Physiotherapy in Older People, Community and Primary Care
Domain focus
This domain tests frailty, falls, sarcopenia, home safety, community resources and primary care triage. The exam expects person-centred goals that keep older people active and safe at home, with attention to polypharmacy, cognition, carers and social context. Community practice requires reasoning beyond the clinic room.
Core rules and concepts
- Frailty is a state of reduced reserve; small illnesses can cause disproportionate decline. Screen for falls, weight loss, exhaustion, low activity and slow gait.
- Falls assessment covers history, medication, vision, feet, cognition, continence, home hazards and fear of falling. A single fall in an older person is not automatically benign.
- Sarcopenia and deconditioning respond to progressive resistance and protein adequacy, but prescribe according to comorbidity and tolerance.
- Primary care physiotherapy uses triage, self-management advice and referral pathways. Know when to send for medical review rather than continue exercise.
- Home assessment considers stairs, lighting, rugs, bathroom equipment, bed height and carer capacity.
- Community resources may include elderly centres, home care, day rehabilitation and carer support; recommendations must be realistic for the patient.
Worked example
An 82-year-old living alone has had two falls and takes seven medications, including a sedative. She wants to stop using a walking stick because it looks old. Reasoning: recurrent falls plus sedative use and possible postural hypotension require medical review before an exercise-only plan. Assess gait, strength, vision, feet and home hazards; involve the carer; practise sit-to-stand and walking with the appropriate aid; explain that the stick supports independence. Do not simply tell her to be careful.
Traps that cost marks
Ageism that dismisses reversible problems; treating one fall as trivial; giving a home programme without checking literacy, cognition or carer support; and ignoring medication or postural symptoms. Another trap is recommending equipment the patient cannot use or afford.
Key points
- Frailty reduces reserve and changes risk.
- Recurrent falls need multifactorial review.
- Exercise must fit comorbidity and context.
- Home assessment includes carers and equipment.
- Know primary care referral triggers.