Initial Evaluation and Developing Goals

Initial Evaluation

Working with older adults is rewarding but can also be challenging.  Often times we get a referral from a client’s doctor for PT or OT services for generalized weakness or gait abnormality.  Some clients we work with often have limited insight into his/her deficits, reporting “I do everything on my own” or “I haven’t fallen.”  Although they may actually be able to get dressed, walk down the hall, toilet, etc themselves, they may present with decreased safety awareness, shortness of breath or take more time to perform these activities.

Applying Our Skill

This is where our skill comes into play. Along with functional outcome measurements, we must analyze each component of the task he/she is performing and use our clinical judgment to determine the appropriate plan of care. Does the client reach for walls or furniture when ambulating throughout their living environment?  Do they have trouble reaching for items? Can they get up from a chair easily?

Questions to Ask

Some more specific questions you can ask your clients are:

• Do you have trouble with fasteners on your shirt/pants?
• Can you reach behind your back to adjust your clothing?
• How often do you bathe a week?
• Have you ever stumbled or tripped?
• Do you drop items often?

Digging Deeper

Sometimes we have to dig a little deeper to understand our client’s deficits and develop goals.  In almost every occurance where my client says “I get myself dressed” or “I never fall,” I find they he/she may be unsteady or struggles with some component of the dressing task such as reaching to donn socks.   

It is also important to involve family members and caregivers.  They may have better insight into their loved ones deficits and can provide a more accurate history of present illness.  

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