Geriatric Physiotherapy
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Direct answer
One in three adults over 65 falls each year, and the physiotherapist's geriatric craft is built around reversing the measurable declines that make that number what it is: sarcopenia stripping muscle mass and power at roughly 1 to 2 per cent yearly after the fifth decade, maximum aerobic capacity falling about 10 per cent per decade, and balance reactions slowing until the righting strategy fails. Screening is numeric — the Timed Up and Go, where 13.5 seconds or longer flags fall risk, the 30-second chair stand (below about 12 repetitions for women, 14 for men in the 60-64 band signals weakness), and the four-stage balance test — and intervention is evidence-stacked: progressive resistance training twice weekly for strength and function, balance training standing and stepping, aerobic work toward 150 weekly minutes, and vitamin D with osteoporosis management where indicated. The frail older adult is not prescribed gentler exercise but progressive exercise, started lower and advanced slower, because deconditioning is the disease being treated.
What you must remember
- Falls epidemiology: roughly 30% of people over 65 fall annually, rising with age; falls are the leading cause of injury in older adults, and the strongest predictor of a fall is a previous fall.
- Timed Up and Go: rise from a chair, walk 3 metres, return, sit — 13.5 seconds or more indicates increased fall risk; pair it with the 30-second chair stand and four-stage balance test for a screen battery.
- Ageing physiology numbers: muscle mass falls about 1-2% yearly after 50, power faster than strength; VO2max drops about 10% per decade; bone density declines post-menopause; reaction time lengthens — together explaining stair difficulty and falls.
- Exercise prescription (WHO-aligned for older adults): at least 150 minutes of moderate aerobic activity weekly plus muscle-strengthening on 2 or more days, plus multicomponent balance training on at least 3 days weekly emphasising practical postures — standing, stepping, turning.
- Multifactorial falls prevention: exercise plus home-hazard modification (lighting, rails, rugs), medication review (sedatives, antihypertensives, polypharmacy), vision correction, footwear, and foot care — single-modality fixes underperform.
- Sarcopenia and frailty: sarcopenia is low muscle mass plus low strength or performance; frailty is reduced reserve across domains — both respond to resistance training and adequate protein, not rest, which accelerates the spiral.
- Osteoporosis thread: fragility fractures of the wrist, spine and hip follow low bone density — physiotherapy contributes weight-bearing exercise, postural and back-extensor training for vertebral fracture patients, and safe-loading guidance.
A faller walked through properly
An 82-year-old widow in Pune, one ground-floor fall in the bathroom last month, now grips furniture indoors. Her screen: Timed Up and Go 19 seconds, chair stand 7 repetitions, four-stage balance failed at tandem eyes-open; medications include a benzodiazepine for sleep, and the bathroom has a high step and no rail. The prescription runs on four fronts at once — a physician review negotiated for the sedative, a grab rail and night lighting installed with her son, progressive strength work (sit-to-stands from a raised chair lowering week by week, heel raises holding the counter, resistance band rows), and balance training exactly at her edge: feet-together to tandem, stepping strategies, then turning practice in the corridor. Walking is her aerobic thread, built in 10-minute blocks toward 150 weekly minutes. Twelve weeks later she stands unaided and her TUG sits under 14 seconds — the numbers that predicted her risk now document her safety, letting her family stop pleading and let her walk.
Exam framing and the Indian demographic angle
Theory questions ask for the physiological changes of ageing with their rehabilitation implications, falls assessment, or the design of an exercise programme for the elderly — where named tests with cutoffs (TUG 13.5 seconds, chair-stand norms) and the WHO weekly dose separate scoring answers from essayistic ones. India's demographic transition is the viva-earning line: the share of Indians over 60 approaches one in five by mid-century while joint-family support shrinks — community-group exercise in parks, screening camps and home-visit triage are realistic delivery models worth naming. Two local cautions: barefoot or slipper-wearing indoors is a correctable fall factor, and floor-level squat toilets decide whether a hip-fracture patient returns home or to a bed — a raised seat and rails is geriatric physiotherapy in one sentence.
Frequently asked questions
What TUG time indicates fall risk in older adults?
A Timed Up and Go of 13.5 seconds or longer is the widely used threshold flagging increased fall risk, interpreted alongside the chair stand and balance tests.
What causes sarcopenia and how is it treated?
Age-related loss of muscle mass, strength and power, accelerated by inactivity and poor nutrition; treated with progressive resistance training and adequate protein, since rest worsens it.
What are the components of multifactorial falls prevention?
Progressive balance and strength exercise, home-hazard modification, medication review, vision correction and appropriate footwear — delivered together, since single measures underperform.
How much exercise should an older adult do weekly per WHO guidance?
At least 150 minutes of moderate aerobic activity plus strengthening on two or more days and challenging balance work on at least three days per week.
Why is a previous fall clinically important?
It is the single strongest predictor of the next fall, automatically qualifying the older adult for detailed multifactorial assessment and targeted intervention.