Time to move: Get up, Get Dressed, Keep on moving. Older people, whether in hospitals, care homes or at their own homes, who do not get enough opportunity to mobilize, can have an increased risk of reduced bone mass and muscle strength, reduced mobility, increased dependence, confusion and demotivation. These problems can be attributed to the phenomenon of what can be termed as ‘Deconditioning Syndrome’. This affects well-being as well as physical function and could result in falls, constipation, incontinence, depression, swallowing problems, pneumonia and leads to demotivation, and general decline.
Preventing Deconditioning Syndrome requires a broader strategic approach that includes physical therapy, maintenance of nutrition, medical management, and psychological support including addressing loneliness; essentially addressing elements of the Comprehensive Geriatric Assessment. But, are all health care staff and patients aware of the phenomenon of deconditioning? Are we doing enough to prevent deconditioning? What can be done?
Simple things first:
- We could ensure that glasses and hearing aids are readily available, calendars and clocks are visible to promote awareness, ensure that patients are sat up in chairs, preferably in their own clothes (#endpjparalysis).
- We could ensure that meals are consumed whilst sitting in chairs and not spoon fed in bed unless circumstances dictate so.
- We could encourage patients to wash and dress independently, walk to the toilet where possible, provide appropriate mobility aids earlier on and encourage patients to keep their arms and legs moving in bed or chair.
- We should ask: Is the chair and mobility aids of the right height; is the urinary catheter still required or can it come out? Removing restrictions on visiting hours (John’s campaign) and encouraging normal social interactions will also help to maintain functionality, regain independence and reduce loneliness.
All this will help with “developing a home first mindset ”. Patients need to be supported and encouraged to get moving as quickly as possible, where possible. As leaders it is our role to encourage our staff to in-turn encourage our patients to do what they can. Education of patients, relatives, carers and staff about the dangers of deconditioning is vital, since bed rest continues to be expected during a phase of illness despite the considerable evidence showing potential adverse effects from inactivity.
Of course there are times and conditions when bed rest would be advisable; but more often than not, this is not the case in the strictest terms. Deconditioning can start within hours of immobility. We need to get our patients up as quickly as possible, while being careful not to overload them. Under the guidance of therapists, it can be done by ward based staff- it’s ‘everyone’s business’ to get involved in restoring normalcy.
We need to develop simple exercise models for our ageing population which should be everyone’s business and not just of therapy staff. This may cost more in the short term, but with major long term societal health gains. We have launched a ‘Deconditioning Awareness’ campaign’ . The message is simple: Get, Get Dressed, Keep on Moving. Your muscles, Your strengths, Your abilities: Use Them or Lose them.
There are banners, posters, screensavers, information leaflets, exercise programs, videos and demonstrations to raise awareness and some of these can be accessed here.