Geriatric physiotherapy on the CPTE is not simply "treating older adults." The domain has its own clinical reasoning framework — one that accounts for multi-morbidity, polypharmacy, cognitive status, social determinants, and the interaction between ageing physiology and rehabilitation goals. Candidates who approach geriatric questions with general clinical knowledge often apply the right technique to the wrong priority.
This guide covers the three areas that appear most consistently in CPTE geriatric questions: fall prevention and risk, frailty syndrome, and dementia care. Sources referenced include Osteoporosis Canada, Canadian Geriatrics Society, and the American Geriatrics Society Beers Criteria, which is referenced in Canadian geriatric pharmacology literature.
Fall prevention — the highest-yield geriatric topic
Falls are the leading cause of injury-related hospitalizations and death in Canadian adults over 65. Physiotherapists have a central role in fall risk assessment and prevention, and CPTE cases test this both in the Written section (outcome measure selection, exercise prescription) and the Oral section (home assessment, interprofessional coordination, patient communication).
Fall risk assessment — the tools you need to know
Timed Up and Go (TUG): The patient rises from a standard chair, walks 3 metres, turns, walks back, and sits. Time is recorded in seconds. A TUG greater than 12 seconds is associated with elevated fall risk in community-dwelling older adults. A TUG greater than 20 seconds indicates high fall risk and dependence in mobility. The TUG is the most widely used, quickest clinical fall risk screen in Canadian physiotherapy practice.
Berg Balance Scale (BBS): A 14-item observational assessment of static and dynamic balance, maximum score 56. A score below 45 indicates elevated fall risk. Below 36, fall risk is high. The BBS is particularly useful for tracking change over time in a rehabilitation program.
30-Second Sit-to-Stand Test: Counts how many times the patient can rise from a chair to full standing in 30 seconds. Below age-specific normative values indicates lower limb weakness and fall risk.
Four Stage Balance Test (Romberg and tandem variants): Progressively challenging static balance — feet together, semi-tandem, tandem, single leg. Used in primary care screening.
Home assessment: The CPTE expects you to know that fall risk is also an environmental and contextual issue. A home visit to assess lighting, floor surfaces, bathroom rails, stairs, and footwear is a component of comprehensive fall prevention — not just exercise.
Fall prevention interventions — what the evidence says
The strongest evidence for fall prevention in community-dwelling older adults comes from exercise programs that include:
- Balance training — static and dynamic, progressive challenge
- Progressive resistance training — targeting lower limb strength
- Functional movement practice — sit-to-stand, stepping, stair training
Tai Chi has strong evidence specifically for fall prevention in community-dwelling older adults (multiple Cochrane-level reviews). It improves balance, coordination, and fall self-efficacy.
In long-term care, multicomponent exercise (balance + resistance + functional walking, ≥3 times per week) has the strongest evidence. Individual exercise programs for LTC residents must be adapted to frailty level.
CPTE exam pattern: Questions frequently present a community-dwelling older adult with multiple fall risk factors and ask you to identify the most appropriate intervention strategy. The answer that includes both exercise and environmental modification, with referral to OT for home hazard assessment, is almost always more complete than exercise alone.
Polypharmacy and falls
The CPTE expects you to recognize that medications contribute significantly to fall risk in older adults. The American Geriatrics Society Beers Criteria identifies medication classes that are potentially inappropriate for older adults, including:
- Z-drugs and benzodiazepines (e.g., zopiclone, lorazepam) — sedation, impaired balance, prolonged half-life in older adults
- Anticholinergic drugs — confusion, sedation, orthostatic hypotension
- Antihypertensives — orthostatic hypotension, especially on rising
- Opioids — sedation and balance impairment
- Antipsychotics — muscle rigidity, sedation, gait impairment
When a geriatric patient presents with unexplained falls or functional decline during a PT session, medication review (communicated to the prescribing physician) is within the physiotherapist's Collaborator role.
Frailty — the clinical syndrome that changes rehabilitation goals
Frailty is a clinical syndrome of reduced physiological reserve that increases vulnerability to adverse outcomes (falls, hospitalizations, disability, mortality) with minor stressors. It is distinct from normal aging, from disability, and from comorbidity — though it frequently co-occurs with both.
The Frailty Phenotype (Fried criteria)
The Fried phenotype defines frailty by five criteria:
- Unintentional weight loss (>4.5 kg in the past year)
- Self-reported exhaustion
- Weakness (reduced grip strength)
- Slow walking speed
- Low physical activity
- 0 criteria: Robust
- 1–2 criteria: Pre-frail
- 3–5 criteria: Frail
The Clinical Frailty Scale (CFS)
The CFS is a 9-point scale (1 = very fit; 9 = terminally ill) used in clinical and research settings. It is pictorial and narrative-based, allowing quick clinical classification. In the CPTE, the CFS is referenced in complex geriatric cases to indicate how much the patient's physiological reserve will affect their rehabilitation trajectory and prognosis.
What frailty means for physiotherapy
Frailty changes rehabilitation in specific ways:
- Lower starting intensity and shorter session duration: Frail patients fatigue more rapidly and recover more slowly
- Higher fall and adverse event risk during exercise: Supervision and modified equipment are more important
- Multi-domain assessment required: Frailty is not managed by PT alone — nutritional status, social support, medications, and cognitive status are all relevant
- Goal calibration: With advanced frailty, goals may focus on maintaining function rather than restoring it. Communicating realistic prognosis with compassion is a scored Oral section behaviour
Reversibility: Pre-frailty and mild frailty are partially reversible with exercise and nutrition. Progressive resistance training and protein supplementation (in combination) have the strongest evidence for attenuating frailty progression.
Dementia — consent, assent, and person-centred care
Dementia in physiotherapy practice raises specific ethical and clinical challenges that the CPTE — particularly the 2026 Oral section — tests explicitly.
Types of dementia relevant to the CPTE
- Alzheimer's disease: Most common form. Progressive memory loss, eventually all cognitive functions. Cardinal feature: episodic memory loss early; executive dysfunction later.
- Vascular dementia: Second most common. Stepwise progression, often with a history of stroke or cardiovascular disease. Cognitive profile depends on which brain areas have been affected.
- Lewy body dementia: Prominent features include hallucinations, fluctuating cognition, REM sleep behaviour disorder, and parkinsonism. Highly sensitive to antipsychotic medications — the CPTE may test your awareness of this.
- Frontotemporal dementia: Personality and behaviour changes precede memory loss in many cases. Younger age of onset than Alzheimer's.
Consent and assent in dementia
A patient with dementia may lose capacity for formal healthcare decision-making as the disease progresses. But loss of formal capacity does not eliminate the obligation to involve the patient in their care.
Capacity is decision-specific and fluctuates in dementia. A patient may lack capacity to consent to a complex surgical procedure but retain capacity to consent to a physiotherapy exercise session. Assess capacity for each decision.
Assent — the patient's expressed willingness to participate — is ethically significant even when formal consent comes from a substitute decision-maker (SDM). If a patient with dementia consistently resists an intervention (turning away, vocalizing distress, refusing to cooperate), the physiotherapist has an ethical obligation to pause, reassess, and find alternatives — not to proceed on the basis of the SDM's consent alone.
The 2026 CPTE Oral section will test this: a station may present a dementia patient with documented SDM consent who is resisting treatment. The correct response is to respect the assent refusal, communicate to the team, and explore person-centred alternatives — not to proceed because "the family said it's okay."
Communication strategies with dementia patients
The CPTE Communicator role in dementia cases:
- Use the patient's preferred name
- Speak slowly, with short sentences and simple vocabulary
- Give one instruction at a time
- Use demonstration alongside verbal instruction
- Maintain eye contact and a calm, warm tone
- Never argue, correct aggressively, or use logic to dispute a misperception — redirect instead
- Involve family in education only with the patient's prior consent (if capable) or as appropriate to their SDM role
At PhysioExamPrep, the Geriatrics chapter includes fall risk assessment tools, frailty syndrome management, dementia care principles, polypharmacy awareness, and scenario-based questions covering all areas above. The Oral section includes cases specifically designed around geriatric ethical and communication challenges.
Sources: Osteoporosis Canada fall prevention guidelines; Canadian Geriatrics Society; Fried Frailty Phenotype (Fried et al., 2001); Clinical Frailty Scale (Rockwood et al.); AGS Beers Criteria 2023.