NEW YORK (Reuters Health) - Physical therapy may help prevent physical declines in older, frail people, study findings suggest.

Lead author Dr. Thomas M. Gill of Yale University in New Haven, Connecticut, said that these results suggest that it is possible for some older people to stave off the disabilities that their weakened state puts them at risk of developing.

"We want to identify older persons who are at risk of being disabled...and try to prevent those outcomes," he told Reuters Health.

Reporting in the October 3rd issue of The New England Journal of Medicine, Gill and his colleagues followed 188 frail patients at least 75 years old, half of whom received a physical therapy program designed to improve their balance, muscle strength and movement.

The remaining patients underwent an educational program, during which healthcare workers visited them and informed them about general health recommendations for the elderly, such as obtaining vaccinations and remaining physically active.

Both programs consisted of home visits by a healthcare worker during the first 6 months, then regular phone calls for an additional 6 months.

The investigators found that patients who completed the physical therapy program reported less disability than their peers at both 7 months and 12 months after the program began.

In an interview with Reuters Health, Gill explained that the physical therapy program may help frail patients prevent disabilities by working on the underlying impairments that both characterize their weakened state and put them at risk of future problems.

For example, he noted, frailty often includes muscle weakness, a symptom that can progress into a serious disability.

However, he added that patients who were very frail at the outset of the program appeared to receive no benefit from physical therapy, and even declined during the program, suggesting that these patients may require a more vigorous type of intervention.

"Our results suggest that our program wasn't sufficient to prevent disability in this group," Gill noted.

Currently, the government health insurance plan Medicare does not cover the cost of home care designed to prevent disabilities in older adults, Gill explained. In the current study, he and his colleagues estimate that the physical therapy program will cost $2,000 per patient. Gill noted that further studies are needed to determine if the benefits of the program--such as reducing the number of days spent in a nursing home or hospital--outweigh its costs.

"It's an uphill battle," Gill noted, describing the difficulties in convincing insurers to cover additional programs. But showing that a relatively inexpensive program may prevent further physical declines "is, I think, a wonderful first step," he added.

The research was funded by the National Institute on Aging, a component of the National Institutes of Health.

SOURCE: The New England Journal of Medicine 2002;347:1068-1074.

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