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Hartley, G W; Gravano, T; Cope, K A; Lemberger, R R; Santana, K M
St. Catherine's Rehabilitation Hospital, Miami, FL and University of Miami Miller School of Medicine, Coral Gables, FL.
Background & Purpose: The population over the age of 100 is increasing. Individuals are living longer with chronic conditions. At present, there is little published on this group. This decreases our ability to design effective plans for these patients. Physical therapists must be aware of these patients'functional potential. This case description attempts to document this potential in a patient in this age group. Case Description: The subject is a 100 year old female residing in an assisted living facility (ALF) prior to admission to acute care with shortness of breath. PMH included degenerative joint disease, hypertension, congestive heart failure (CHF), spinal stenosis, dementia, and functional decline. Eleven days after admission, she transferred to an inpatient rehabilitation facility (IRF) and began physical therapy (PT) for debility due to decompensated CHF and an electrolyte imbalance. She received 19 PT treatments for a total of 810 minutes over a period of 15 days. She also received occupational therapy. Upon the IRF PT assessment, she demonstrated an increased risk for falls (Tinetti score 13/28), gross strength UEs 3+/5 and LEs 4−/5, and decreased functional status (total Functional Independence Measure [FIM] score =57). On admission the FIM score for transfers=2, walking=1, toilet transfers=3 and tub transfers=0. Her mental status was 27/30 as measured by the Mini Mental State Exam. She was able to walk 30 feet with a rolling walker and minimum assistance. She required maximum assistance to move in bed, and maximum assistance for transfers (supine to/from sit). Interventions included education and training for gait, transfers, balance, endurance, and strength. Outcomes: At discharge, the patient needed supervision for bed mobility. Transfers required minimal assistance (FIM =4). She was able to ambulate 60 feet (twice in a 45 minute session) with a rolling walker and supervision (FIM =2). She was able to transfer to/from a toilet and a tub with minimal assistance (FIM =4). At discharge, her total FIM score was 83, representing a gain of 26 points. The adjusted national average for admission FIM during the same quarter the patient was treated was 58.1, and the national average discharge FIM was 86.9, resulting in an average FIM gain of 28.8 (national data from Uniform Data Systems). The patient was discharged back to her ALF with home health PT, nursing, and an aide. Discussion: This patient presented with multiple comorbidities and significant functional decline. Despite these challenges, she made functional gains similar to those of the national average. It is important to note that these averages include a younger population. This case report demonstrates that patients among the oldest old (100 years old) can improve in functional areas measured by the FIM. Results in this case are only slightly lower than national averages for the same time period. These patients can benefit from the intensity of services provided in an inpatient rehabilitation facility. This level of service allowed this patient to return home environment and avoid institutionalization.
© 2007 Academy of Geriatric Physical Therapy, APTA
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