Health & Fitness

Editor’s note (Summer 2007): Since this article first appeared in Bay Area Summit’s Spring 2004 issue, Susanne McQuade has retired. Geoffrey Suguitan has directed CalFIT’s 50+ Fitness programs since April 2006.

If you’re 50 or older and searching the East Bay for classes in yoga, tai chi, qigong or even ballroom dancing, you might want to look into U.C. Berkeley’s 50+ Fitness program.

Run by the university’s Department of Recreational Sports, the five-year-old program offers classes in a wide range of exercise activities, from aerobics, pilates and strength training to tennis, swimming and sea kayaking. Click here to read full article

Many elderly people develop movement problems that can affect their coordination, balance, mobility and comfort. Movement disorders are often triggered by an injury, illness, operation or disease. Movement dysfunctions can also develop when a person tries to compensate for muscle weakness, chronic pain or impaired sensation.

Movement disorders and dysfunctions can increase a person’s risk, and fear, of falling. It’s estimated that between one third and one half of Americans ages 65 and older fall at least once per year, and fall-related injuries are the leading cause of accidental death among older adults. Falls account for more than 90 percent of all hip fractures among older adults and are responsible for nearly 40 percent of all hospital admissions for seniors.   

There is hope, however, for people with movement problems. These conditions can be at least minimized, if sometimes not completely cured, through physical therapy interventions. Physical therapy can also help the frail elderly improve their conditioning and flexibility, build muscle strength, alleviate chronic pain, maintain their independence and stave off disabilities that their weakened state puts them at risk of developing.

To learn more about physical therapy interventions for older adults, Bay Area Summit spoke in September 2008 with Lise McCarthy, PT, MA, GCS. McCarthy is certified by the American Board of Physical Therapy Specialties as a clinical specialist in geriatric physical therapy, and she heads McCarthy’s Interactive Physical Therapy (MIPT), a private fee-for-service and Medicare provider based in San Francisco.

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Lise McCarthy, PT, MA, GCS

Founded in 2000, MIPT evaluates and treats adults of all ages with a wide variety of medical conditions. McCarthy specializes, however, in working with older adults, including those with cognitive deficits, increased frailty and a high risk of falling. Most of her clients are in their 80s and 90s.

McCarthy’s specialization remains a rarity – there are currently less than 1,000 board-certified geriatric PT specialists in the entire United States. McCarthy has served on the board of the Coalition of Agencies Serving the Elderly (CASE), and she has helped convalescent hospitals, assisted living facilities and other long-term care homes develop or improve physical activity and restorative nursing care programs.

Bay Area Summit (BAS): What sets the geriatric PT specialization apart from other types of physical therapy?
Lise McCarthy (LM): The main difference is that geriatric physical therapists have met certain standards set forth by the American Board of Physical Therapy Specialties, which involve submitting evidence demonstrating completion of at least 2000 hours of direct clinical practice in geriatrics and passing a rigorous all-day written examination to demonstrate advanced knowledge in the specialty field of geriatric physical therapy. Just like physicians who specialize in different areas, physical therapists can specialize in pediatrics, sports medicine, neurology, orthopedics and, in my case, geriatrics. It makes sense that there are healthcare professionals who have advanced skills and knowledge to better serve those people with more specialized needs. For example, I often work with people who have balance problems, chronic pain, or extensive debility after an illness. Many of them have dementia or impaired cognition, and I think the potential for improved quality of life in this population is generally not very well appreciated, but I have had success in working with them. I frequently hear from families that they are glad they found me.

BAS: What issues do geriatric PT interventions generally focus on?
LM: I start with a detailed history and examination, which can include performing tests or screenings. Among the range of issues I look at are mobility limitations, fall prevention, home safety, and functional capacity. I also look at what medications a person is taking and identify those meds which might be negatively contributing to a patient’s problem. In some cases I refer patients back to their physician for further medical consideration or because I want further medical diagnostic work done. I look at the kind of support network the person has in place, because that makes a huge difference to the success of their treatment, progress and recovery. When appropriate, I may contact other parties involved in the person’s overall care. I also look at their equipment needs. Do they have a walker that is well-matched to their specific walking needs and abilities? When a person has a chronic condition, the focus of my physical therapy intervention may be on developing a plan to maximize and maintain functional status or prevent functional decline, also determining the person’s need for assistive equipment, and training the person and his or her family and care providers about safety and appropriate exercises.

BAS: Where do you see your clients?
LM: I visit most clients in their homes. Some are in assisted living communities, nursing homes, board and care homes or other senior residential communities. Providing these services at home makes things a lot easier for older and frail adults who may have difficulty going out into their community for these services. I also meet some clients at swimming pools for aquatic therapy. I don’t think there are many PTs in private practice who see people in their homes. Most in-home physical therapy services are provided by home health agencies, but therapy is also provided in outpatient clinics and hospital settings.

BAS: How do you identify and address problems that can increase a person’s fall risk?
LM: It’s very important to conduct a fall risk assessment when an older person has fallen or is concerned about falling. The healthcare community is starting to look more closely at fall prevention strategies to reduce the high number of fractures and deaths that can occur from falling. A fall risk assessment includes a look at the person’s home environment and what can be done to make it safer. I also look at functional capacity, postural control, strength, joint movements, balance reactions, vital sign changes with exercise and position changes, and I look for compensatory movement patterns that could affect the person’s balance. I also look at any medications the person is taking and how these might contribute to fall risk. After the assessment is done, I make recommendations on ways to reduce fall risk.

BAS: At what stage do you usually get involved with a client, and how are clients referred?
LM: Most of the people who come to me have gotten to a place where they have been through the rehab process, but they are still experiencing difficulty moving and they want to take a look at what other therapy options may be available. I’m kind of a “second opinion” person. I get a lot of complicated cases, people who are looking for a clinician who specializes in geriatric issues, who can take the time to take a very close look at them and their entire presentation. Many of my patient referrals come from physicians. They also come through care managers, conservators, social workers and other healthcare professionals, and from assisted living and other senior residential communities. There are actually more referrals than I can accept because I’m a solo practitioner and there is such a big and growing demand for geriatric PT specialists.

BAS: What are some of the techniques you use to help clients achieve therapy goals?
LM: A lot of what I do initially is to talk to my patients and their families and caregivers, listen carefully to what they all say. I don’t want to repeat therapies that have already been tried unsuccessfully and I want to understand what their real issues are. I also screen them from head to toe and obtain a thorough history. I am most effective when I understands people’s issues and what they want to achieve, and when people understand and agree with the goals of the treatment and when the therapy is doable. The trick is to find something the people will accept and consistently follow through with. The process may involve setting up a paced exercise program, or looking at what equipment is or isn’t working for the person and how they use it. The program I develop also may focus on a part of the body that hasn’t been focused on before by other therapists or doctors. I focus a lot on teaching and educating my patients about what they need to do to reach their goals, and getting them to see different ways of looking at things and to accept realistic goals. It takes patience and understanding on both sides.

BAS: How do you generally define success in working with frail elderly clients?
LM: My number one goal is to have really good communication between me, my patients and their families and caregivers, and their physicians. I like helping people live more safely and more comfortably at home for as long as possible. One of the best things I can do is help people reach what I call a “lightbulb moment,” when they can really understand what their options are from here and why I have made certain recommendations. Rarely is physical therapy not successful in some measured way, but there are times when a person may need to turn to other service providers to address residual issues. In these cases, at least my patients come away feeling understood and in charge and with the sense that they have tried the PT path fully. This is an important step on their journey.

BAS: Do you have any success stories you’d like to share?
LM: I like helping people walk again. I’ve had people come to me who have not walked for months or in some cases years. Some have been told they would never walk again. I have been able to provide them with an appropriately paced exercise program, and information about how to succeed in meeting their particular goals and about equipment that allows them to take the necessary steps and learn to walk again. One of my clients was told he’d never walk again. I helped him obtain a shoe lift and the right walker that matched his specific needs. He was motivated and eventually became strong enough to walk from his apartment to the YMCA several blocks away to swim. I’ve also been successful in reducing some types of pain for patients. I’ve had good success with people with cognitive deficits or dementia, and getting them and their families and caregivers to work together on a progressive or maintenance exercise program to maximize their mobility skills. It takes time and motivation, the right equipment, the right approach. This has been a recurrent theme in my practice.

For information about McCarthy’s Interactive Physical Therapy (MIPT), see http://www.mipt.us. Information about the American Physical Therapy Association’s geriatric specialist certification program is available at http://www.apta.org. An article describing the potential benefits of geriatric physical therapy is available at http://preventdisease.com/news/articles/physical_therapy_elderly_staves_disability.shtml. Lise McCarthy can be reached by email at Lise@mipt.us or by phone at (415) 665-4953. McCarthy is currently not contracted with any health insurance company other than Medicare, and information about her professional fee schedule may be obtained by calling MIPT.

Disclaimer: The views and opinions expressed by the subject of this interview are not necessarily those of Bay Area Summit or its sponsors.

(This article originally appeared in the Fall 2008 issue of Bay Area Summit)

Acupuncture and other forms of traditional Chinese medicine are gaining wider acceptance and use in the United States and other Western countries. For perspective on these ancient healing techniques, and their effectiveness in treating physical ailments common among middle aged and elderly people, Bay Area Summit spoke in June 2004 with Dr. Kun Xiang (pronounced “Kwan Sean”), a physician who has practiced acupuncture and Chinese medicine in San Francisco for 15 years. Click here to read full article

Topics related to diet and nutrition have never been more in the news than they are today. In February, for example, the Institute of Medicine, a division of the National Academy of Sciences that sets desirable nutrient intake levels, announced that healthy adults between the ages of 19 and 50 should consume no more than 5.8 grams of salt (a little more than one teaspoon) per day, and that adults older than 50, African-Americans and people with chronic diseases such as hypertension and diabetes should consume even less than 5.8 grams per day.

And in early March, a study which found that treatment with high doses of cholesterol-lowering statin drugs reduces the risk of heart attack, bypass surgery and chest pains was published in the The New England Journal of Medicine. This finding is now being touted by some proponents of the Atkins and other low-carbohydrate diets that sanction unlimited consumption of protein and saturated fat to address concerns that these diets boost cholesterol levels and elevate the risk of heart attack, stroke and other health problems.

For perspective on these issues, Bay Area Summit spoke in March 2004 with Judith Levine, a registered dietician and consulting nutritionist with the American Heart Association in San Francisco. Click here to read full article

Joan-Marie Shelley has enjoyed writing ever since she was in elementary school. So when her assisted living residence began offering a creative writing class in 2004, Shelley jumped on board.

The class and its related writing assignments “keep me intellectually stimulated,” says Shelley, 72, who taught a range of subjects, including English and French, for nearly 30 years at San Francisco’s Lincoln and Lowell high schools. She also spent 12 years as president of the United Educators of San Francisco, a union representing public school teachers. “We’re writing verse now, and I’m really enjoying the freedom it provides. It’s about letting the spirit move you, and you don’t have to be so logical.”

Shelley, the daughter of former San Francisco Mayor Jack Shelley, is one of about 10 members of the cross-generational writing class, which mixes residents of Sunrise Senior Living on 19th Avenue, where the instruction takes place, with high school students from San Francisco’s School of the Arts.

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The class is part of a program called Center for Elders and Youth in the Arts (CEYA), which runs a variety of arts-related classes – taught by professional musicians, artists and writers – at locations around San Francisco. The program’s mission is to keep older adults connected and contributing to their community, and to provide opportunities for them to rub shoulders with young people. The classes also have health benefits: one study found that people age 65 and up who participate in creative pursuits for at least one hour per week tend to have fewer health declines than those who don’t participate.

CEYA is one of many programs provided through the Institute on Aging (IOA), a San Francisco-based nonprofit that works to promote health, safety and independence among older adults. Founded in 1975, the IOA’s programs serve San Francisco, Marin and the Peninsula, and include on-site adult day services, home care, case management, grief and loss support, psychological services, elder abuse prevention, research and education for families, seniors and professionals in the field of aging.

The IOA helps operate the Irene Swindells Center for Adult Day Services [add link], located at California Pacific Medical Center’s California Street campus, which was profiled by this newsletter in the summer of 2005. Another IOA program is the Center for Elderly Suicide Prevention, which helps older adults with life-threatening depression. The center’s 24-hour Friendship Line provides crisis support, as well as scheduled phone calls that offer encouragement, medication reminders and safety checks.

“The Friendship Line has been calling me every day except Sunday for the past two years,” says Karin, a 68-year-old San Franciscan who asked that we not print her last name. Karin has recently suffered a variety of health problems, including pneumonia, and has battled depression since her mother died a few years ago. “When you live alone and your social circle is diminishing through death, it’s helpful to have an outlet like this. It’s kind of nice to know that someone cares and is is nice and friendly. I look forward to the calls.”

The IOA, which has about 250 employees and an annual $20 million budget, has gained recent attention with its plans to build a new headquarters at 3575 Geary Boulevard on the site of the old Coronet Theatre in San Francisco’s Richmond District. The project, a partnership between the IOA and Bridge Housing, a development company that specializes in affordable housing, will combine 150 units of low- and moderate-income senior housing with a center providing health and social services.

The six-story Mediterranean-style building, which the San Francisco Planning Commission approved in April 2006, will house the IOA’s health center, geriatric assessment service, and education and research activities. Among other things, the design features a senior fitness center and a creative arts studio.

Groundbreaking is planned for mid-2006, and the $60 million project is expected to be completed in early 2009. The building will be the first permanent home for the IOA, which is now scattered in rental space around the city – including several Geary Boulevard locations. “It will be great for us, and a lot less confusing for the public, to consolidate many of our services under one roof,” says Mary Twomey, the IOA’s vice president for community programs.

Find out more information about the Institute on Aging, the CEYA program, and the Friendship Line.

(This article originally appeared in the Summer 2004 issue of Bay Area Summit)

Walk into most gyms and chances are you will encounter loud rock or rap music, a staff that offers little assistance or instruction (unless you pay extra for a physical trainer) and throngs of people competing for exercise equipment and space while hurrying to complete their workouts.

Enter Phytness Connection, however, and you’re in for a very different experience. For starters, the club, located in Oakland’s Montclair neighborhood, is never crowded. Instead, members are required to schedule their visits in advance and there are only a handful of men and women at any given time independently exercising or using the state-of-the-art stationary bicycles, treadmills and other machines. And in place of a blaring soundtrack, there is soft-playing music and an interior décor that exudes calm.

“Our facility was specifically designed to be a comfortable, pleasant environment for older adults to work out and stay in shape,” says owner Laura VanHarn, Click here to read full article

Since opening in 1988, Lakeside Senior Medical Center has carved a reputation as one of San Francisco’s leading healthcare providers for people aged 65 and older.

In fact, the UCSF-managed clinic may be the ONLY resource of its kind in the Bay Area.

Lakeside “is the only free-standing primary care practice I’m aware of that specializes in patients over the age of 65,” says Verne Doxey, a San Francisco geriatric care manager. “Aside from maybe the [Veterans Administration] Medical Center, there’s no other place in San Francisco that provides the same combination of geriatric medicine and case management services.”

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MaryLu Murphy (left) and Dr. Carolyn Welty of Lakeside Senior Medical Center

“Lakeside’s full-service geriatric medical practice is a one-stop medical and psychosocial center,” adds Jane Mahakian, another San Francisco geriatric care manager. “The quality of care they provide is outstanding and comprehensive.”

The clinic’s reputation among health and eldercare professionals stems largely from its focus on treating the whole person and the amount of time its staff – including two physicians and a full-time social worker – spends with patients.

“There is more to health than just medicine,” explains Dr. Carolyn Welty, a specialist in geriatric and pulmonary medicine who joined the clinic in 2001. “We take the time to listen to our patients and their families and to develop a plan of care that addresses their individual needs and preferences. We want them to feel comfortable talking to us about anything.”

Older patients “want to be comfortable and respected and know that their doctor is concerned and cares about them,” continues Dr. Welty, who helped develop a geriatrics clinic at Boston City Hospital and now teaches geriatric medicine at UCSF. “Many health problems associated with age can, with appropriate care and treatment and support, be modified or ameliorated and the overall condition improved.”

Located in a converted 1940s pharmacy in the city’s Lakeside Village shopping area, the clinic is headed by Dr. Daniel Pound, who teaches in UCSF’s Department of Family & Community Medicine. “We make an effort to deal with the whole person, rather than just one organ system, which is what so many specialists do today,” says Dr. Pound.

Having a social worker on staff enables Lakeside “to coordinate with families and with service providers such as mental health case managers and home care nurses to maximize a patient’s care,” says MaryLu Murphy, the clinic’s social worker since 1990.

“Most of our patients have multiple, chronic medical problems and need to be seen quite often. And if they have dementia or problems with [activities of daily living], it often involves the whole family, so it’s important to have a social worker here,” adds Murphy.

Lakeside’s physical design also makes it a friendly environment for older adults. The street-level clinic provides a comfortable lobby, spacious bathrooms and wide, wheelchair accessible hallways with handrails. The examination rooms are equipped with special beds that allow easy access for people with mobility problems, and much of the clinic’s lab work is done on site. “We try to do as much as we can here, which is important for people who have difficulty getting around,” says Murphy. The clinic is also located near several public transit lines.

As of this writing, Lakeside is still accepting new patients. While new patients must generally wait three to four weeks for an appointment, established patients can usually make a same-day or next-day appointment to see one of the clinic’s doctors. “We make every attempt to see people in a timely manner,” says Dr. Welty.

Nearly all of Lakeside’s patients are over the age of 65. The clinic accepts Medicare with supplemental insurance, as well as leading senior HMO and private insurance plans like Health Net Seniority Plus and Brown and Toland.

UCSF Lakeside Senior Medical Center is located at 2501 Ocean Avenue at Junipero Serra. For information or to make an appointment, call (415) 586-8600.

(This article originally appeared in the Summer 2005 issue of Bay Area Summit).

Editor’s note (Summer 2007): Since this article first appeared in Bay Area Summit’s Fall 2004 issue, the CHRC’s Senior Care Program was canceled due to a funding shortage. CHRC social worker Scott Plymale is available to advise seniors on a range of issues, such as housing and transportation. Beth MacLeod’s private practice can be reached at 415-441-4782.

Helen, a 77-year-old widow, lives alone in San Francisco’s Richmond District. Her three adult children, who live in New York and Southern California, are increasingly concerned about their mother’s social isolation and frail health. But the children are only able to visit Helen a few times each year, as they are busy with work and their own families.

“What the children need is professional help, someone who can step in and develop a care plan that increases the safety and well-being of their mother,” says Beth MacLeod, program director of the Community Health Resource Center’s new Senior Care Program. ” Click here to read full article

Each year, millions of older men and women around the world are disabled, sometimes permanently, by falls that result in broken bones. Falls account for more than 90 percent of all hip fractures among Americans over the age of 65, and fall-related injuries are the leading cause of accidental death for people in this age group. Moreover, many people with hip fractures never regain their previous mobility and have a heightened risk of repeat fractures.

For information about things people can do to reduce their risk of falling, Bay Area Summit spoke in October 2004 with Lee Cutler, a member of Marin County’s Older Adult Fall Prevention Task Force. Click here to read full article

In addition to taking steps to strengthen bones and avoid falls, men and women with osteoporosis and/or a history of falls should consider wearing hip protectors. These external devices are designed to prevent hip fractures by reducing the impact of falls when they occur. Most hip protectors are worn under clothing and consist of plastic shields or foam pads that are held in place at the hips with specially designed underwear. Click here to read full article