The ageing process and the increased likelihood of a more active older population has implications for the provision of podiatric care that is age specific and age appropriate. Podiatric care is part of the comprehensive primary health care of older persons. Podogeriatrics is a valid subspeciality of podiatric clinical practice, but it is not seen to be professionally challenging as other subspecialities.
In societies that are ageing there is likely to be an increased requirement for Podiatric care of the older person that needs to be reflected in courses of training in podiatric medicine. In a proposal for curriculum content for podiatric medicine, Helfand (2000) suggests the fostering of the following attitudes:
1) Respect and compassion for older persons, particularly in terms of their autonomy and dignity
2) Appreciation of the importance of maintaining and restoring function and quality of life in older adults, especially in those with chronic and incurable conditions
3) Realisation of the importance of family and the entire social network, including the nursing home staff, in patient care
4) Appreciation of the value of an interdisciplinary team approach to patient evaluation and management
However, the increased demand for podiatric services from the aging population may not be as great as previously considered . In this study, the increased age of the population was predicted to increase the demand for podiatric services by a low prediction of 0.8% to a high prediction of 1.6% per year over the 23 years from 1994 to 2016.
Reasons for improving foot health in the older person:
• improve comfort/lessen pain
• keep ambulatory
• decrease risk of further complications
• decrease the risk of institutionalisation/hospitalisation
all these related to quality of life
Most foot problems in the older person are chronic in nature and should be managed like any other chronic health problem, but unfortunately they are still considered by many to be minimal, routine and only a comfort issue. Routine foot care can be defined as ‘cutting and removal of corns or calluses, the trimming of nails and other hygienic and preventative maintenance that might be defined as self care’ – certain of these care procedures can pose a hazard/risk when performed by unqualified persons or when certain systemic diseases are present. Podiatry is essential for adequate and comprehensive health care. The Podiatric management of older persons is more that just the clinical management of foot pathology and making appropriate referrals when needed, it is the involvement in the integrated team management of the patient.
Podiatric management of the older person involves:
• Clinical treatment – pain reduction; foot hygiene prevent infection; footcare and footwear advice; screening
• Entry point to health care system – as see on regular basis role in primary prevention by detecting disease precursors or early signs of systemic disease
• Referral (medical and non-medical)
• Detection of potential drug interactions
• Family, caregiver, long term care staff education
• Routine general ‘check ups’
• Rehabilitation and maintenance of mobility (eg range of motion and muscle strength activities) independence
Gerontology Forum at Podiatry Arena