Prescribing exercise for frail elders.

BACKGROUND: Frail elders often have chronic illnesses, such as osteoarthritis, hypertension, diabetes, and peripheral vascular disease, for which exercise is a proven means of achieving nonpharmacologic benefits, even at advanced age. Exercise has been shown to enhance the quality of life for these elders. METHODS: A literature search of exercise literature applied to older adults and lifestyle modifications was conducted, summarized, and then reviewed with practicing colleagues. RESULTS AND CONCLUSIONS: Exercise continues to be an underused therapeutic intervention for frail elders as a result of barriers created by patients themselves, their caregivers, and their health care providers. Family physicians can overcome these barriers by prescribing appropriate exercises and by tailoring the exercise to the functional needs and preferences of their patients. An exercise prescription for frail elders is based on a pragmatic strategy that makes therapeutic exercise both sustainable and safe. Such a strategy incorporates motivational elements and knowledge of achievable benefits.

The BATHE Method: Incorporating Counseling and Psychotherapy Into the Everyday Management of Patients.

Physicians today are required to do more than ever before; skills that were unnecessary in the past are now "givens." In order for physicians to keep patients well, help them manage chronic problems, and encourage them to adhere to medication regimens, a positive doctor/patient relationship is vital. Establishing patient rapport, obtaining patient trust, and allowing patients to tell their stories show respect and allow a healing partnership. Patients often expect help with emotional as well as physical problems, so it is important to obtain as much information from patients as possible. The BATHE technique is a psychotherapeutic procedure and serves as a rough screening test for anxiety, depression, and situational stress disorders. The BATHE technique consists of 4 specific questions about the patient's background, affect, troubles, and handling of the current situation, followed by an empathic response; the procedure takes approximately 1 minute and must be practiced. Physicians may use the BATHE technique to connect meaningfully with patients, screen for mental health problems, and empower patients to handle many aspects of their life in a more constructive way.