Interventions and Management of the Geriatric Patient
What the candidate must understand
Dosing matters. Strength training for older adults should be progressive, 2 to 3 days per week, at moderate-to-high intensity (roughly 60-80% of one-repetition maximum) to overcome anabolic resistance. Balance training must be challenging and progressive, with task-specific, destabilizing practice; static standing alone is insufficient. Aerobic exercise should accumulate moderate intensity most days. Multicomponent programs (strength, balance, aerobic, flexibility) produce the best functional outcomes.
Know the evidence-based fall-prevention frameworks: the Otago Exercise Program, Tai Ji Quan: Moving for Better Balance, and the STEADI algorithm (screen, assess, intervene). Know that exercise reduces falls but that vitamin D supplementation is not a reliable stand-alone fall intervention in unsupplemented community dwellers without deficiency. Know the role of hip protectors, home modification, and deprescribing.
Manual therapy and modalities are adjuncts; they do not replace loading. Consider bone health: avoid high-impact or flexion-with-compression loading in severe osteoporosis; emphasize extension-based and postural loading. In frailty, start low and progress slowly, and expect longer recovery between sessions.
Traps
- Prescribing balance exercise that is not challenging enough to drive adaptation.
- Applying high-intensity loading without considering cardiac, orthopedic, or osteoporotic risk.
- Assuming bed rest or immobility is benign; deconditioning is rapid in older adults.
- Forgetting caregiver training and home program adherence.
Rule of thumb
If a program does not progressively increase challenge, it will not produce adaptation. Pair every strengthening prescription with a balance and functional-task prescription, and document intensity, frequency, and progression criteria.