Christopher Ball

Within the underserved and rural environment, there is a decreased presence of community recourses to promote transition of positive outcomes and the prevention of chronic disease conditions upon discharge from primary healthcare entities. Furthermore, older-adults residing in rual and underserved communities tend to demonstrate decreased knowledge as well as awareness regarding the severity and seriousness of chronic disease conditions. These insufficiencies interact in a feed-forward negative fashion and at times, are present throughout life, further promoting inactivity and chronic diseases such as frailty and malnutrition during older-adulthood.5 Large “up- stream” organizations and public policies predispose rural and underserved populations to lower heath-related quality of life. Public funding allocated for parks & recreation departments is grossly inadequate, hinder participation in physical activity throughout life that leads to pronounced negative affects on the overall health and functional independence in older-adults.2 Also, hospitals located in underserved and rural communities are often not-for-profit. A large percentage of the prospective patient population in rural and underserved areas receive publicly funded healthcare (Medicaid and/or Medicare) throughout their life-span. Those who are under 65 years of age typically rely on Medicaid which at the present time offers limited coverage and allocates inappropriate amounts of skilled rehabilitation and preventative care. Instead these services are preset based on diagnosis and/or disease rather than socio-ecological factors of the patient or patient population and results in the increased rate of primary hospital admission, subsequent instances of readmission and the compounding of chronic disease conditions as the population ages. This feed forward negative cycle in turn, places enormous financial burdens on the local hospital itself and public healthcare system as a whole. Doctors of physical therapy (DPTs) are currently recognized as a primary care entity. Many health officials and fellow health care professions believe DPTs are the ideal health care professionals for the development, initiation and continued implementation of health promotion programs for the elderly and their associated interventions. DPTs are trained in movement analysis, differential diagnosis of musculoskeletal injury or pathology and the developing a plan of care that is patient-centered at any point along the developmental lifespan and continuum of care. DPTs are able to make appropriate program referrals and ensure accurate selection and performance of task-based interventions that are both evidence based and modified for the elder adult to prevent negative effects of aging. As experts in functional movement, DPT’s will be able to instruct, train and monitor participants in the use of proper body-mechanics and ergonomic positioning and make necessary modifications in form or technique when completing functional tasks. This better enables achieving moderate intensity activity whilst preventing re-injury, the development of musculoskeletal overuse injuries and/or early identification and evidenced based treatment if injury/pathology did occur. DPTs are also well versed regarding balance, its integral components and falls prevention and best allows for the safe selection and development of hiking trails, gardening environment/parameters, and optimal utilization of the multi-sensory balance training to challenge postural control and static/dynamic balance within a functional environment. A health and wellness program for older adults in Mills-River will provide a consistent source of social networking and social support late in life.34 Also, older-adults who receive sources of primary care within the inpatient or outpatient settings are exposed to means of patient education regarding their current condition and/or maladaptive health behaviors. This concerted effort to improve awareness can promote the beginning of pre-contemplation, active contemplation or developing/initiating a plan of action for health behavior change.31 Program interventions such as community gardening programs as well as hiking groups can be considered a means of enhancing continuity of care regarding therapeutic activity among underserved populations and facilitate successful transition and (9)(10) long-term maintenance of positive outcomes.

Background: