As part of Physiotherapists' Month, Cathy Stovell highlights the work physiotherapists do with the elderly and disabled. Community therapist Andrew Cooper is a Government worker who the visits the elderly and disabled where they live to try and help them retain or regain as close to normal functioning as possible. He described the work he does, its challenges and how it shows where preventative measures may help the future.

Question: What does your area of physiotherapy entail?

Answer: Assessment and treatment of elderly and disabled people in their own homes, as well as in residential and nursing facilities. Our basic goal is to maintain or restore safe, independent living, and prevent clients from being admitted to King Edward VII Memorial Hospital (KEMH) or residential care. For those already in residential homes, we work to improve independence or at least prevent decline.

Shirle Crockwell and I divide the Island at the Paget traffic lights: she has the West half, I have the East half. We receive referrals from general practitioners, orthopaedic surgeons, physiotherapy staff at KEMH, as well as from registered nurses at the Island's nursing homes.

We communicate frequently with other disciplines in the Department of Health, so it is not unusual for us to refer a patient to one of the district nurses and vice-versa. Most of our patients have more than one problem. For example, he may have fractured his hip, but also has Parkinson's Disease, which makes standing up and moving more difficult. All of our elderly patients have osteoarthrosis (wear and tear of the joints) to varying degrees. When combined with a stroke, amputation or surgery on other joints, a painful hip or knee can limit movement and increase the risk of falls.

Arthritic hands can make it painful for a patient to hold onto a conventional walker. The first thing we do is look at the client's living situation, what his/her physical problems are, and what we can change immediately to make everyday life safer and easier. For example, the walking aids of about 80 percent of all new clients we see are usually too tall.

Frequently a cane or walker is a hand-me-down from a relative, so right away the height is incorrect! Sometimes the ferrules (rubbers) of a walker or cane are worn right through, making the aid unsafe.

We carry such supplies in our GP vehicles, along with walkers, Quad canes, canes and reachers. We can supply a ferrule as needed, to make the client safer on the first visit. We can also make short-term loans of equipment, so a client can try out a device before buying it.

We observe the client's exercise tolerance, and when indicated, take baseline measurements of pulse and respiratory rate. These can be used for comparison to monitor the client's progress.

One of our major activities is education of the patient and the caregivers.

We educate the patients, about their condition, and what they need to do to get better. There are still a great many "old wives' tales" and ignorance about what is good for a body that is trying to heal.

As physiotherapists we have a good understanding of the processes of injury, inflammation and repair, as well as the myriad degenerative processes that affect all of us as we age.

We are accustomed to putting such information into layman's terms, free of medical jargon, so that the average person can understand.

Educating the patient's family or caregiver can make all the difference, as we are thinly spread over the Island. As soon possible we set up an individualised home programme for each client. It is up to the clients or their caregivers to ensure that stretches, strengthening exercises and functional activities are done. Usually we can visit only once a week to re-assess and make changes to the programme as necessary. The onus is on the client to work hard for his/her own benefit.

We work hard to help people regain their normal function as much as possible. Some people stay in bed, in their pyjamas and have their meals brought to them. In Bermuda we see a lot of this. Some people have been sick for so long that it's become their way of life. This is not healthy as people were built to be active. Our bodies are maintained by simple daily activity, especially walking. Walking makes the muscles have to work, stimulates the heart and lungs, keeps bones strong and promotes circulation. People should get up and get dressed and ready for the day and they should do things wash dishes, do laundry, fold clothes as much as possible do what they did before they got sick, as long as the activity does not put them at risk of injury.

Q: On average how many patients do you see in a typical week?

A: About 25 to 30 a week, with one or two of those patients being seen twice. As people improve, we see them less frequently. Many patients are on a "monitor" list, so that we do a follow-up check every two or three months. Often the situation has changed, and adjustments are needed.

Q: What are the most common ailments/conditions that you come across in clients? Any idea why this is so?

A: Falls and difficulty with walking and balance are our most commonly addressed problems. These problems tend to be the sum of the ageing process, small strokes, osteoarthrosis and diabetes. There are also significant numbers of patients whose main disability is from stroke. Strokes are linked to uncontrolled high blood pressure and poorly controlled diabetes, both of which are common locally.

Q: Are there any major issues with treating the elderly (perhaps certain equipment or facilities are needed, major problems with health insurance etc.)

A: No problem with insurance for our services, as they are free to the young disabled population and those 65 and over.

Working with people in their own homes can be challenging because of lack of space and rehab equipment that one would find in a hospital setting, but this makes us more creative!

Q: Given that you see the physical problems of the elderly are there any preventative measures younger people should be playing closer attention to? And why.

A: Obesity (in my opinion) is the greatest health risk of our time. It is linked to early osteoarthrosis, heart disease, type 2 diabetes and stroke. And it is totally preventable!

Q: Is community work more challenging than working in one facility?

A: Yes, but the challenge to come up with a creative solution to a difficult problem, i.e. to think outside the box – is stimulating and rewarding.

Q: What do you love most about your work? What do you dislike?

A: I love the fact that every day is different, I get to meet people who have led very full lives (the average age is 75), and I have a great deal of autonomy. I dislike having to punch my statistics into the computer.