AN IMPAIRMENT AND DISABILITY ASSESSMENT AND TREATMENT PROTOCOL FOR COMMUNITY-LIVING ELDERLY PERSONS

Background and Purpose. Falls and immobility are common among communit y-living elderly persons and result from the accumulated effect of mul tiple impairments and disabilities as well as environmental hazards. W e developed and tested a simple assessment and intervention protocol f or use in prevention and treatment programs among community-living eld erly 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 ad aptations, training, and exercise programs targeting the diagnosed pro blems. Subjects. A convenience sample of 11 residents of a senior hous ing 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 in tervention recommendations. Methods. The assessment and intervention p rotocol 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 ag reement in assessment and intervention results by the two physical the rapists. The assessment required approximately 45 minutes to complete, suggesting it is feasible for use in clinical practice. Conclusion an d Discussion. A simple, standardized assessment and intervention proto col, such as the one described, could aid physical therapists in evalu ating and treating community-living elderly persons by improving commu nication among care providers, providing better documentation for reim bursers, and ensuring a direct linkage between assessment and interven tion, thus simplifying the development of a treatment plan for elderly persons with complicated or multiple impairments. The ultimate test o f this assessment and intervention protocol will be ascertainment of t he goal of the protocol, namely a reduction in falls and improvement i n mobility among multiply and chronically ill elderly persons.