BScN, RN, GNC(C) President,
Eldercare Home Health Inc.

Senior rehab

Senior Rehab is essential in helping those who have suffered a set-back, get back on their feet – often literally.

Maybe it’s part of the human condition that we can know so much and yet act so little.

Nowhere was that more apparent than in a hospital family meeting that I attended yesterday.  The Client, age 88 years, was present with her three children and the social worker.

Prior to her hospitalization she had lived independently. In the three weeks she had been in hospital since her heart attack she had barely been out of bed.

This is a huge issue.

Colleen S. Campbell, Geriatric Evaluation & Management Director at the Geriatric Research Education and Clinical Center outlined many of the issues  in her paper; Deconditioning: the consequence of bed rest. 

Deconditioning (disuse) can lead to:

  • Muscle weakness and Atrophy.
  • A 3% loss in muscle mass within thigh muscles within 7 days
  • 3 – 5 weeks of total inactivity can lead to a staggering 50% decrease in muscle strength.
  • Disuse Osteoporosis can result from a lack of weight bearing, gravity and muscle activity.
  • Within 24 hours of bed rest there is an increase in the resting heart rate of 4 – 15 beats per minute. And a 5% decrease in blood volume. An Increase in Orthostatic hypotension can result.
  • Immobility can result in atrophy of the heart muscle
  • Seniors who are left in bed are more likely to suffer from Pressure ulcers, decreased appetite, and constipation.
  • Psychologically immobility can result in depression, loss of motivation and a feeling of helplessness.
  • Increase in Anxiety, fear, and neurosis
  • Decreased concentration and impaired judgement
  • A life threatening Pneumonia can result from the decrease in all pulmonary function parameters.

In short, seniors who become deconditioned because they have been left to languish in bed are more likely to suffer a loss of independence because of their inability to function.

Now back to our meeting….

The social worker explained that the physiotherapist was stretched very thin (no pun intended) and would not likely be in a position to offer much.

Somehow she didn’t appear to be mortified by this.

The family understood that an application had been made to a rehabilitation setting so that this once semi-independent senior could receive senior rehab and return to her home with assistance.

The social worker corrected this impression by stating that the Social Worker who had originally been assigned was no longer on the case. She added that as the new social worker, she was unaware whether the application had been completed or not. (She then felt it was important to inform us that she worked only part time, did not know this Client at all, and that these things were known to move very slowly….no kidding!)

There was no acknowledgement about the negative impact on the Client, no suggestion as to how things could be moved along any faster or how to improve the outcome of the Client’s hospital stay.

There was also an observation that the Client was not eating or drinking well while in hospital. On more than one occasion she was dizzy, tired and weak (see Deconditioning, above).

Those who had seen the hospital meals felt that the poor quality of the meal was partially to blame. Everyone agreed that this might be an issue – no one suggested how to deal with it. (Family could bring in food, meal choices might include sandwiches or other foods that are more agreeable to the Client’s palate, contact the dietitian, allow client have a meal in the cafeteria each day…something-do something!)

Everyone knows that a prolonged hospital stay with these kinds of conditions is not in the best interest of the Client. Everyone agreed that if the Client did not start moving soon, she might permanently lose the ability to do so.  (Essentially use, it or lose it).

And to top it all off,  there seemed to be an error or miscalculation in the application for rehab itself. The application had been made for aggressive rehabilitation, not the slow stream rehabilitation more suited to the Client’s age and frailty. (The wait for aggressive rehabilitation is longer – the social worker said it could be months!).

We insisted that the social worker check the status of the client application for senior rehab while we waited. She returned and told us that all she needed to do now was touch a button to set the slow stream application process in motion – push the button, push the button!

What if the client had not had the benefit of an experience Registered Nurse advocating for her at that meeting?  Would the button have ever been pushed? Why is a previously independent senior left to languish in a bed? Why is there not more urgency to the whole process?

We absolutely know that a person has to eat, drink and move around in order to improve in their general condition. We absolutely know that a lack of nutrition, hydration and movement are debilitating to anyone – never mind a frail senior.

And yet, the lack of action that we saw with this client appears to be more the norm than the exception.

What you can do:

Remember inaction is a decision (today we are not going to do range of motion exercises with Mrs Smith) – In the hospital setting, a person’s condition can  get better or it can get worse. You can make a difference. Decide to act and ask others to act.

Be informed, know what is going on and why, ask questions. Don’t be shy. If the answers you get don’t seem to make sense, ask someone else.

Oh and did I mention, ACT!

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