Attracting PT Students to Geriatrics

Attracting and Maintaining Physical Therapists in the Face of an Increasing Geriatric Population
Edward Pizzo Bouv College of Health Sciences Northeastern University

Attracting PT Students to Geriatrics

Abstract The geriatric population is one of the fastest growing population segments in any developed nation, the United States being no exception. With more and more people seeking physical therapy, an increased number of trained therapists will be necessary to treat clients. An increase in the popularity of physical therapy combined with an increase in the geriatric population will lead to a shortage of geriatric physical therapists. This paper explores factors that attract physical therapists and physical therapy students to working with a geriatric population. Although there are many reasons for this attraction, such as doctor-client relationships, client appreciation, and previous experience with geriatrics, the demand may still outweigh the supply. The paper then considers a number of perceptions and stereotypes that drive students away from geriatrics, including lack of client motivation, less chance for prestige and growth, and personal hygiene and incontinence issues. Research has found that education and hands on experience with geriatrics seems to be a reliable way of attracting students to the field. The efficacy of these methods and their use are discussed. Finally, the paper argues that although some may say that there is no increased need for geriatric physical therapists, as geriatric patients can be treated by general physical therapists, this is a short-sighted view. While it is true that all licensed physical therapists can offer effective care, geriatric patients have a variety of unique issues that need to be treated properly and thoroughly.

Attracting PT Students to Geriatrics

Introduction The Department of Health and Human Services predicts that by the year 2030, there will be more than 72,000,000 Americans over the age of 65, making up 19.3% of the total population, up from 40,000,000 Americans making up 13.0% of the total population in 2010 (2010). Physical therapy is a rapidly growing field, with the US Bureau of Labor Statistics predicting a 36% growth rate from 2012-2022 (2014). Although the field of physical therapy is growing at a rapid pace, the demand of geriatric physical therapy care far outstrips supply. As people age, their muscles, bones, and joints deteriorate, organs and senses fail, and they become increasingly susceptible to disability. Elderly people aged 75 years or older use twice the bed disability days as people aged 45 to 64 years (Coren, Andreassi, Blood, & Kent, 1987). The treatment of geriatrics includes: early referral, comprehensive assessment by a team of healthcare professionals, interest in mundane heath issues that may be of great concern to the patient, and a holistic view of care. (Mulley, 1994). Mulley (1994) states, An essential component of geriatric medicine is rehabilitation (p. 1). Physical therapists, alongside occupational therapists and speech pathologists are among the primary rehabilitators of patients, geriatric or otherwise. Without an adequate supply of geriatric physical therapists, elderly patients cannot receive the full benefits of rehabilitative care. Attractants There is, in fact, a population of physical therapists who work with and/or specialize in geriatrics. A 2012 study polled 786 members of the Section on Geriatrics of the American Physical Therapy Association (APTA). The data was compiled into various graphs and charts detailing metrics that attract physical therapists to the field of geriatrics. 47.9% of physical therapists polled reported that they enjoy the patient population and 11.6% reported enjoying

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work hours (Collins, 2012). Having nearly 50% of therapists enjoying the patient population makes negativity toward geriatric attitudes seem unfounded. 70% of geriatric physical therapists polled worked full time and over 65% worked in either SNF (skilled nursing facilities) or ICF (intermediate care facilities), home health, or acute care (Collins, 2012). Clearly, job stability throughout the field is another perk of geriatric physical therapy. Some physical therapy students are attracted to working with geriatrics. A common reason for said gravitation towards the field includes patient appreciation. Many elders receiving physical therapy are doing so with the hope of returning to their previous quality of life. Although they may seem like small goals, ambulation, range of motion, and balance allow elders to continue living their daily life and pursue their hobbies unimpeded. According to the study by Coren et al. (1987), the 326 polled students most frequently mentioned positive aspect (p. 63) of working with elders was that geriatric patients were so appreciative of the care they received. In the study by Coren et al. (1987), it was found that the highest rated question for students intending to work with geriatrics was living with elderly relatives. Green et al. found a more positive correlation between [students] interest in geriatrics and the quality of their previous contacts with older people (as cited in Brown, Gardner, Perritt, & Kelly, 1992, p. 12). Interestingly, one study found that contrary to other studies, previous interaction with the elderly, geriatric-centered classes, and instructor influence did not influence students likelihood to work with geriatrics (Dunkle & Hyde, 1995). This could be due to the sample of students polled, or the way in which metrics were counted and calculated. Having a close relationship with elders can make students more empathetic and willing to help geriatric patients recover (Coren et al., 1987). The quality of the relationship itself has been found to correlate with the desire to work with

Attracting PT Students to Geriatrics

geriatrics (Green et al., 1992). In other words, those with positive relationships with elders are more likely to want to work with them. Another common aspect of working with geriatrics that interested students was the potential to form close friendships with patients. Getting to know patients and having emotional ties with them and their families was a primary attractant for many students. Some students believe that by working with elderly patients, there will be ample time to get to know the patients and their families (Dunkle & Hyde, 1995). Since geriatric patients often have chronic conditions, and geriatric physical therapists sometimes work in nursing homes or hospital settings, there is a frequency of care that allows for the formation of a relationship that may not happen with other sectors of physical therapy. Deterrents The study by Collins (2012) showed an uneven distribution of years of experience in geriatrics as reported by therapists, with numbers of those with 0-2 and 3-5 years of experience significantly lower than other experience brackets. With the elderly becoming a larger population segment, one would hope that the number of new geriatric physical therapists would be increasing, or at the very least would remain fairly consistent across all age and experience ranges. However, these numbers are not completely telling and should be held up to some scrutiny. The data could have shown decreasing numbers of incoming geriatric physical therapists simply because established geriatric physical therapists are more willing to respond to the survey than their younger counterparts. Several societal attitudes have been found to deter students from pursuing geriatric physical therapy. It was widely believed that salaries would be lower for those working in the geriatric field. Working with elderly patients was believed to be less prestigious than working with other

Attracting PT Students to Geriatrics

population cohorts, and granted geriatric practitioners lower status as a result (Coren et al., 1987; Dunkle & Hyde, 1995). Reasons why such a view is held were not discussed and should be further researched in order to help dispel such misgivings. Some students also thought that working with an elderly population would not allow them to practice many of the skills they had learned and significantly narrow their experiences (Dunkle & Hyde, 1995). While geriatric patients do have different needs than other, younger patients, it does not mean that they have less modalities used on them. Unfortunately, this did not seem to be well understood by uninformed students. Physical therapy students often did not want to work with geriatrics because they believed that it would be a great emotional strain on themselves. It was commonly believed that there is a lesser likelihood of effecting change in an elders life. Since elders are typically weaker and generally in poorer health than those younger than them, they are thought of as chronically debilitated. Over half of students polled in one study reported that working with geriatric patients would make students imagine themselves at old age (Coren et al., 1987). Well-educated, healthy students, of physical therapy or otherwise, do not want to think of themselves as old, infirm, or handicapped. It comes as no surprise that these students did not want to face their inevitable deterioration so early. It turns out that the emotional strain of working with elders is so strong that in a study by Brown et al. (1992) in which 275 physicians, nurses, and social workers were given case descriptions of two patients, one with age related issues and the other with disease related issues, 60% of participants preferred the diseased patient, citing a more rewarding feeling, even though their prognosis was worse for this patient. This result is contrary to the 2012 study mentioned above where nearly 48% of geriatric physical therapists polled were attracted to their work because of their clients. Although the students from the Brown et al. (1992) study

Attracting PT Students to Geriatrics

believed that they would not enjoy working with geriatrics, half of the geriatric physical therapists polled in the Collins (2012) study listed their clients as the primary variable that has attracted them to their work. Hygiene, specifically incontinence, was a frequent concern of physical therapy students. This was the most common mentioned negative aspect in the Coren et al. study (1987) and was mentioned in the Dunkle & Hyde (1995) as a cause for concern. Elders do sometimes suffer from incontinence. However, they are not the only type of patient that has these troubles. Pediatrics, neurological patients, and the mentally and physically disabled can all have incontinence issues, but it is rarely as much of a negative talking point for those sectors as it is for geriatrics. Increasing attraction while decreasing deterrence If experience with elderly patients was enough to get students and therapists interested in working with geriatrics, the supply and demand problem would solve itself, as most therapists will work with some number of geriatrics throughout their career. However, contact with the elderly does not correlate with knowledge of geriatrics (Brown et al., 1992). Luckily, as is the case with most problems, education and experience appear to have success in attracting physical therapy students to geriatrics. Several studies have found various methods and talking points useful in increasing positivity and decreasing negativity towards working with geriatrics. It has been found that by teaching students about geriatric care, their attitudes towards the elderly can increase. Lectures, reading about the process of aging and its effects on the body, and group discussion all have led to more positive attitudes towards the elderly (Coren et al., 1987). A study by Gunter found that stereotyping towards the elderly by nursing students who

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completed a geriatric related course decreased. Interestingly, however, decreased stereotypes correlated with decreased desire to work with the elderly (as cited in Coren et al, 1987, p. 61). Working with geriatrics during a clerkship, as opposed to working a traditional clerkship can improve student perceptions of geriatrics. In the study by Brown et al. (1992), subjects were divided into a control group that did a 12 week rotation of traditional clerkships and an experimental group that did a 12 week rotation of various geriatric-centered classes and clerkships. At the end of the trials, both groups were more positive in their attitudes towards the elderly. However, the control groups negativity was remained the same while the experimental groups opinions of the elderly were less negative. The study makes note of the fact that the control groups results can be due to communication between the two groups and the control groups general competitiveness and desire to improve. Another component that factored into students decision to work with geriatrics in the Brown et al. (2002) study was the fact that most of the elderly patient volunteers were educated, mobile, and involved in several hobbies and activities. The impact of these healthy elders was found to be the most important [factor] in affecting the experimental groups overall attitudes (p. 16). Placing the students with active elderly patients exposed them to the reality that people, regardless of age, have hobbies, interests, and personalities. This softened students views towards the elderly and showed them the potential for a high standard of living for geriatric patients. It has been postulated that the decreased opportunity for peer interactions turns students away from geriatrics (Dunkle & Hyde, 1995). The study goes on to mention highlighting ways that one could develop professional networking (p. 44). However, this study was conducted in 1995. With the explosion of social media that has occurred in the past few years, physical therapy students have access to social networking websites such as LinkedIn and Facebook. Social media

Attracting PT Students to Geriatrics

could have dispelled students apprehension towards a lack of networking, and the specific impacts of social media on students selection of a field need to be further researched. Counterpoint: Geriatric physical therapists are unnecessary Some may argue that there is no increasing need for geriatric physical therapists, as the elderly can be treated by general physical therapists. Although physical therapists can use many of the same modalities on the elderly as they do on younger clients, this is a gross oversimplification of the problem. A minimum of 85% of elders have at least one chronic pathological condition (Coren et al, 1987). If even a small fraction of elders seek continuous physical therapy for their chronic conditions from general physical therapy practitioners, the therapists will have significantly less time to spend treating other, younger patients. As previously mentioned, there is a predicted 36% growth rate over the next decade for physical therapy (US Bureau of Labor Statistics, 2014). The largest projected need will be in long-term care, such as assisted-living homes and nursing homes (Dunkle & Hyde, 1995). Although geriatrics often require the same treatment as other patients range of motion, strength training, pain management, etc. they have a host of issues including balance, frailty, cardiovascular weakness, and sensory deprivation that impede recovery and prevent therapists from employing traditional methods. Geriatric physical therapists with the correct specialized training and equipment are needed to thoroughly treat an older population. Conclusion Geriatrics continue to be the fastest growing population cohort of the United States. With public attitude less and less positive about rushing into surgery, the field of physical therapy continues to grow. Some physical therapy students are attracted to working with this increasing

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population of elders for various reasons. However, it does not appear that enough physical therapy students are interested in geriatrics to meet the growing demand. Many students believe working with geriatrics would not provide them with the satisfaction and prestige they want, despite current geriatric PTs offering information to the contrary. Education and clinical experience with geriatrics are two effective tools to attract students to the field. Despite arguments that there is no increased need for geriatric physical therapists, geriatric patients have a host of unique issues that require separate training. The deficit in geriatric physical therapists is something the medical world is well aware of and actively trying to prevent. With any luck, geriatric-centered educational and clinical techniques continue to spread and attract increasing numbers of students to the field.

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References

Brown, D. S., Gardner, D. L., Perritt, L., & Kelly, D. G. (1992). Improvement in attitudes toward the elderly following traditional and geriatric mock clinics for physical therapy students. Journal of Physical Therapy, 72, 251-257. Retrieved from http://physther.net/content/72/4/251.full.pdf+html Collins, T. L., (2012). Characteristics of geriatric practice settings that attract and retain physical therapists. Journal of Physical & Occupational Therapy in Geriatrics. 30, 124-137. Retrieved from http://eds.a.ebscohost.com.ezproxy.neu.edu/ehost/detail?sid=a3da88f1-9979-4d68-85082b3e1eb945aa%40sessionmgr4004&vid=1&hid=4213&bdata=JnNpdGU9ZWhvc3QtbGl 2ZSZzY29wZT1zaXRl#db=ccm&AN=2012250004 Coren, A., Andreassi, M., Blood, H., & Kent, B. (1987). Factors related to physical therapy students decisions to work with elderly patients. Journal of Physical Therapy, 67, 60-65. Retrieved from http://www.physther.net/content/67/1/60.short Department of Health & Human Services Administration on Aging. (2010). Older population as a percentage of the total population: 1900 to 2050. [Excel File]. Retrieved from http://www.aoa.gov/Aging_Statistics/future_growth/future_growth.aspx#age Department of Health & Human Services Administration on Aging. (2010). Older population by age group: 1900 to 2050 with chart of the 65+ population. [Excel File]. Retrieved from http://www.aoa.gov/Aging_Statistics/future_growth/future_growth.aspx#age Department of Labor Bureau of Labor Statistics. (2014). Occupational Outlook Handbook, Physical Therapists. Retrieved from http://www.bls.gov/ooh/healthcare/physical-therapists.htm Dunkle, S. E., & Hyde, R. S., (1995). Predictors and subsequent decisions of physical therapy and nursing students to work with geriatric clients: An application of the theory of

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reasoned action. Journal of Physical Therapy, 75, 614-620. Retrieved from http://ptjournal.apta.org/content/75/7/614.long Mulley, G. P., (1994). In rehabilitation. Age and Ageing. 23, S28. Retrieved from http://go.galegroup.com.ezproxy.neu.edu/ps/i.do?action=interpret&id=GALE|A15964494 &v=2.1&u=mlin_b_northest&it=r&p=AONE&sw=w&authCount=1