There is an element to healthcare that most providers – and even patients – don't want to discuss. At least until it's the only conversation left on the table.
The topic: When to continue care and when to stop.
There is a harsh reality that for some patients, rehabilitation after a significant health crisis may not be necessary or even possible. The problem, though, is knowing where to draw that line. Many healthcare providers draw it too early, says Dr. Eric Turk, a sports medicine specialist in NYC.
"Often, rehabilitation services don't look at treatment for older adults the same way they'd treat someone younger, and it has nothing to do with the injuries themselves," he says.
Sometimes, providers may look at a patient and decide it's not 'worth' it because of their age. Other times, coexisting conditions like cognitive decline deem the case too complicated for providers.
"The problem is that it's difficult to find staff with the necessary specialized training, which means many older adults don't get access to the care they need," he says. "A stroke is bad enough, but what happens if you also have dementia? Is it fair to deny someone healthcare because it's too difficult? Is it fair to say that because someone is old, they should sit in a wheelchair for the rest of their life?"
Turk has more than 2 decades of experience providing at-home rehabilitation services primarily for patients working through neurological issues like strokes, Parkinson's and cognitive decline. These neurological and cognitive issues mean there are so many more factors to consider than the rehabilitation itself.
When hiring a rehabilitation specialist for an older adult in your life, here are 3 things to consider.
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Many rehabilitation services won't take these patients on because they're hopeless or not worthy – they don't know how to provide the care they need, says Turk.
"This type of care takes extra consideration. You need to find the right time of the day, when they're at their peak cognitively between medications and side effects, for example," says Turk. Then you need to learn to work around cues other specialists rely on.
"In any other circumstance, the patient's listening skills are intact. I can say to them, 'I need you to do this movement or move this part of your body,' and they understand," he says. "But for somebody who has had a neurological event or is in the middle of a neurological progressive disease, their brain and body don't cooperate or communicate in the same way."
"They may not understand the words coming out of my mouth," Turk adds. "They often can't tell me when they're in pain. They're often confused and overwhelmed by your presence alone, and then you add the frustration that comes with being unable to use their body how they want to."
But that doesn't mean they can't be rehabilitated – it just means they have to go about it differently.
Make sure they address emotional needs first.
"Rehabilitation is more than just physical therapy – it's about understanding the person behind the condition and customizing the treatment to their specific needs," says Turk.
Rehabilitation for older adults often requires an approach that addresses cognitive and emotional needs just as much as physical needs.
"Humans are meant to move. We are creatures of movement," he says. "Any functional impairment is going to make people, especially older adults, feel incredibly vulnerable. Before I can address any physical needs, I have to address that first."
That, he says, all comes down to trust.
"When you hire a rehabilitation specialist for an older adult, you want to look for someone who will integrate themselves into the caregiving team," he says. "That way, when you meet the patient, you're already familiar with the people that the patient trusts and they can show them that they trust you in return."
This is especially helpful in cases of cognitive decline, where older adults take their cues from the people most familiar to them. If the caregivers are at ease, the patient is also more likely to be.
"Without that bond, no healing can occur," he says. "Rehabilitation isn't just physical. The patient has to be motivated and trust that you have the same goals, even if you do it in what seems like an unconventional way. See what type of healing people can achieve through time, patience, and trust."
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Many older adults also require a modified physical treatment plan that specifically adapts to their abilities.
"While this seems like it might require a highly specialized, little-known approach, it's almost the opposite," says Turk. "It's returning to some of the most fundamental, tried-and-true rehabilitation practices in our arsenal. For example, there's a well-documented but seldom-used practice in which, when one side of the body is immobilized, exercising its opposite counterpart can improve the functionality of the side that's not working."
This opens up healing opportunities that other specialists may not have thought possible.
"I've seen patients who are wheelchair bound from Parkinson's or a stroke and are told they'll never walk again, standing on their own," says Turk. "The difference is in applying these methods correctly, with the patience older adults need to see results."
While getting every patient's full range of motion and ability back would be great, that is not always possible. Choose a specialist who understands that success isn't limited to completely restoring a patient's ability and mobility.
"When you have patients who know they'll never be back to 100% again, you have to redefine what 100% means," says Turk. "Sometimes, it is something as big as feeling stable on their own two feet. But often, it's even smaller, like regaining the ability to hold a fork."
Ultimately, the best success is that the patient sees enough potential that they want to go back for more treatments.
"The most important element to choosing the right specialist is choosing someone who gives your loved one the hope that they really can improve their quality of life, so long as they have the motivation, support and right technique," says Turk.