By RENEE STOVSKY
Last summer, Ronald Gentry, 85, and his wife, Mary Jo, 81, were referred by their physician to the Center for Optimal Aging at the Providence Little Company of Mary Medical Center in San Pedro, Calif. The couple, married for 64 years and still residing in the two-story home they bought in 1970, was beginning to experience some challenges with independent living.
"My wife is having trouble with her long-term memory," says Ronald Gentry. "I still drive and can do all the shopping and so on, but the doctor thought it might be a good idea to take some tests, see how well we function, and get an understanding of issues we might encounter in the future."
Pam Den Hartog, 70, lives alone — except for her three dogs and two cats — and still works full-time from her home office as an account and media development manager for a manufacturing company. She had concerns about her physical well-being after experiencing a heart attack and receiving a pacemaker a few years ago.
"I was taking a diuretic and some blood pressure medicine, and that caused some dizziness. I'd also become quite sedentary and put on some weight, and I was worried about my balance," she says.
After hearing a presentation at her church about the Center for Optimal Aging, she decided to get a full appraisal there as well.
Measures of independence
At the center, established in 2012 to provide seniors with a comprehensive assessment to enhance and support the physician-patient-caregiver relationship and help guide long-term care plans, both the Gentrys and Den Hartog underwent evaluations by a team of physical and occupational therapists, nutritionists, pharmacists, social workers and geriatric care specialists.
"We use evidence-based standardized assessments to identify key risk factors that could compromise the safety or health of our seniors," explains Jackie Devries, occupational therapy supervisor of Providence Little Company of Mary Medical Center.
Typically, says Devries, Center for Optimal Aging clients spend two full days taking a battery of tests to determine their functional abilities. (Cost of the testing is covered by Medicare following a physician's referral.) On day one, seniors undergo both physical therapy and occupational therapy evaluations.
"Our PT evaluation is designed to measure strength, balance, safety and fall risks," she says. "Our OT tests try to determine a person's ability to function independently in terms of bathing, dressing, preparing meals, managing money and other aspects of self-care."
Call a plumber
On the second day of testing, the emphasis is on cognitive performance. "These are real-time function tests, not paper/pencil examinations," explains Devries. "We give patients prompts and see how they react. For instance, we might tell them that their home is flooded and ask them what they would do. Could they assess an emergency situation? Look in a phone book and find a plumber to call?"
Cognition evaluations focus on five key areas, says Devries: money management; the ability to use the telephone; medical management (following prescription instructions, for example); cooking/safety in the home; and dressing (such as picking appropriate clothing for the weather).
Results of cognitive performance tests are measured on a six-level scale, based on the Allen Cognitive Disability Theory, that scores for everything from working memory and problem solving to motor planning, attentiveness and the ability to learn new activities. Outcomes help with recommendations on how much supervision is needed and how to structure environments to keep seniors living as independently as possible.
Flagging hazards
After the PT/OT and cognitive evaluations are completed, clients and their families fill out extensive questionnaires on diet, medicine and finances which are reviewed by licensed dieticians, pharmacists and social workers trained in areas such as advanced health care planning, elder abuse risk screening, transportation access and basic financial solvency and protection of assets. In some cases, additional testing is suggested, such as driving evaluations. In others, home evaluations are scheduled to check for fall hazards such as throw rugs or cords that need to be relocated.
Once all the information is compiled, it's gerontology specialist Patty Logan's job to decipher the reports, look for red flags, check into community resources and then schedule a meeting with clients and their families.
"This is the time to sit down together, look at our findings in a relaxed setting and get a conversation going about what is possibly happening that made the physician refer a patient to the program," says Logan. "It's my job to clarify problems and help families take care of business, be it identifying power of attorney candidates, explaining continuum of care housing options, discussing resources for caregiver respite or clarifying final wishes."
Balancing act
Many times, clients return to the Center for Optimal Aging for additional physical and occupational therapy sessions. A full report is sent to the referring primary care physician. After 90 days, all clients receive follow-up calls to check on their progress; a second call is made after six months. And if dementia is an issue, repeated assessments can be scheduled once a year.
Purnima Karia, an occupational therapist with the Center for Optimal Aging, observes as patient Alfonso Nuno counts out change as he selects, and pretends to purchase, a pair of gloves that fit him.
Ronald Gentry says he found the evaluation "very helpful and extremely professional. I've also learned how to sit down and talk more effectively with my wife, bringing things to her attention to help her remember more." The couple continues to live at home, although in addition to a nearby daughter's help, they now have a caregiver come three to four times a week to help Mary Jo with bathing and to help the family keep up with the housework.
Meanwhile, as she suspected, Den Hartog's evaluation showed she had balance issues. She followed up by working one-on-one with a physical therapist and beginning a home exercise program that includes a side stepper, balance discs and TheraBands to improve her balance.
"The therapy I received at the Center for Optimal Aging changed my attitude and completely cheered me up," she says. "I was afraid I'd be off-balance the rest of my life, that it was just a function of age. But after a few sessions I could see the difference; I now walk straighter with better balance and more security."
Outcomes like these, says Logan, validate the Center for Optimal Aging's belief that it is at the forefront of the "aging in place" movement. "In addition, it fulfills our mission of respect for human dignity and service to vulnerable populations," she says.
Adds Devries: "Our goal is to build a healthier community by partnering with primary care physicians and area resource professionals. This helps us achieve our Providence Health & Services vision of 'Know me, care for me, ease my way' for the people we serve."