Physiotherapist

The physiotherapist’s role in working with an older adult receiving palliative care at the end of life is led by the older adult’s sense of what is important to them to co-create realistic goals and expectations based on their symptoms, their physical performance status, and their psychological adjustment to their condition/diagnosis or in the face of decline and impending death within the context of a therapeutic relationship.

Key points

The physiotherapist liaises within the interprofessional care team to promote best outcomes. Physiotherapists who work with older adults receiving palliative care at the end of life may contribute in numerous ways during end of life:

• Assess therapy needs and appropriate therapeutic interventions. Physiotherapists may use a range of methods to record the assessment outcomes and progress, including:
  • WHO-5 personal well-being
  • Performance-specific tests may or may not be appropriate depending on the older person’s requirements.
• Reassess the older adult’s changing care needs as their condition changes.
  • Measures used to assess performance and quality of life and well-being can be repeated at various time points to evaluate the older person’s progress and needs.

The results of physiotherapy assessment and tests will guide methods of physiotherapy treatment and care. Physiotherapists are well-equipped to advise the older adult, their carers and family on holistic strategies for pain management.

• For people who are weight-bearing and mobile, they may need assessment, advice and/or intervention to improve mobility, promote independence or aid comfortable effort and reduce activity-related fatigue. Such methods may include pain relief using massage, range of motion and/or electrophysical agents (such as hot/cold packs, transcutaneous electrical nerve stimulation (TENS) or photobiomodulation (PBM) therapy, where clinically appropriate), strengthening exercises, or balance training and falls prevention; and / or education to help the older adult manage the physical aspects of daily activities, such as walking and transfers; provision of advice and / or prescription of and / or education regarding physical aids.
• People who are largely confined to bed or a chair may need assessment, advice and/or intervention to promote relaxation, safe bed mobility and comfortable positioning, and safe transfers from bed to chair and return, and avoidance or treatment of pressure injuries. Integration of physical or electrotherapy will also assist with quality of life.

Further services a physiotherapist might provide

Education of residential aged care facility staff, or carers and family

• How to safely exercise, massage, ensure supported positioning to reduce pain and stiffness, conserve energy and increase mobility.
• Ways to best position, move or transfer the older adult, recognising red flags that may be indicative of risk or actual harm (e.g., uncharacteristic pain on movement).
• If appropriate, provides support, education and training to informal carers about manual handling within the home context in order to reduce risk of injury.

Respiratory care

• How to safely exercise, massage, ensure supported positioning to reduce pain and stiffness, conserve energy and increase mobility.
• Ways to best position, move or transfer the older adult, recognising red flags that may be indicative of risk or actual harm (e.g., uncharacteristic pain on movement).
• If appropriate, provides support, education and training to informal carers about manual handling within the home context in order to reduce risk of injury.

Oedema management

Assist with oedema management through positioning, gentle movement exercise, compression, low level laser therapy (photobiomodulation) and lymphoedema massage as indicated:

• Lymphoedema management, additional training required.
• Oral mucositis as a side-effect of head and neck cancer treatment can be effectively treated using photobiomodulation therapy (previously known as low level laser therapy).
• Wounds of many types can be effectively managed using photobiomodulation therapy (previously known as low level laser therapy).