I am currently completing my gerontology placement at an outpatient day-hospital where most of the patients are at risk of falling or have balance problem. I have started to treat patients under supervision. I found some interesting information to share with you in terms of patients’ cultural background for balance issues.
77 year old Malaysian lady was assessed in the falls clinic. She tells a fall-specialist she remains independent in her activities of daily living. She is living in a two storey home and is a non-drinker and non-smoker. The main problem is a two-year history of gradual decline in balance and gait. This is associated with her complaint of numbness in her bilateral fore foot. It is not associated with history of stroke, TIA or onset of arthritis, or leg weakness. Her performance deteriorates on uneven surface and there is a concern that she is thrown off balance by her small dog which she continues to walk with on a daily basis. Moreover, her gait seemed abnormal. She seemed off balance when initially standing and when turning. However, there was no evidence of tremor or cogwheel rigidity. She reports she does not understand why she needs to come to see physio and she does not feel she has any problem with her balance and gait.
Overall, as far as I am concerned, her balance is not as sever as other patients in my placement. Here is my question in terms of clinical decision whether she can be discharged after first session of physio treatment. Do we need to see her more to prevent further deterioration, even though her level is good enough to be discharged.
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Hmm, a tricky one with a few issues. I suppose if I had to plan this kind of discharge I would ask myself if I thought the patient did have a balance problem which required physio. If I thought she did, I would ensure she clearly understood the potential benefits of physio and what contribution on her behalf would be required. Then I would leave it up to her to make the decision. We cannot force people to participate and treating someone who is reluctant is probably not going to be very effective.
Also, this patient may have better balance than other patients who attend the same facility, but it sounds as if her lifestyle depends on her balance being of a high level. The other issue is that of her sensory deficits. I suppose it would be worth ensuring this was under medical investigation.
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