Tangible Outcomes, Intangible Results

Getting older patients into the water can provide renewed independence and a sense of pride

As of 2010, there were more than 40 million adults aged 65 and over living in the United States. Within the next four decades, that number is expected to double, according to National Census Bureau statistics.1 For those in the field of physical therapy, these statistics indicate that there will be a growing need for professionals who understand how to work with geriatric patients.

Working with an Older Clientele

The geriatric population is unlike their younger counterparts because of processes that can weaken the body over a lifetime. While some people are stronger than others, it's impossible to completely negate the forces of nature.

Additionally, the elderly are often plagued with physical ailments, as well as neurological conditions such as multiple sclerosis. Frequently, they are taking many different types of medications, some of which may be solving one issue while simultaneously exacerbating another.2

As a result, it's necessary to recognize that older clients will have special requirements when it comes to their rehabilitation programs and realistic outcomes. An elderly patient who has undergone a hip replacement will not suddenly have the physical capabilities of a 30-year-old. However, that doesn't mean they can't regain lost mobility.

The physical therapist must be cognizant of suitable rehab techniques for aging adults. Land-based activities can be difficult for many seniors; consequently, whenever possible, aquatic therapy in a warm-water pool with integrated treadmill, guard rails and resistance jets should be integrated into rehabilitation. By taking advantage of water's natural hydrostatic properties, as well as its buoyancy, the physical therapist can help a patient safely and comfortably perform prescribed exercises without a fear of increased pain or falling.

Introducing Aquatics

Many geriatric patients may have heard about aquatic therapies, but most have never experienced rehabilitation in a specialized therapy pool. Therefore, it becomes incumbent upon the physical therapist to guide the patient through each session, carefully explaining processes and setting the stage for expectations.

For example, the physical therapist will want to answer common questions, such as whether or not bathing suits are required attire, and how the client will securely get into the pool. Because the pool at our facility has a variable depth floor with an embedded treadmill, we can start a patient at a standing position - or seated in a wheelchair - and slowly decrease the water depth until the patient overcomes the fear of falling. Aquatic lifts are a safe and convenient means to lower patients into the pool.

Once the physical therapist and the client are in the water, exercises can begin. As with land-based rehabilitation, it's recommended that patients be gently led through a variety of motions designed to address their specific needs.

As the client and physical therapist continue through weeks of aquatic therapy, they will begin to see improvement that regularly translates to land-based movements. For instance, a patient may begin aquatic therapy, but be unable to comfortably bear weight on land, thereby requiring an assistive device. However, the patient may end up needing the assistive device less frequently - or sometimes not at all - after progressing through aquatic rehabilitation.

After physical therapy sessions have ended, the patient may then opt to continue with aquatic therapy by paying out-of-pocket on an as-needed basis. This frequently occurs at our facility, where our specialized therapy pool is available to residents for an additional fee. Overall, it's an excellent add-on for geriatric residents who want to keep their health as strong as possible.

Intangible Outcomes

Beyond the tangible outcomes that we regularly see in our aquatic therapy patients, we also see intangible results. These characteristically come in the form of confidence and pride, and are a source of great joy to not only the patient, but to the physical therapist and family. After all, the stronger their gait and balance, the more mobility and independence they have. This is critically important to most geriatric patients.

I've enjoyed hearing the shocked reactions to the words, "Guess what, kids? I've been jogging on the treadmill!" Children of elderly patients may not realize that a pool outfitted with an underwater treadmill floor can allow some geriatric clients to jog, or even run, while partially submerged. Our residents also adapt well to the social relationships they develop with other residents who have experienced aquatic therapy. It becomes like a "special club," and they support one another through their rehab, celebrating even the smallest successes along the way.

These emotional and psychological responses to aquatic therapy in our specialized pool are not part of the prescribed expectations; yet they're an essential element of the process. For many geriatric patients, the pool brings an unexpected level of possibilities to the foreground. Not only does it help them improve their quality of life, but gives them a reason to keep striving to get better.

Aquatic Therapy as a Lifestyle

We are fortunate to have our therapy pool at our senior living campus, which gives direct access of the advanced technologies to our residents. As the numbers of geriatric patients increase, one cannot help but hope that these therapy pools will one day be commonplace.

Currently, we are the only community in our area to feature this advancement; chances are good that we will not hold that place forever. Meanwhile, we continue to welcome people who have chosen our facility partially because of this amenity.

Family members of our residents constantly tell us that having the therapy pool on site gives their loved one the opportunity to exercise and stay as fit as possible. Residents frequently tell us that the warm-water pool offers experiences unlike those in typical community pools.

In the end, it's all about helping people. If we can play a part in a person's chance to blow out 80 candles on a birthday cake, we consider our job well done.


1. "Older Americans Month - May 2012." United States Census Bureau. Accessed Sept. 6, 2013 via www.census.gov/newsroom/releases/archives/facts_for_features_special_editions/cb12-ff07.html

2. "American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults." The American Geriatrics Society. Accessed via www.americangeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf

Nick Drey is director of wellness at Walnut Ridge at Clive Senior Community, Clive, IA. He is a certified health fitness specialist by the American College of Sports Medicine and holds a master's degree in exercise science from Wayne State College, Wayne, NE.

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