Welcome to our fourth Thieves' Market issue for Topics in Geriatric Rehabilitation! Here, we provide a platform where rehabilitation professionals from all over the world can share their borrowed (or owned) treasures for others to admire, critique, and adopt as their own. In this issue we are pleased to feature diverse articles from Brazil, Poland, Canada, and the United States. Let us start this issue with a poem written by Shel Silverstein in 1981.
The Little Boy and the Old Man
By Shel Silverstein
- Said the little boy, sometimes I drop my spoon.
- Said the little old man, I do that too.
- The little boy whispered, I wet my pants.
- I do too, laughed the old man.
- Said the little boy, I often cry.
- The old man nodded. So do I.
- But worst of all, said the boy,
- It seems grown-ups don't pay attention to me.
- And he felt the warmth of a wrinkled old hand.
- I know what you mean, said the little old man.1
Although short, this poem has a powerful message! The old man is obviously struggling with clumsiness, incontinence, depression, and isolation. These are just a few of the issues that older adults face in our world due to the inevitable aging process. The National Institute on Aging cites,
Aging is associated with changes in dynamic biological, physiological, environmental, psychological, behavioral, and social processes. Some age-related changes are benign, such as graying hair. Others, result in declines in function of the senses and activities of daily life and increased susceptibility to and frequency of disease, frailty, or disability. In fact, advancing age is the major risk factor for a number of chronic diseases in humans.2
In this issue, we discuss a myriad of topics related to aging including deconditioning, decreased cardiac function, decreased oxygen consumption, decline in instrumental activities of daily living (IADL), impaired exercise tolerance, gait impairments, pain, loss of independence, heart failure and general dissatisfaction with life. We also discuss the use of certain modalities which we, as rehabilitation professionals, are inadvertently avoiding in our treatment planning. We should be cautious not to forget that certain modalities are, in fact, jewels that we have left on the shelf of our daily practice. Let us dust it off and consider a body of knowledge that can supplement what we do. You, as a rehabilitation professional, are relied on to help your patients improve their quality of life. Let us open up our toolbox and look at any test, any treatment, and any trick that could possibly help our patients. After all, that is why you are reading Topics in Geriatric Rehabilitation. We sincerely hope you will look and find rehabilitation tips that you can immediately apply to improve the lives of your patients.
Here is a sneak peek of some of the treasures you can glean from this issue:
- The incremental shuttle walk test may help identify IADL disability and predict peak oxygen consumption in older adults.
- Whole-body vibration may be an effective alternative training regimen to improve both O2max and CO2 to enable the patient to better sustain activities that require respiratory efforts.
- A 16-week multifactorial exercise program with health education may contribute to an improvement in functional fitness in older adults.
- In patients with Parkinson's disease, acute transcranial direct-current stimulation may improve gait cadence.
- Health care professionals should be sensitive to the presence and complexity of pain in their older patients. Individuals can react differently to pain according to their culture, their values, and/or their relationship with what surrounds them.
- In the Canadian province of Ontario, upcoming legislative changes will require occupational therapists to be involved with the reporting of medically at-risk drivers to the transportation authority.
- Shortwave diathermy and pulsed electromagnetic frequency may provide clinical benefits for improving pain, function, and quality of life.
These and many more thieves' treasures are awaiting you within this issue. So, next time you are providing care for older men or older women, take their hands and look them in the eyes. Tell them, “You are important and valued.” Then, reach in your toolbox or your bag of treasures and give the gift of your time, attention, and rehabilitative care. Whether their duration of improvement is a year, month, or only a day, working together and sharing what you have learned will reward both you and your patient. Remember, if we are privileged to live to a ripe old age, our hope is that caring rehabilitation professionals like you will be there to take on our challenge and be our advocate! For as Maya Angelou once said, “I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
—Wendy Powers James, PT
Topics in Geriatric Rehabilitation