An unknown author once said, "Age is no barrier. It's a limitation you put on your mind." Although this may be true in certain instances, there are very real barriers that exist when attempts to provide appropriate healthcare services to the older adult with a variety of health conditions are made. Some barriers are recognized as internal and manifest themselves in statements such as "I'm too old" or simply "I can't do it." Others are more external and present themselves as unavailable funds or decreased access to care. Recognition of existing barriers to healthcare and treatment, whether internal or external, is a necessary first step to overcoming them. Overcoming barriers allows older adults access to facilities, equipment, and the means for having a healthier lifestyle.

In the following articles, barriers to exercise, care, and equipment are addressed from the perspectives of proper evaluation, participation, and healthcare access. Janice Pitts, PT, PhD, addresses holistic care of the older adult from the perspective of spirituality. She presents us with the viewpoint that proposes the teaching of spirituality in physical therapy curriculums so as to be better prepared to address the spiritual needs of older adults. Dr Pitts takes a unique look at how physical therapy faculty and practitioners may be barriers to incorporating this concept into the education of future physical therapy professionals.

In the article "Barriers to Exercise Scale for Chinese Older Adults" by Kee-Lee Chou et al, psychometric properties as well as a factor analysis of the Chinese Barriers to Exercise Scale (CBE) were explored as a way to identify exercise behaviors in a sample of older adults living in Hong Kong. These authors identified several factors within the CBE that measure both structural and personal barriers to exercise and suggest the CBE as a reliable and valid scale for use in the Chinese older adult. In addition, Chou et al suggest a mediating effect of self-efficacy on quantity of exercise participation.

Bernadette Williams, PT, DSc, GCS, et al offer a unique perspective of the older adult by addressing participation and walking goal achievement in a sample of African American postmenopausal women. In their article, "The Relationship Between Achievement of Walking Goals and Exercise Self-Efficacy in Postmenopausal African American Women," the concept of self-efficacy as it relates to exercise is explored.

The article "A Pilot Community-Based Walking-for-Exercise Program for Senior Women" speaks to the barriers to achieving safe and optimum levels of physical activity via a walking for exercise program. The authors Keiba Shaw, PT, MPT, MA, EdD, and Catherine Page, PT, PhD, discuss the availability and use of assistive devices and the feasibility of implementing a minimally supervised walking program in older community-dwelling adult women. In addition, these authors utilized the Yale Physical Activity Survey for Older Adults to determine level of energy expenditure as a result of participation in a walking for exercise program for older women.

Four select barriers that impede access to prosthetic care are highlighted in the article "Barriers to the Provision of Prosthetic Services in the Geriatric Population," by M. Jason Highsmith, PT, DPT, CP, FAAOP. With so many older adults receiving lower extremity amputations for a multitude of reasons, proper components, fit, and care are essential for contributing overall quality of life. Dr Highsmith comments on the unavailability of components for the geriatric client, reimbursement issues, aging in the geriatric amputee, and the paucity of research involving the older amputee.

In the article entitled "Barriers Limiting the Geriatric Client From Accessing Orthotic Care," Jason Kahle, CPO, et al highlight the difficulties encountered by orthotists in accessing the geriatric client to evaluate and prescribe proper orthotics for identified problems. These barriers range from issues related to referral to poor reimbursement for services rendered and financial woes on the part of the patient. Kahle et al give us a unique perspective of the challenges faced from the eyes of an orthotist working in conjunction with the physician, physical therapist, patients, and their families.

Finally, in the article by Jacqueline Lovejoy Osborne, PT, DPT, GCS, entitled "Physical Therapy Services for the Elderly: Barriers to Access in Rural America," the predicament of the elderly living in rural America is underscored. Dr Lovejoy Osborne speaks to extrinsic and intrinsic barriers that often preclude older adults living in rural areas from obtaining needed physical therapy services. She examines healthcare policy, technological disadvantages, and financial challenges that rural older adults may encounter when attempting to gain access to these services.

This issue of Topics in Geriatric Rehabilitation should be interesting and revealing and will provide the reader with an abundance of information regarding the challenges encountered by older adults of varying cultural and situational backgrounds.

Keiba L. Shaw, PT, EdD

Issue Editor