Mobility Decline Prevention

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Modules - Mobility Decline Prevention

FREQUENTLY ASKED QUESTIONS


Many of our residents cannot walk but could get around in their wheelchairs more than they do. How can we encourage residents to propel their wheelchairs more? (Back to top)

    Of the estimated 1.8 million nursing home residents in the United States, more than half are incapable of independent ambulation. For these residents, wheelchair propulsion is their only means of mobility. Wheelchair use also increases feelings of independence and fosters a sense of physical and emotional well-being, say residents (1). But for all these advantages, few nursing homes formally assess or evaluate residents for a wheelchair, and too often the staff assumes that wheelchairs are meant to be pushed, not self-propelled (2). The upshot is that most residents in wheelchairs rarely take those chairs for a spin (2). But you can help increase their mobility with a few easy-to-implement strategies:
    • Residents who need or want to use a wheelchair should be assessed by a physical therapist or occupational therapist for the most appropriate type of wheelchair.
    • Customize the wheelchair so that it fits the resident. Consider seat width, back cushions, ankle positioning aides, leg-rest panels, foot supports, headrests, and head supports.
    • Make sure the resident can reach and release the chair’s brakes. A PVC pipe can be fitted to a chair’s brake as an extender so that the brake is easier to reach and release.
    • Show residents how to use their wheelchairs. Demonstrate how to operate the brakes and foot pedals, where to place their hands and legs, how to use their hands and/or legs to propel the chair, and how to get up from and sit back down in the wheelchair.
    • Pay attention to residents’ safety behaviors. For example, does the resident lock the wheelchair and move the foot pedals before standing?
    • Regularly check wheelchairs for defects and, if found, promptly repair them.
    • Label each wheelchair so that it stays with the right resident.

How can we tell if residents are spending too much time in bed? (Back to top)

    Try this: Stroll down your facility’s hallways at 10 a.m. and again at 4 p.m. on the same day. Each time, note the names or room numbers of residents whom you observe in bed. Compare the two lists to identify those residents observed in bed at both times. Our research indicates that these residents spend an estimated 16 or more hours a day in bed (3). And that’s too much, even for very frail residents. Our research indicates that the more time residents spend in bed during the day, the more they sleep during the day, the more socially isolated they are, and the less they eat (4). These findings are in keeping with other studies showing that excessive time in bed is associated with detrimental outcomes, including under-nutrition, pressure ulcer development, pneumonia, and urinary incontinence.

Is it likely that residents who participate in the FIT program will eat more as a result of being more active? (Back to top)

    We thought it might, but upon examination, it didn’t. For this study, we enrolled 89 incontinent residents in two nursing homes (5). Half the residents participated in the FIT program, receiving regular incontinence care and exercise. The other residents, the control group, received usual care. At the end of 32 weeks, the FIT group showed significant improvements or maintenance across all measures of daily physical activity, functional performance, and strength compared to the control group. But there were no differences between the two groups in the amount of food and fluids consumed. Both groups consumed an average of 55% of all meals, with no change over time. There was also no change in the frequency of bowel movements in either group. Based on these findings, we believe a feeding assistance intervention aimed specifically at increasing mealtime consumption may be more effective than physical exercise in helping residents maintain and increase weight. Our Weight Loss Prevention Module available on our website, http://www.geronet.ucla.edu, presents protocols for a feeding assistance intervention that has proven effective for nursing home residents.

If residents exercise more during the day, will they sleep better at night? (Back to top)

    Our research suggests that increased physical activity alone will not improve residents’ nighttime sleep, but exercise combined with a nighttime noise and light abatement program will (6). The noise and light abatement program centered on common sense procedures such as closing doors to residents' rooms, fixing squeaky equipment, turning off unattended TVs and radios, and using table lamps instead of overhead lights when providing incontinence care. In one study, daytime exercisers who received the nighttime noise and light abatement program were in bed less during the day and showed less agitation than residents who received only the nighttime program (6). A second study showed that an exercise program alone did not improve nighttime sleep for residents (7).

References (Back to top)

    1. Pawlson LG, Goodwin M, Keith K. (1986). Wheelchair use by ambulatory nursing home residents. Journal of the American Geriatrics Society; 34:860-864.
    2. Simmons SF, Schnelle JF, MacRae PG, and Ouslander JG. (1995). Wheelchairs as mobility restraints: Predictors of wheelchair activity in nonambulatory nursing home residents. Journal of the American Geriatrics Society; 43:384-388.
    3. Schnelle JF, Bates-Jensen BM, Levy-Storms L, Grbic V, Yoshii J, Cadogan M, and Simmons SF. (2004). The Minimum Data Set Prevalence of Restraint Quality Indicator: Does it Reflect Differences in Care? The Gerontologist; 44(2):245-255.
    4. Bates-Jensen BM, Schnelle JF, Alessi CA, Al-Samarrai NR, and Levy-Storms L. (2004). The effects of staffing gon in-bed times of nursing home residents. Journal of the American Geriatrics Society; 52:1-8.
    5. Simmons SF and Schnelle JF. (2004). Effects of an exercise and scheduled-toileting intervention on appetite and constipation in nursing home residents. Journal of Nutrition, Health, and Aging; 8(2):116-121.
    6. Alessi Ca, Yoon EJ, Schnelle JF, Al-Samarrai NR, and Cruise PC. (1999). A randomized trial of a combined physical activity and environmental intervention in nursing home residents: Do sleep and agitation improve? Journal of the American Geriatrics Society; 47:784-791.
    7. Alessi CA, Schnelle JF, MacRae PG, et al. (1995). Does physical activity improve sleep in impaired nursing home residents? Journal of the American Geriatrics Society; 43: 1098-1102.

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