What is a common possible barrier to patient adherence/compliance to a home program or therapy in general that you have found with home care clients?
Answer
The major barrier is depression. There is a free app available for Droid and iPhone called the Geriatric Depression Scale. There is a 15-item scale and a 5-itme scale that has been validated to the 15. It is 15 yes/no questions. The scoring is with a 0 or a 1 and then you add the scores. If they get a certain number or greater, then it is predictive of depression and you would want to refer to a physician, social worker, or behavioral health. For my patients who are not doing the program that I am asking them to do and they are not eating or drinking well, or they appear to have depression or have no motivation, I will do the GDS 15. Based on those results, I will refer them to the nurse, physician or social worker. Sometimes I may even stop therapy at that point until they get properly medicated. They may need an antidepressant, and then I would come back in a couple of weeks once they have the motivation. Then we can make effective change. If I go in there and they are not exercising or doing the program, then I would rather wait and make the visits when they will be more effective. I would recommend that you start doing the GDS 15. It takes less than 5 minutes.
Kenneth L. Miller, PT, DPT, GCS, CEEAA
Dr. Kenneth L. Miller is a board-certified geriatric clinical specialist, advanced credentialed exercise expert for aging adults, and credentialed clinical instructor from the APTA. He has over 26 years of clinical experience with the older adult population. Dr. Miller is an assistant professor at the University of North Texas Science Center with dual appointments in the Department of Physical Therapy in the School of Health Professions and in the Department of Internal Medicine and Geriatrics in the Texas College of Osteopathic Medicine.
His clinical focus is on best practices for use with the older adult population. He has spoken nationally and internationally on topics of gerontology including primary prevention, fragility, outcome measures, and pharmacology.
He serves on editorial boards related to geriatric care and physical therapy education including Topics in Geriatric Rehabilitation where he was guest editor for a thematic issue dedicated to pharmacology and nutrition. He also serves the physical therapy profession as director of practice for the Academy of Geriatric Physical Therapy and on several Academy Task Forces. Most recently, he has helped to develop the best practice guidelines for the Academy that describe best practices for the care of older adults. Dr. Miller is also a co-editor of the Ciccone's Pharmacology in Rehabilitation 5th edition textbook update.
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