EDITOR'S MESSAGE: Editorial
We begin this issue with the first of a series of integrative reviews, Proceedings from the interdisciplinary conference “Exercise, Physical Activity and Aging (ExPAAC): Blending Research and Practice,” sponsored by Section on Geriatrics, July 29–31, 2010. This series of articles focuses on the application of current knowledge of exercise to clinical practice with older adults with specific diagnoses or functional problems. Dr Tiffany Shubert highlights the growing public health challenge of falls and their consequences and presents best current evidence about designing interventions to reduce risk of falling. She calls our attention to principles of mode, intensity, and duration, and the need to examine whether the care we currently deliver reflects this best evidence.
Dr Shubert's summary has prompted this editor questions whether the optimal care for those at risk of falling that emerges from Dr Shubert's summary fits the current “episode of care”–based reimbursement model in which we traditionally practice. Given this question, her summary should encourage us to think “outside the box” about how we might best deliver such care to address this growing public health issue. The evidence that she presents to us has prompted this editor to consider our potential to serve as expert consultants (rather than primary care providers) for community-based programs aimed at reducing risk of falling. Of all health professionals involved in this important issue, we have the knowledge and skill to interpret results of screening programs, to design and adapt exercise programs for older adults with multiple comorbidities using current best evidence about the most effective exercise parameters, to train and mentor those likely to be carrying such programs (or to figure out a cost-effective way to deliver those programs ourselves), and to track and interpret the outcomes of fall-prevention efforts. If we do not step up to the challenge that this public health issue presents, others will certainly step in to fill the void. We cannot permit the constraints of the current health care payment system to prevent us from being a central resource for older individuals, their families, and their communities in the effort to reduce both the risk of falling and the negative consequences that result from falls.
I would challenge us to undertake a “needs assessment” of the communities in which we practice: what programs for fall risk reduction are in place; who is delivering such programs; and are there opportunities to collaborate? Are there existing models that effectively partner physical therapists and community resources to deliver such needed care? What would it take to make such programs financially “do-able” for us? Might there be a way to provide screening, deliver one-on-one care for those most at risk, develop community-based group exercise programs to serve those as lower risk of falls and to “graduate” those we see in our traditional practices to as an extension of care? Considering such questions would certainly move us “outside the box” and serve as catalyst for our profession to be a part of the solution for this challenging public health problem. Are we ready and willing to take on the challenge?
Michelle M. Lusardi