Maintaining and impr oving mobility in long- te r m c ar e home - - PowerPoint PPT Presentation
Maintaining and impr oving mobility in long- te r m c ar e home s Caitlin Mc Ar thur , PhD, MSc PTBSc (KIN) Re g iste re d Physic al T he rapist and Po st-Do c to ral F e llo w, Ge riatric E duc atio n and Re se arc h in Ag ing Sc ie
Caitlin Mc Ar thur , PhD, MSc PTBSc (KIN)
Re g iste re d Physic al T he rapist and Po st-Do c to ral F e llo w, Ge riatric E duc atio n and Re se arc h in Ag ing Sc ie nc e Ce ntre (GE RAS), Mc Maste r Unive rsity
F e br uar y 22, 2018
mc a rthurc @ hhsc .c a @ Mc ArthurCa itlin
e xpe rie nc e s in L T C
T his we b inar is b e ing funde d b y the Ontario Go ve rnme nt thro ug h the Ce ntre fo r L e arning , Re se arc h and I nno vatio n in L
e rm Care (CL RI ) ho ste d at the Sc hle g e l-UW Re se arc h I nstitute fo r Ag ing as part o f a fre e we b inar se rie s to impro ve q uality o f c are in Ontario lo ng -te rm c are ho me s. T he vie ws e xpre sse d in the we b inar do no t ne c e ssarily re fle c t tho se o f the Go ve rnme nt o f Ontario .
K a te Duc a k, MA, CPG
Ca itlin Mc Arthur, PhD, MSc PTBSc (K I N) mc a rthurc @ hhsc .c a @ Mc ArthurCa itlin
E . Othe r (L T C sta ff o r le a de rship, e duc a to rs, re se a rc he rs, e tc )
Wha t se c to r do yo u wo rk in the ma jo rity o f the time ?
OR
I
f yo u a re a re side nt o r fa mily me mb e r, whe re do yo u live o r whe re do yo u visit?
E . Othe r (c o mple x c o ntinuing c a re , e tc )
re side nt mo b ility
pra c tic e in lo ng -te rm c a re ho me s
c o g nitive a b ilitie s.
T C ho me s in Onta rio :
77 477 lo ng -sta y b e ds, 617 c o nva le sc e nt b e ds, 355 re spite b e ds
fa c ilitie s, like L T C
he Onta rio g o ve rnme nt ha s pla ns to a dd 5000 mo re L T C b e ds o ve r 4 ye a rs
http:/ / www.c b c .c a / ne ws/ c a na da / ha milto n/ se nio rs-a nno unc e me nt-1.4390828 https:/ / www.o ltc a .c o m/ o ltc a / OL T CA/ L
e rmCa re / OL T CA/ Pub lic / L
e rmCa re / F a c tsF ig ure s.a spx# L
te rm%20c a re %20ho me %20pro vinc ia l%20a nd%20L HI N%20da shb o a rds%20(Oc to b e r%202016)
e xpe rie nc e d a stro ke
T C ha ve so me de g re e o f c o g nitive impa irme nt
95% o f re side nts re q uire so me a ssista nc e with a c tivitie s o f da ily living (ADL
s)
mo re tha n 80% re q uire e xte nsive c a re On a ve ra g e spe nd thre e q ua rte rs o f the ir wa king time in se de nta ry a c tivitie s
Hirde s e t a l. Canadian Jo urnal o n Ag ing . 30.3 (2011): 371-
De So uto Ba re tto e t a l. J Am Me d Dir Asso c . 2016, 381-392.
De So uto Ba re tto e t a l. J Am Me d Dir Asso c . 2016, 381-392.
De So uto Ba re tto e t a l. J Am Me d Dir Asso c . 2016, 381-392.
Crocker T, et al. Age Ageing. 2013;42(6):682-688.
2012 Co c hra ne re vie w:
the e vide nc e surro unding e xe rc ise to pre ve nt fa lls in L
T C wa s inc o nsiste nt a nd did no t de mo nstra te a n o ve ra ll b e ne fit.
e xe rc ise pro g ra mme s ma y inc re a se the risk o f fa lling fo r fra ile r re side nts, b ut re duc e the risk
inte rve ntio ns ta rg e ting multiple risk fa c to rs ma y b e e ffe c tive – spe c ific a lly g a it, b a la nc e ,
a nd func tio na l tra ining
2013 syste ma tic re vie w b y Silva e t a l.:
c o mb ine d e xe rc ise pro g ra ms (i.e ., multiple type s o f e xe rc ise ) tha t inc lude b a la nc e ta sks,
a re c o mple te d fre q ue ntly (2-3 time s pe r we e k), a nd o ve r a lo ng -te rm (g re a te r tha n 6 mo nths) we re mo st e ffe c tive a t pre ve nting fa lls.
Ca me ro n ID e t a l. Co c hrane Datab ase Syst Re v. 2012;12. Silva RB e t a l. J Am Me d Dir Asso c . 2013;14(9):685-689.e 2. do i:10.1016/ j.ja mda .2013.05.015. Stub b s B e t a l. Maturitas. 2015;81(3):335-342. do i:10.1016/ j.ma turita s.2015.03.026. Pa pa io a nno u A e t a l. Can Me d Asso c J. 2015;187(15):1135-1144. do i:10.1503/ c ma j.141331. She rring to n C e t a l. . Br J Spo rts Me d. Oc to b e r 2016. do i:b jspo rts-2016-096547 [pii].
2015 umb re lla re vie w b y Stub b s e t a l.:
multifa c to ria l inte rve ntio ns we re the mo st e ffe c tive a t pre ve nting fa lls in L
T C
2015 re c o mme nda tio ns fo r fra c ture pre ve ntio n in L
T C:
b a la nc e , stre ng th, a nd func tio na l tra ining sho uld b e inc lude d fo r re side nts who a re no t a t a
hig h risk o f fra c ture , while fo r tho se a t hig h risk, e xe rc ise sho uld b e pro vide d a s pa rt o f a multifa c to ria l fa lls pre ve ntio n inte rve ntio n.
2016 syste ma tic re vie w b y She rring to n e t a l.:
the re wa s no e vide nc e tha t e xe rc ise a s a sing le inte rve ntio n c a n pre ve nt fa lls fo r re side nts in
L T C.
Ca me ro n ID e ta l. Co c hrane Datab ase Syst Re v. 2012;12. Silva RB e t a l. J Am Me d Dir Asso c . 2013;14(9):685-689.e 2. do i:10.1016/ j.ja mda .2013.05.015. Stub b s B e t a l. Maturitas. 2015;81(3):335-342. do i:10.1016/ j.ma turita s.2015.03.026. Pa pa io a nno u A e t a l. Can Me d Asso c J. 2015;187(15):1135-1144. do i:10.1503/ c ma j.141331. She rring to n C e t a l. . Br J Spo rts Me d. Oc to b e r 2016. do i:b jspo rts-2016-096547 [pii].
He witt, J. e t a l. 2018). Jo urnal o f the Ame ric an Me dic al Dire c to rs Asso c iatio n.
individua lly pre sc rib e d pro g re ssive re sista nc e tra ining plus b a la nc e tra ining Gro up se tting 2x/ we e k, 1 ho ur se ssio n fo r 25 we e ks – fo llo we d b y a ma inte na nc e pro g ra m
fo r 6 mo nths
Re sults:
De c re a se d fa lls (142 vs. 277) a nd fa ll ra te (1.31 vs. 2.91 fa lls pe r pe rso n-ye a r) Simila r numb e r o f fa ll re la te d fra c ture s b e twe e n g ro ups (5 vs. 6) Pa rtic ipa nts who a tte nde d mo re tha n 30 ho urs o f tra ining sa w impro ve me nt in fa lls
He witt, J. e t a l. 2018). Jo urnal o f the Ame ric an Me dic al Dire c to rs Asso c iatio n.
Cro c ke r T e t a l. Co c hrane datab ase Syst Re v. 2013;2:CD004294. Pa pa io a nno u A e ta l. Can Me d Asso c J. 2015;187(15):1135-1144. do i:10.1503/ c ma j.141331. Je nse n J, L undin-Olsso n L e t a l. Ann I nte rn Me d. 2002;136(10):733-741. Be c ke r C e t a l. J Am Ge riatrSo c . 2003;51(3):306-313. do i:jg s51103 [pii]. Hua ng T
e t a l. Ag ing Me nt He alth. 2016;20(1):2-12. do i:10.1080/ 13607863.2015.1020411.
de So uto Ba rre to P e t a l. J Am Me d Dir Asso c . 2016;17(5):381-392. do i:10.1016/ j.ja mda .2016.01.021 [do i].
Cha lle ng ing :
o ne to two se ts o f 6 to 8 (13 to 15) re pe titio ns b e fo re b e ing fa tig ue d Re side nts who a re pa rtic ula rly de c o nditio ne d ma y ne e d to b e g in with lo we r
inte nsity stre ng th e xe rc ise s (e .g ., o nly do o ne se t, with a lo we r re sista nc e a nd pro g re ss to a hig he r re sista nc e )
Pro g re ssive :
Pro g re ssio n c o uld inc lude inc re a sing the numb e r o f se ts (e .g ., inc re a se fro m o ne
to two se ts), the re sista nc e (e .g ., ho lding dumb b e lls while sq ua tting ), o r the inte nsity o f the e xe rc ise (e .g ., sq ua t lo we r o r fa ste r)
de So uto Ba rre to P e t a l. J Am Me d Dir Asso c . 2016;17(5):381-392. do i:10.1016/ j.ja mda .2016.01.021 [do i].
1. E xte rna l re sista nc e 2. Bo dy we ig ht
1. re duc ing the b a se o f suppo rt 2. sta nding witho ut using a rms fo r suppo rt o r re duc ing re lia nc e o n the uppe r limb s fo r suppo rt 3. mo ving the c e ntre o f g ra vity a nd c o ntro l b o dy po sitio n
https:/ / c a re ho me sto da y.c o .uk/ o lde r-pe o ple -a rthritis-ne e d-45-minute s-e xe rc ise -pe r-we e k-ma inta in-mo b ility/ http:/ / sta rtmo ving sta rtliving .c o m/ 2014/ 12/ ho w-muc h-do e s-physic a l-a c tivity-he lp-ma inta in-mo b ility-in-o lde r-a dults/
xe rc ise s tha t no tic e a b ly inc re a se he a rt ra te a nd re spira tio n, witho ut b re a thle ssne ss o r undue fa tig ue
1-4 fo r ve ry vulne ra b le pe o ple , o r just b e g inning to e xe rc ise 5-6 ma in ta rg e t 7-9 ma y re q uire c lo se r mo nito ring Sitting All o ut e ffo rt
de So uto Ba rre to P e t a l. J Am Me d Dir Asso c . 2016;17(5):381-392. do i:10.1016/ j.ja mda .2016.01.021 [do i].
stro ke , Pa rkinso n’ s dise a se , multiple sc le ro sis)
impa irme nts (e .g ., he miple g ia , dro p fo o t, fre e zing g a it)
xa mple : He miple g ia - c a nno t fully a c tiva te the musc le s o f o ne a rm
Sug g e stio n: do re sista nc e e xe rc ise s with a dumb b e ll o n the func tio ning side a nd
a c tive a ssiste d ra ng e o f mo tio n (i.e ., the e xe rc ise pro vide r a ssists the re side nt to a c hie ve full ra ng e o f mo tio n a g a inst g ra vity) o n the he mipa re tic side .
xa mple : Pa rkinso n’ s dise a se - fre e zing g a it
Sug g e stio n: visua l o r rhythmic a l ve rb a l c ue s to b e a b le to a c c o mplish sta nding
b a la nc e ta sks suc h a s a lte re d wa lking pa tte rns (e .g ., wide o r na rro w ste pping ).
McArthur C, Giangregorio LM. (2018) Journal of Clinical Outcomes Management. 25 (1): 28-38.
Clic k the link to watc h the Mo difying E xe r c ise s fo r Re side nts Who Can’t Stand vide o http:/ / www.ge r asc e ntr e .c a/ ltc - se r ie s T his vide o will be available the we e k of Mar c h 5, 2018.
Re sult o f: stro ke , de pre ssio n, tra uma tic injurie s, me dic a tio ns, Pa rkinso n’ s a nd
Alzhe ime r’ s dise a se
Hirde s e t a l. Can J Ag ing . 2011; 30(3), 371-390 Pa tte rso n e t a l. Alzhe ime r’ s De me nt. 2007;3(4):341-347. https:/ / kids.na tio na lg e o g ra phic .c o m/ e xplo re / sc ie nc e / yo ur-a ma zing -b ra in/
re side nts with c o g nitive impa irme nt c a nno t b e ne fit fro m e xe rc ise b e c a use the y c a nno t le a rn ne w skills a nd ha ve diffic ulty fo llo wing dire c tio ns. e vide nc e sug g e sts tha t e xe rc ise c a n impro ve func tio na l mo b ility fo r re side nts with c o g nitive impa irme nt ma y re q uire a diffe re nt a ppro a c h b e c a use o f diffic ulty fo llo wing multi-ste p dire c tio ns, re spo nsive b e ha vio urs, o r inc re a se d distra c tib ility
McArthur C, Giangregorio LM. (2018) Journal of Clinical Outcomes Management. 25 (1): 28-38.
Appro a c h the pe rso n fro m the fro nt Whe n g re e ting the re side nt sta nd in fro nt o f the m. I de ntify yo urse lf Be fo re sta rting the e xe rc ise s, intro duc e yo urse lf a nd sa y why yo u a re the re : “He llo , I ’ m Caitlin and I ’ m he re to do so me e xe rc ise s with yo u.” Ma inta in e ye c o nta c t Whe n de sc rib ing the e xe rc ise a nd g iving fe e db a c k, ke e p lo o king a t the re side nt. Addre ss the re side nt b y na me Use the re side nt’ s na me whe n de sc rib ing the e xe rc ise : “Bo b , I want yo u to stand up.”
McArthur C, Giangregorio LM. (2018) Journal of Clinical Outcomes Management. 25 (1): 28-38. Alzheimer Society of Ontario. Rethink Dementia. http://rethinkdementia.ca/. Accessed September 18, 2017.
Re pe a t o r re phra se the re side nt’ s re spo nse s to c la rify wha t the y a re trying to te ll yo u “T hat e xe rc ise made my le g s fe e l wo b b ly.” “Did that e xe rc ise g ive yo ur le g s a wo rko ut? ” Ask “ye s” o r “no ” q ue stio ns a nd a llo w time fo r a re spo nse “Jim, are yo u fe e ling o k? ” inste a d o f “Jim, ho w do yo u fe e l? ” Use g e sture s to b a c k up yo ur wo rds De mo nstra te the e xe rc ise a s we ll a s de sc rib e it.
McArthur C, Giangregorio LM. (2018) Journal of Clinical Outcomes Management. 25 (1): 28-38. Alzheimer Society of Ontario. Rethink Dementia. http://rethinkdementia.ca/. Accessed September 18, 2017.
L iste n a c tive ly, a c kno wle dg e the ir e mo tio na l sta te Ac kno wle dg e the re a so ns fo r why a re side nt ma y no t wa nt to e xe rc ise a nd pro vide a n a lte rna tive : Ca itlin: “Mary, I ’ m Caitlin. I ’ m he re to do e xe rc ise s with yo u to day.” Ma ry: “I do n’ t want to e xe rc ise , I am to o tire d rig ht no w.” Ca itlin: “I unde rstand yo u are tire d rig ht no w. May I c o me b ac k late r? ” L e t the re side nt kno w if yo u a re g o ing to to uc h the m to pre ve nt sta rtling L e t the re side nt kno w yo u a re g o ing to g ive the m ha nds o n fe e db a c k: “I re ne , I ’ m g o ing to mo ve yo ur arm to the side .”
McArthur C, Giangregorio LM. (2018) Journal of Clinical Outcomes Management. 25 (1): 28-38. Alzheimer Society of Ontario. Rethink Dementia. http://rethinkdementia.ca/. Accessed September 18, 2017.
Clic k the link to watc h the Wo r king with Re side nts with De me ntia o r Co gnitive Impair me nt vide o http:/ / www.ge r asc e ntr e .c a/ ltc - se r ie s T his vide o will be available the we e k of Mar c h 5, 2018.
xe rc ise is a n impo rta nt pa rt o f a multifa c to ria l stra te g y to ma inta in a nd impro ve mo b ility fo r re side nts in L T C
xe rc ise sho uld b e do ne a t le a st twic e a we e k fo r 35 to 45 minute s
impa irme nts