PREFACE e of this textbook has not changed since the first provide nuance to examination findings or modulate the edition 18 years ago.The editors'intent for undertaking outcomes of intervention.Part IlI provides the scientific andaicnrpPrableeate em ematic o tools to integrate health and functional status informa comes.In the tion with examination data,formulate an accurate diag. next section,the chapters cover some health conditions nosis,and that care settings adults but represent points of of phy informed advocate for older adults.What has changed Thehercapis in rppic ication of rha the original pubication for ened t in Part Finally, section g for the exar ce that can pel or obstruct the ofession's abil to be certified as geriatric clinical specialist as well as ityothe efradph health of the nation:reimbursement and advocacy. mos t gratifyin Geriatri What started as an attempt to update a w nd t ceive th of c ertified the cha atric physical therapyand the area all attest to the fact that physical therapist practice 20 vears The goals which we first described in 1993 and oriented toward ol dults is no onger a ne velty,con epeated the secon edition remain:to denne the sc sis population.On the contrar.griatris physical physical therapist practice in general;and to promote the ion in practice and cuing adoption of evidence-based principles of clinical care e physical therapists to exer hat advanc geriatric physical therapist practice.It is oug from primary prevention to end-of-life care. that we have contributed to this phenomenon. The new edition of Geriatric Physical Therapy has organize cphys Andrew A.Guccione,ThD.DT vers,PT,DPT.PhD ology of disease and disability.Next,our contributors P R E F A C E Although the content of previous editions has been sub￾stantially revised, it is remarkable that the overall pur￾pose of this textbook has not changed since the first edition 18 years ago. The editors’ intent for undertaking the third edition of Geriatric Physical Therapy is to as￾sist the development of reflective physical therapists who can use the available scientific evidence and objective tools to integrate health and functional status informa￾tion with examination data, formulate an accurate diag￾nosis, and design effective treatment plans that can be implemented at all levels of care and across all settings to produce optimal outcomes. We further believe that this practitioner can serve both patients and society as an informed advocate for older adults. What has changed throughout the years is that the original publication was intended only as a textbook for entry-level students. In the intervening years we have expanded the vision of this text to include individuals studying for the examination to be certified as geriatric clinical specialist as well as practicing clinicians. The last group is perhaps the most surprising and the most gratifying. Geriatric physical therapy has come into its own in the last two decades. The emergence of the specialty, the growth of certified specialists, and the number of practicing clinicians in the area all attest to the fact that physical therapist practice oriented toward older adults is no longer a novelty, con￾fined to a few physical therapists whose good hearts and intentions led them to concerns about America’s aging population. On the contrary, geriatric physical therapy is bursting with innovation in practice and cutting edge research that will enable physical therapists to exercise the full range of their education, experience, and exper￾tise across the full continuum of the health care system from primary prevention to end-of-life care. The new edition of Geriatric Physical Therapy has been arranged in six parts. In Part I, we organize the foundational sciences of geriatric physical therapy, which range from basic physiology of aging to clinical epidemi￾ology of disease and disability. Next, our contributors explore the personal and environmental contexts of ex￾amination and intervention, particularly as these factors provide nuance to examination findings or modulate the outcomes of intervention. Part III provides the scientific basis for evaluation and diagnosis of prototypical health conditions and patient problems that are emblematic of geriatric physical therapy as well as the design of plans of care for effective treatment and optimal outcomes. In the next section, the chapters cover some health conditions that are not common to the entire population of older adults but represent points of substantial health impact requiring specific expertise to be addressed effectively. The practice of physical therapists in our application of specific education, experience, and expertise in the health problems of older adults across spectrum of healthcare delivery is presented in Part V. Finally, the last section tackles the societal issues affecting physical therapist practice that can propel or obstruct the profession’s abil￾ity to address the health of older adults and optimize the health of the nation: reimbursement and advocacy. What started as an attempt to update a well-received resource was infused with a new vision and turned into a substantial revision to reflect the changes in geri￾atric physical therapy and the profession itself in the last 20 years. The goals which we first described in 1993 and repeated in the second edition remain: to define the sci￾entific basis of physical therapy; to describe how physi￾cal therapist practice with older adults differs from physical therapist practice in general; and to promote the adoption of evidence-based principles of clinical care that advance geriatric physical therapist practice. It is clear now that the best scientific thoughts are being translated into clinical actions. We are pleased to think that we have contributed to this phenomenon. Andrew A. Guccione, PT, PhD, DPT, FAPTA Rita A. Wong, EdD, PT Dale Avers, PT, DPT, PhD ix