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. Ken Miller, PT, DPT, is a board-certified geriatric clinical specialist and advanced credentialed exercise expert for aging adults. Dr. Miller is an assistant professor at the Medical University of South Carolina in the Division of Physical Therapy and serves as the founding director of the USC Geriatric Residency Program. His clinical focus is on best practices for use with the older adult population. Dr. Miller is the Director overseeing Practice for the Academy of Geriatric Physical Therapy. He has spoken nationally and internationally on topics of gerontology, including pharmacology, primary prevention, frailty, outcome measures, best practices, and pain management for the older adult. Dr. Miller has over 20 years of clinical expertise in risk mitigation and error prevention and is currently researching well-being, mental health, and burnout in physical therapists.
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