By Lynda Holt, CEO of Health Service 360 (www.healthservice360.co.uk)
Without dwelling on the pandemic, it feels like 2020 changed everything in the care world. Carers, health professionals and volunteers gave relentlessly, often in scary and difficult circumstances, and sometimes with little thanks.
The pandemic has also created the perfect conditions for physical and psychological deconditioning to thrive. The impact of isolation, social distancing, restrictions on visitors and changes to the way care is delivered have all made it more difficult to prevent deconditioning in care homes.
While there may be a sense of urgency around how we stem deconditioning, the conversation is certainly not a new one, we have been considering the dangers of immobility for over 70 years. But we have a challenge; the evidence may be there, but our emotional desire to help, to care for people, hasn’t quite caught up.
The bad news is there isn’t a clear set of early warning signs, we are all at risk if we don’t move – I bet if you think about a period of inactivity, or not going to the gym, not playing your favourite sport, it’s hard work getting back into it, isn’t it? That is a very mild form of deconditioning.
We know there are circumstances that exacerbate deconditioning such as lack of movement, particularly weight bearing, lack of cognitive stimulation and lack of social contact. We have to make these our early warning signs, or if you like, our prevention triggers.
One of the challenges we face is that early signs of deconditioning are often written off as inevitable old age. We lose muscle mass as we age which results in a loss of strength of around 1-2% a year, and when you are over 75, immobility rapidly accelerates this, creating a spiral of decline. Yet deconditioning is often not considered until reduced functional ability is evident.
Let’s look a little deeper into deconditioning.
Deconditioning is the term given to the physical, psychological and social consequences of inactivity and/or lack of social and cognitive stimulation. The following occurs:
• Loss of muscle strength, poorer balance and increased risk of falls
• Decrease in cardiopulmonary capacity – including breathlessness and heart failure
• Difficulty in maintaining daily living activities, functional mobility, dignity and choice
• Lethargy, constipation, incontinence, poor appetite
• Confusion and memory loss, leading to reduced self-confidence and withdrawal from social interaction.
In older people this can happen really quickly – 24 hours in bed can reduce muscle power by 2-5%, and in 7 days up to 20%, mostly in lower limbs which may be the difference between being able to walk or not. We know prevention is much more effective than treatment, and while deconditioning is, in theory, reversible, most older people do not regain their prior functionality and independence.
We need to be proactive in our prevention strategies, with an individualised focus on what is important to the resident, maintaining functional ability, and preserving independence and dignity. There are three areas to focus on:
1. Physical activity
2. Cognitive or intellectual stimulation
3. Social interaction
This is not about exercise or activity for its own sake, it’s about adding value, helping residents with the things that matter to them, and having some fun along the way.
There are a few things which might seem obvious but are worth a mention; ensure people have the equipment they need, from glasses and hearing aids through to well-fitting footwear, sticks, frames, that they are hydrated and don’t have health contraindications and that there is appropriate supervision. When it comes to exercise, resistance and gravity exercises are the most effective.
A final word on fun. Add a bit of competition and you could well tick all three of the above. Having run many #EndPJParalysis Challenges and activities like ‘pimp my zimmer’, creating a little competitiveness between units, care homes or individuals increases engagement and commitment while also preventing deconditioning.
The #EndPJparalysis campaign (link: www.endpjparalysis.org/join) is a global social movement committed to reducing deconditioning by sharing best practice, research and expert talks. It is hosted by Lynda Holt & Professor Brian Dolan OBE