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Charting a Course for Older Persons Healthcare issues and needs of older

persons worldwide were the topics of a collaborative meeting between members of the World Confederation for Physical Therapy (WCPT) and representatives of the International Institute on Aging (United Nations) - Malta (INIA),* As a result of the meeting a pilot short course on physical therapy services for older persons was planned for 1993.

pilot Test Short Course At the meeting priority was given to

raising awareness of the contribution of physical therapy to services for elderly people, and ultimate aims are:

.To improve health care services for elderly people by developing relevant physical therapy attitudes, skills and knowledge. 0 To develop physical therapy skills to influence policy both locally and nationally.

The pilot short course will address these aims and the resulting curriculum will be available for further courses world-wide. Criteria for selection to the pilot course, costs and funding details will be available from INlA during 1992. Applications from developing countries will be encouraged.

Draft Statement Also as a result of the meeting the Expert

Group has prepared a draft WCPT position statement on ‘Physical Therapy for the Care of Elderly Persons’ (see below). This statement was accepted and agreed by the WCPT Executive Committee at its recent meeting in New Delhi, and will be presented for ratification at the 1995 WCPT General Meeting in Washington, DC.

The meeting in Malta was a follow-up to the recommendations in the joint WH0:WCPT Report ‘The Role of Physical Therapy in the Care of Elderly People’ (1987, WCPT, f20).

The physiotherapists present were Margrit List from Europe, Doreen Bauer from Western Pacific, Jo Beenhakker from Africa, and Neva Greenwald from North America, along with rapporteurs Barbara Sutcliffe and Lois Dyer. Present from INlA were Dr Alfred Crech, Dr Julian Mamo, Dr Mario Garrett and Ms Marika Wirth. The final report of the meeting and proposed curriculum will be available on request from INIA. ‘Founded in 1988, the International Institute on Aging (United Nations) - Malta provides multidisciplinary education and training in geriatrics and gerontology for professionals, allied health workers, bducators and policy makers in the field of ageing. INlA also conducts research, provides for information exchange and technical co-operation,, and issues a journal and other publications. Its address is 117 St Paul’s Street, Valletta VLTO7, Malta.

POSITION STATEMENT

Physical Therapy for the Care of Elderly Persons The World Confederation for Physical Therapy: Accepting the United Nations’ Principle for Older Persons - Item 10 (New York 1991): ‘Older persons should have access to health care to help them maintain or regain the optimum level of physical, mental and emotional well-being and to prevent or delay the onset of illness’; Recognising the rapid escalation in the number of elderly persons throughout the world;

Appreciating that epidemiological data indicate that 20% or more of elderly persons experience mobility and functional problems which may compromise their well-being;

Mindful of the financial implications of disability to the elderly individual, the family and the community; and Aware that many physical problems may be prevented, corrected or ameliorated by the timely intervention of physical therapists; Uges member organisations to take action by vigorously encouraging legislative and regulatory bodies to incorporate the following principles into their national Planning and programmes. 1. There should be active involvement of Physical therapists with appropriate knowledge and experience of the develop- ment of services for elderly people in policy and planning at international, national and local levels. 2. Prompt and co-ordinated services Provided by physical therapists should be available and accessible to elderly persons

experiencing problems affecting their ab,i!ity to function. 3. The provision of physical therapy services in the home or in programmes organised for elderly persons who usually reside at home, such as out-patient clinics, day hospitals, day care centres or respite care programmes, should be promoted as an alternative to high-cost hospital or institutional care.

4. The establishment of physical therapy programmes for those who do not have direct access to mainstream services, for example, elderly persons in rural areas. 5. There should be recognition that functional assessment, especially the home environment, is necessary to determine the needs of elderly persons, and that physical therapists are key personnel in the management of mobility and physical function problems.

6. That health promotion programmes conducted by physical therapists and aimed at enhancing physical function, especially in well elderly persons, may contribute subsequently to the develop- ment of optimal health and well-being of elderly persons.

7. Reimbursement systems should allow for the complex and multiple health problems which elderly persons may have, and take into account the likely slower responses to intervention. 8. The identification of gaps in services in health and welfare programmes for elderly people which may be filled by the provision of physical therapy.

9. The provision of funding for research and programme development into aspects

of physical therapy relevant to the care of elderly people should receive due recognition. 10. That physical therapists participate in the education and training programmes for primary health care workers, including families.

WCPT Initiatives The World Confederation for Physical

Therapy 72nd Executive Committee meeting held in New Delhi, India, in February, agreed the following specific initiatives for the period until the next meeting: 1. That WCPT should continue its co- operation with the International Institute on Aging (United Nations) - Malta, and should present progress to the XV World Congress on Gerontology in 1992. 2. That WCPT should continue its co- operation with the World Health Organisation (WHO) to produce a text on the care of children with cerebral palsy in developing countries.

3. That WCPT should- continue its co- operation with WHO and the World Federation of Occupational Therapists on

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policy for community-based rehabilitation and the training of mid-level workers.

4. That WCPT should continue to consider the possibility of an international research review-type journal.

5. That WCPT should continue to review its publication programme but should not change the nature of the Newsletter at present, nor should the ‘Programmes of Physical Therapy Education in Countries Represented in WCPT’ be updated at present.

6. That WCPT should continue to co- operate with international agencies such as Rehabilitation International and the lntepational Council on Disability, United Nations and WHO on a consultative basis.

7. That WCPT should set up a task force on standards.

Recruitment Reservations The CSP International Affairs section

is receiving an increasing number of calls from members asking for specific recommendations of recruitment agencies. The Society has neither the resources nor the desire to endorse one advertiser over another but recommends that members read all the literature very carefully and take nothing for granted. See the article on page 844 of the December 1991 Journal for more details.

Emergency and Disaster Relief Register The United Kingdom’s first Emergency

and Disaster Relief Register for health professionals has been established by the charity International Health Exchange (IHE). Members of the Emergency and Disaster Relief (EDR) Register are experienced health and management professionals who are available at short notice to relief agencies in the event that outside assistance is required for emergencies overseas. IHE has been designated the main provider of health personnel to the British Government’s Disaster Response Initiative announced in August 1991.

To help health workers ascertain if they have the right skills, minimum entry requirements have been established. For example, registrants need to have had two years’ experience of work in a developing country or at least six months’ experience in emergency work overseas.

IHE also maintains an extensive general register of health professionals interested in working in developing countries. It is aware of many vacancies for physio- therapists through several agencies - governmental, voluntary, mission, etc - in all parts of the world and for differing lengths of time.

IHE is extending its general register in co-operation with Action in International Medicine (AIM), of which the Chartered Society of Physiotherapy is an associate

member. AIM’S focus is upon the frontline professional health worker at district level in developing countries. Those interested in joining are invited to send a CV directly to AIM (address below) and they will be placed on the EDR or General Register as appropriate.

International Health Exchange, 38 King Street, London WC2E 8JT (tel 071-836 5833).

Action in International Medicine, Windeyer Building, 46 Cleveland Street, London W1P 6DB (tel 071-636 3610).

Your Patients are Waiting . . . . , . in Bangladesh, Cambodia,

Cameroon, Central Asia, Egypt, India, Jamaica, Lesotho, Malawi, Nigeria, Pakistan, Papua New Guinea, Sri Lanka, Tanzania, Thailand, Uganda.

Experienced physiotherapists are needed for overseas contracts of varying lengths and with many different voluntary government or mission agencies.

Details from lnternational Health Exchange (formerly Bureau for Overseas Medical Service), Africa Centre, 38 King Street, London WC2E 8JT (tel 071-836 5833).

books in brief Patients’ Voices Rainbow Hues wrltten and published by Dorcas Munday, 2 5 Debdale Road, Wellingborough, Northamptonshire NN8 5AA (1991). Illus. 52 pages. f 3 plus 5Op p&p from the autho,:

Well produced and pleasant to read, this small book is largely an account of travels around the UK, to Japan and to Austria by the author, who is severely handicapped by cerebral palsy.

She has tutored courses and organised clubs for PHAB (Physically Handicapped and Able-Bodied), and the book should give an indication of the possibilities for travel by people with physical handicaps - in fact, it might irritate those who are not fortunate enough to have so many opportunities.

But the last chapter is perhaps the most important, with an apprehensive

Read Any Good Books Lately? If you have come across a new book which might help other readers, and it has not been reviewed in Physiotherapy, please let us know.

look at what the future may bring as Miss Munday grows older, and a realistic appraisal of marital prospects for people who do not fit into modern society’s concept of the ideal recipients of sexual and emotional love, however much they have to offer in other respects.

Bitter-sweet FA by Alun Peredur Jones. Brynglas Publications, 23 Durham Avenue, Bromley, Kent BR2 OQH, 1991 (ISBN 0 9515195 1 4). Illus. 80 pages. f3.85 plus 75p p&p.

In an earlier book, Sweet FA, the author described his experience as a sufferer and sibling of sufferers from Friedreich‘s ataxia - concentrating on his childhood and the milder early stages of the disease.

In this book his autobiography is continued with an account of Mr Jones’ interest in Citizen’s Band radio, writing and making television programmes. Counterpoint to this is a description of the aids and equipment he needs for daily living and the intensifying battle against disability and loss of sight, hearing, and sometimes speech.

The book is informative and even entertaining but as the author reaches the age of 36 years, knowing that his brother and sister both died of the disease a t 34, the conclusion is inevitably pessimistic.

It Shouldn’t Happerr to a Patient: A survivor’s guide to fighting life-threatening illness

by Pitta Launganl. Whiting and Birch, PO dox 872, Forest Hill, London SE2 3HL, 1992 (ISBN 1 871177 14 6). 199 pages. f18.95 hardback, f8.99 paperback.

Yet another book by a patient on his experiences of serious illness, and to the shame of the professionals yet another aceount of the shortcomings of the staff who were in charge.

Dr Laungani is a social psychologist who contracted polymyositis. Physiother- apists might share his displeasure - at one point (page 171) he was advised against physiotherapy because his muscles would ‘grow of their own accord‘; the value of physiotherapy had never been clearly demonstrated; and. it had its obvious limitations - in fact, he was warned against damaging his muscles by exercising them.

Set against that is the fact that Dr Laungani was not a compliant patient, and he acknowledges the commitment and care of many health professionals during his very serious illness. This well-written book is a gripping story in its own right, and an interesting view of the health service by an insider-turned- patient.

Physiotherapy, June 1992, vol78, no 6