FEATURE Use it or lose it
Lynda Holt and Professor Brian Dolan OBE of Health Service 360, and hosts of #EndPJparalysis Campaign, offer advice on helping clients to halt the process of deconditioning.
It’s easy to write off deconditioning as inevitable decline associated with old age, yet this is simply not true. We do lose some muscle mass and strength as we age, a condition known as sarcopenia, and this can affect how we move, but research indicates that this muscle loss is between 1-2% a year past the age of 50. Hence, most people might be slower and less strong at 80 than at 50, but in the absence of other medical conditions, you should be able to balance, support your own body weight, walk without aid, and get up out of your chair.
Deconditioning, by contrast, is the catch-all term given to the physical, psychological and social consequences of inactivity and/or lack of social and cognitive stimulation. It is the rapid deterioration in functional ability usually as a result of immobility. This can affect anybody, at any age, of any level of fitness. If you take a break from sport, walking – any physical activity really, it can be hard getting back into it. This is mild deconditioning.
In older people, deconditioning can happen really quickly, 24 hours in bed can reduce muscle power by 2-5% and a week in bed can reduce muscle power by up to 20%. This may be the difference between walking again or not.
We know there are things that accelerate deconditioning. Lack of movement is oſten the primary factor, especially reduced weight bearing, but a lack of cognitive stimulation and social contact both have a significant role too. So, it would be fair to say that the pandemic has created the perfect conditions for deconditioning to thrive.
The harsh reality is that by the time people become residents some degree of deconditioning may already be evident, it may even be the reason they are coming into your care home. Why?
Deconditioning affects most body systems, not just the muscles. The following can occur:
• Loss of muscle strength, poorer balance, loss of flexibility and an increased risk of falls.
• Decreased cardiopulmonary capacity, including decreased cardiac output, faster heart rate, reduced oxygenation of organs, breathlessness, and increased risk of both heart failure and pneumonia.
• Poor appetite and constipation.
• Urinary incontinence and greater risk or urinary tract infection.
• Pressure ulcers and skin damage. • Confusion, memory loss and psychological withdrawal.
Together they result in significant loss of functional ability, difficulty in maintaining activities of daily living, loss of dignity, loss of choice and reduced self-confidence and social withdrawal.
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While, in theory, deconditioning is reversible, most older people never regain their prior functionality aſter becoming deconditioned. This really is a case of prevention being better than cure, especially when that is prevention of further deconditioning.
Helping residents to stay connected with their family and friends and maintain their sense of self has been particularly hard over the last 18 months, in many cases making it more difficult to keep people motivated to stay mobile, mentally active and as independent as possible.
At the risk of stating the obvious, people had lives prior to being residents, oſten full of amazing stories and experiences, things that made them who they are. If you want your deconditioning prevention to work, tap into this – keep people connected with the things that matter to them and that they enjoy. Include things that maintain functional ability, preserve dignity and independence and where possible, create the plan in collaboration with your resident.
There are three main areas to focus on:
Physical activity – this should be a weight bearing activity and function focused, rather than just exercise for its own sake. If you can add value and help your residents with the things that matter to them, they are much more likely to engage – or not resist. Sometimes you have to resist the temptation to ‘help’ by doing something for someone, or wheeling them somewhere because it’s quicker. These kindnesses can have unintentionally harmful consequences.
Cognitive or intellectual stimulation – while this needs to be appropriate to the person’s ability, even the simplest of activities can impact concentration, perceived sense of purpose, and reduce disconnection. Dementia should not be a reason to ignore this; it’s oſten a case of meeting people where they are and doing what you can with them. Activities that can be stopped and started, like simple jigsaws, can sometimes work, as can things like caring for a doll, engaging with animals or nature.
Social interaction – keeping people connected, recognising them for who they are and keeping their experiences alive all help. The single most important part of socialisation is for people to feel purposeful, and that they have contributed, whether that’s to a conversation, to help someone, or to share some wisdom. Including elements of fun and even competition shouldn’t be underestimated.
We are social creatures, we need to belong and, to some extent, fit somewhere. Suddenly finding yourself unable to maintain your independence, perform basic self-care functions, is a massive blow to your sense of who you are. Good deconditioning prevention plans help to create both a sense of purpose and connectedness.
www.tomorrowscare.co.uk
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