise; and concurrent enrollment in PTAT-2301 Long Term Physical Therapy Rehabilitation Procedures, and departmental approval. I. ACADEMIC CREDIT Academic Credit According to the Ohio Department of Higher Education, one (1) semester hour of college credit will be awarded for each lecture hour. Students will be expected to work on out-of-class assignments on a regular basis which, over the length of the course, would normally average two hours of out-of-class study for each hour of formal class activity. For laboratory hours, one (1) credit shall be awarded for a minimum of three laboratory hours in a standard week for which little or no out-of-class study is required since three hours will be in the lab (i.e. Laboratory 03 hours). Whereas, one (1) credit shall be awarded for a minimum of two laboratory hours in a standard week, if supplemented by out-of-class assignments which would normally average one hour of out-of class study preparing for or following up the laboratory experience (i.e. Laboratory 02 hours). Credit is also awarded for other hours such as directed practice, practicum, cooperative work experience, and field experience. The number of hours required to receive credit is listed under Other Hours on the syllabus. The number of credit hours for lecture, lab and other hours are listed at the beginning of the syllabus. Make sure you can prioritize your time accordingly. Proper planning, prioritization and dedication will enhance your success in this course. The standard expectation for an online course is that you will spend 3 hours per week for each credit hour. II. ACCESSIBILITY STATEMENT If you need any special course adaptations or accommodations because of a documented disability, please notify your instructor within a reasonable length of time, preferably the first week of the term with formal notice of that need (i.e. an official letter from the Student Accessibility Services (SAS) office). Accommodations will not be made retroactively.

2 2 PTAT-2330: Geriatric Physical Therapy For specific information pertaining to ADA accommodation, please contact your campus SAS office or visit online athttp:// Blackboard accessibility information is available athttp://access.blackboard.com. Eastern (216) Voice Metropolitan (216) Voice Western (216) Voice Westshore (216) Voice Brunswick (216) Voice Off-Site (216) Voice III. ATTENDANCE TRACKING Regular class attendance is expected. Tri-C is required by law to verify the enrollment of students who participate in federal Title IV student aid programs and/or who receive educational benefits through other funding sources. Eligibility for federal student financial aid is, in part, based on your enrollment status. Students who do not attend classes for the entire term are required to withdraw from the course(s). Additionally, students who withdraw from a course or stop attending class without officially withdrawing may be required to return all or a portion of the financial aid based on the date of last attendance. Students who do not attend the full session are responsible for withdrawing from the course(s). Tri-C is responsible for identifying students who have not attended a course, before financial aid funds can be applied to students accounts. Therefore, attendance will be recorded in the following ways: For in-person courses, students are required to attend the course by the 15th day of the semester, or equivalent for terms shorter than 5-weeks, to be considered attending. Students who have not met all attendance requirements for an in-person course, as described herein, within the first two weeks of the semester, or equivalent, will be considered not attending and will be reported for non-attendance and dropped from the course. For blended-learning courses, students are required to attend the course by the 15th day of the semester, or equivalent for terms shorter than 5-weeks, or submit an assignment, to be considered attending. Students who have not met all attendance requirements for a blended-learning courses, as described herein, within the first two weeks of the semester, or equivalent, will be considered not attending and will be reported for non-attendance and dropped from the course. For online courses, students are required to login in at least two (2) times per week and submit one (1) assignment per week for the first two (2) weeks of the semester, or equivalent to the 15th day of the term. Students who have not met all attendance requirements for an online course, as described herein, within the first two weeks of the semester, or equivalent, will be considered not attending and will be reported for non-attendance and dropped from the course. At the conclusion of the first two weeks of a semester, or equivalent, instructors report any registered students who have Never Attended a course. Those students will be administratively withdrawn from that course. However, after the time period in the previous paragraphs, if a student stops attending a class, wants or needs to withdraw, for any reason, it is the student's responsibility to take action to withdraw from the course. Students must complete and submit the appropriate Tri-C form by the established withdrawal deadline. Tri-C is required to ensure that students receive financial aid only for courses that they attend and complete. Students reported for not attending at least one of their registered courses will have all financial aid funds held until confirmation of attendance in registered courses has been verified. Students who fail to complete at least one course may be required to repay all or a portion of their federal financial aid funds and may be ineligible to receive future federal financial aid awards. Students who withdraw from classes prior to completing more than 60 percent of their enrolled class time may be subject to the required federal refund policy. If illness or emergency should necessitate a brief absence from class, students should confer with instructors upon their return. Students having problems with class work because of a prolonged absence should confer with the instructor or a counselor. IV. CONCEALED CARRY STATEMENT College policy prohibits the possession of weapons on college property by students, faculty and staff, unless specifically approved in advance as a job-related requirement (i.e., Tri-C campus police officers) or, in accordance with Ohio law, secured in a parked vehicle in a designated parking area only by an individual in possession of a valid conceal carry permit. As a Tri-C student, your behavior on campus must comply with the student code of conduct which is available on page 29 within the Tri-C student handbook, available athttp:// must also comply with the College s Zero Tolerance for Violence on College Property available athttp:// documents/ zero-tolerance-for-violence-policy.pdf Outcomes Design physical therapy treatment interventions for the older adult in various health care settings that recognizes the special needs of this

3 PTAT-2330: Geriatric Physical Therapy 3 1. Examine the reason for studying geriatric physical therapy and the need for modification of treatment and approaches for this specific segment of the 2. Relate the communication changes that occur in normal aging and describe how these changes affect older adult lives and the lives of their families. 3. Design interventions for reducing the effect of these communication changes on performance and safety. 4. Select the precautions and modifications that are necessary for exercise and the use of modalities for the geriatric patient. 5. Identify modifications in the treatment or training programs of the older adult patient with cardiopulmonary changes/disease. 6. Identify the types of cancer that commonly occur in the older adult Identify physical therapy interventions for patients with these types of cancer. 7. Discuss techniques that can enhance sexual participation for the older adult patient who may be confronted with pain, joint limitations, abnormal muscle tone, and fear of further injury. 8. Analyze the social and economic ramifications of our ever-growing older adult population and the impact this will have on health care in general and physical therapy specifically. 9. Relate the impact of culture, ethnicity, religion, socioeconomic status, and family history on the interaction and treatment of the older adult patient. 10. Demonstrate developing-level to entry-level professional behaviors in the classroom and during all course related activities. 11. Design interventions and approaches to enhance treatment based on the nature of how the older adult learns. 12. Select special procedures and approaches needed to successfully interact and motivate the geriatric patient. Relate how later life is unique among all developmental stages and how theories, myths, assumptions and attitudes impact physical therapy treatment approaches and interventions. Essential Learning Outcome Mapping: Written Communication: Demonstrate effective written communication for an intended audience that follows genre/disciplinary conventions that reflect clarity, organization, and editing skills. 1. Examine the reason for studying geriatric physical therapy and the need for modification of treatment and approaches for this specific segment of the 2. Examine the psychosocial and socioeconomic aspects of aging, and discuss the impact these may have on the geriatric patient. 3. Differentiate between myth and fact regarding older adults and discuss the impact of these myths on interaction and treatment of the geriatric 4. Examine the changes that occur in strength, flexibility, posture, and gait of the older adult. 5. Select the precautions and modifications that are necessary for exercise and the use of modalities for the geriatric patient. 6. Compare examples of ageism in American society with the attitudes and beliefs about older adults in other countries and cultures. 7. Describe the age-related changes in the human sexual response cycle and other barriers to sexual expression among older adults. 8. Analyze the social and economic ramifications of our ever-growing older adult population and the impact this will have on health care in general and physical therapy specifically. 9. Relate the impact of culture, ethnicity, religion, socioeconomic status, and family history on the interaction and treatment of the older adult patient. 10. Explain the need for sensitivity and understanding of the special needs of the geriatric patient, and the impact of previous life experiences on performance, communication, and compliance. 11. Describe the history of U.S. legislation regarding older adults and relate how each piece of legislation impacted the older adult Design Physical therapy interventions to address typical aging changes and pathologies that are common in the older adult 1. Examine the psychosocial and socioeconomic aspects of aging, and discuss the impact these may have on the geriatric patient. 2. Discuss common functional problems that impact the ADL of the older adult and formulate a practical suggestion for each of these problems. 3. Relate the communication changes that occur in normal aging and describe how these changes affect older adult lives and the lives of their families. 4. Design techniques that can be utilized to compensate for changes in vision, hearing, taste, smell, touch, and proprioception. 5. Analyze the neurological changes that occur in the older adult that impact functional performance, proprioception, and balance. 6. Select the precautions and modifications that are necessary for exercise and the use of modalities for the geriatric patient. 7. Identify modifications in the treatment or training programs of the older adult patient with cardiopulmonary changes/disease. 8. Identify the types of cancer that commonly occur in the older adult Identify physical therapy interventions for patients with these types of cancer. 9. Describe the age-related changes in the human sexual response cycle and other barriers to sexual expression among older adults.

4 4 PTAT-2330: Geriatric Physical Therapy 10. Discuss techniques that can enhance sexual participation for the older adult patient who may be confronted with pain, joint limitations, abnormal muscle tone, and fear of further injury. 11. Describe how balance problems, functional limitations and fear contribute to the risk of falls in the older adult 12. Create a fall prevention plan that includes education, environmental adaptation and therapeutic exercise. 13. Classify the changes that take place during normal aging to the various body systems. 14. Differentiate the essential features and role of physical therapy for the conditions that tend to target the older adult such as heart disease, cancer, CVA, Parkinson's disease, and joint replacements. Adapt treatment interventions based on the unique circumstances regarding medication use and adverse reactions in the older adult 1. Explain why older adults are considered a high-risk group for substance use/abuse. Discuss how multiplicity of disease and therefore medication use contributes to the risk. 2. Discuss how financial status may impact medication use and compliance. Adapt communication, interaction,treatment approaches and treatment to meet the needs of the older adult patient with Alzheimers Disease or any of the various forms of Dementia. 1. Differentiate between acute and chronic brain syndromes and between depression and dementia. 2. Select strategies for working with the patient with dementia; relate the impact of Alzheimer's Disease on the patient, family, and health care workers. 3. Describe the changes in the brain and the progression of those changes in the patient with Alzheimer's Disease. 4. Compare and contrast Alzheimer's Disease with other forms of Dementia such as Frontal Lobe Disease, Pick's Disease and Lewy Body Disease. 5. Describe the signs and symptoms of Alzheimer's Disease and relate these to the progression of symptoms through the various phases of the disease. 6. Design a plan of interaction and physical therapy intervention for the Dementia patient and his/her caregivers that includes addressing wandering, agitation and safety. 7. Describe the possible physical, emotional, legal and psychosocial ramifications of Dementia on the patient and family. Create appropriate documentation and reports of suspected elder abuse according to the requirements of the law. 1. Describe the various categories of older abuse and the legal and ethical guidelines that dictate the reporting of that abuse by the physical therapist assistant. 2. Consider the risk factors for the perpetrator and the victim to assess the potential for abuse. Adapt end of life interaction and treatment for the dying older adult patient recognizing the role of paliative care, advanced directives and mourning tasks for the bereaved. 1. Discuss factors affecting the older adult patient who is dying and communicate effectively with this patient and their family. 2. Discuss the mission of hospice and its goals for the terminally ill patient and his/her family including the role of physical therapy. 3. Describe the role of life sustaining interventions and legal ramifications of the living will and health care power of attorney. Identify the circumstances when intervention can be performed without consent. Design and produce reimburseable interventions and documentation to meet the needs of the elderly adult patient. 1. Describe Medicare, Medicaid, and the prospective payment system and relate these to the provision of physical therapy services. 2. Distinguish between skilled and non skilled care. 3. Relate third party payers and source of reimbursement to physical therapy treatment and documentation. 4. Analyze the social and economic ramifications of our ever-growing older adult population and the impact this will have on health care in general and physical therapy specifically.

5 PTAT-2330: Geriatric Physical Therapy 5 5. Create documentation that meets reimbursement guidelines for Medicare and other third party payors. 6. Discuss the criteria for defining and receiving reimbursement for Durable Medical Equipment. 7. Distinguish between the assessment forms required for physical therapy in various health care settings as required by Medicare standards. Design and advocate programs for wellness, community integration and instrumental activities of daily living for the older adult 1. Compare various ways in which the family plays a central role in caring for the older adult. 2. Discuss common functional problems that impact the ADL of the older adult and formulate a practical suggestion for each of these problems. 3. Compare strategies to enhance more effective communication with the older adult patient; utilize and demonstrate these techniques during the required geriatric interview. 4. Consider architectural and societal barriers that impact rehab, safety, and the participation in ADL/leisure skills of the older adult and prepare recommendations for modifications to reduce these barriers. 5. Design interventions for reducing the effect of these communication changes on performance and safety. 6. Describe the age-related changes in the human sexual response cycle and other barriers to sexual expression among older adults. 7. Discuss techniques that can enhance sexual participation for the older adult patient who may be confronted with pain, joint limitations, abnormal muscle tone, and fear of further injury. 8. Examine ways of promoting wellness, disease prevention and research in the older adult 9. Identify community resources available for the older adult patient including the role of the ombudsmen/patient advocate program. 10. Relate the impact of culture, ethnicity, religion, socioeconomic status, and family history on the interaction and treatment of the older adult patient. 11. Explain the need for sensitivity and understanding of the special needs of the geriatric patient, and the impact of previous life experiences on performance, communication, and compliance. 12. Demonstrate developing-level to entry-level professional behaviors in the classroom and during all course related activities. 13. Assess potential barriers to the geriatric patients participation in health promotion/wellness activities. 14. Discuss the need for community outreach and advocacy for this patient 15. Design an environmental assessment for fall prevention in the clinic and home that includes the benefits and risks of the use of physical restraints. 16. Examine the unique skills needed to provide physical therapy treatment to the older adult in the home care setting. Methods of Evaluation: 1. Written tests and final examination 2. Announced and unannounced quizzes 3. Interview with written report 4. Geriatric interim notes 5. Web discussion board and activities Course Content Outline: 1. Defining Geriatrics a. Statistics b. Myths and ageism c. Legislation d. Normal aging versus pathology 2. Theories of aging a. Developmental-Genetic b. Neuroendocrine and Hormonal c. Non-genetic or Stochastic d. Psychosocial 3. Age related changes in anatomy, physiology and function a. Musculoskeletal b. Neurological c. Cardiovascular d. Pulmonary e. Sensory f. Endocrine

6 6 PTAT-2330: Geriatric Physical Therapy g. Reproductive h. Urinary and GI 4. Impact of aging changes a. Activities of daily living and IADL b. Socialization c. Communication d. Cognition and learning e. Falls and restraints f. Posture and gait g. Sexuality h. Nutrition i. PT modalities 5. Common Pathological Conditions and treatment approaches a. Arthritis and total joint replacements b. Arrhythmias and Congestive Heart Failure c. Stroke d. Diabetes e. Cancer f. Multiplicity of disease 6. Drugs and function in elderly a. Absorption, transformation and excretion b. Prescribed drugs and OTC use c. Adverse side effects d. Substance abuse e. Role of PTA 7. Organic Brain syndrome a. Alzheimer s Disease b. Dementia c. Communication d. Intervention strategies e. Wandering and agitation f. Family education 8. Oncology in the older adult population a. Palliative care/hospice b. Advanced directives c. Living Will d. Health Care Power of Attorney e. PT interventions f. Suicide 9. Elder Abuse a. Legislation b. Categories of abuse c. Role of PTA in reporting 10. Reimbursement for older adult services a. Managed care system b. Medicare c. Medicaid d. Settings of care e. Durable medical equipment 11. Treatment rationale and design in geriatrics a. Education and leaning styles b. Culture, race and ethnicity c. Previous life experience d. Socioeconomic status e. Advocacy and research f. Home care

7 PTAT-2330: Geriatric Physical Therapy 7 Resources Lewis, C., and J. Bottomley.Geriatric Physical Therapy: A Clinical Approach.3rd. Upper Saddle River, NJ: Prentice Hall, Bottomley J.Geriatric Rehabilitation A Textbook for the Physical Therapist Assistant.Thorofare, NJ: Slack Inc., Bonder B and Dal Bello-Haas, V.Functional Performance in Older Adults.3rd. Philadelphia F.A. Davis Co., Bertoti, D.Functional Neurorehabilitation Through the Life Span.Philadelphia F.A. Davis Co., O' Sullivan, S. and Schmitz, T.Physical Rehabilitation.6th ed. Philadelphia: F.A. Davis, Lescher, P.Pathology for the Physical Therapist Assistant.Philadelphia: F.A. Davis, Fell, D. and Lunnen, K.Lifespan Neurorehabilitation.Philadelphia: F.A. Davis, Resources Other 1. DVDs--updated as needed. Top of page Key: 3833