Chapter 7 Promoting mobility.pdf

Promoting mobility Objectives: Disscuss the effect of impaired mobility on the function and quality of life Describe age-related changes in bones, joints and muscles Discuss the risk factors for immobility Describe the beneficial effect of exercise and appropriate exerci...

Promoting mobility Objectives: Disscuss the effect of impaired mobility on the function and quality of life Describe age-related changes in bones, joints and muscles Discuss the risk factors for immobility Describe the beneficial effect of exercise and appropriate exercise regiment Describe factors the increase vulnerability to falls Develop a paln for older adults at risk of falls © Ma'en Aljezwi 1  Mobility Capacity for movement within personally available microcosm and macrocosm Includes ability such as moving oneself by turning over in bed Transfer from lying to setting From sitting to standing Walking with or without assistive devices Throw-out life, movement remains a significant mean of personal contact, sensation, exploration, pleasure © Ma'en Aljezwi 2  Mobility It is fundamental to active aging and is intimately linked to health status and quality of life Impairment of mobility is an early predictor of physical disability and associated with poor outcome such as falling, loss of independence, decreased quality of life, initialization, and death © Ma'en Aljezwi 3  Mobility and aging Aging affect muscle strength, flexibility, postural stability, vibratory sensation, cognition and perception of stability Aging produces changes in muscle and joints, particularly in back and legs Decrease movement and range of motion (ROM) Gait changes include a narrower standing base, wider side to side swaying, greater reliance of proprioception (sense of the relative position of one's own parts of the body and strength of effort being employed in movement ) © Ma'en Aljezwi 4  Mobility and aging Sarcopenia: age-related loss of muscle mass and function Limitations in mobility are three times greater in older women than men Mobility impairment are caused by diseases and impairments across many organ systems Diseases such as DM, Parkinson's, strokes, hemiplegia, osteoporosis can decrease mobility © Ma'en Aljezwi 5  Mobility and aging Sedentary lifestyle, obesity, smoking could be associated with mobility problems Regular physical activity throughout life is likely to enhance health and function © Ma'en Aljezwi 6  Assessment of mobility in older adults Screening and identifying health problems, this is for 1. Identify medical problems 2. Identify functional limitations 3. Minimize injury Frail and older people will need more comprehensive assessment and close monitoring © Ma'en Aljezwi 7  Interventions to enhance mobility Physical fitness: there is no age no start a physical fitness programme Physical fitness is also associated with better cognitive function in old age Improves health outcome in people with chronic conditions Regardless off age every person can find physical activity that are suitable for him © Ma'en Aljezwi 8  Guidelines for physical activity - 150 minutes of moderate intensity aerobic activity (brisk walking, swimming, bicycling) - Muscle strengthening activities on two or more days that work all the major muscle groups - Stretching and balance exercise are also recommended - Exercise may be integrated to the life activities such as walking to the market instead of driving © Ma'en Aljezwi 9  Special consideration Nonambulatory older people can also engage in physical activity and may benefit most from an exercise programme in term of function and quality of life Suggested exercise may include: upper extremity cycling, marching in place, stretching, range of motion, use of resistive bands, and chair yoga Other guidelines next slide: 10 © Ma'en Aljezwi Activity guidelines © Ma'en Aljezwi 11 © Ma'en Aljezwi 12  Falls Unintentionally coming to rest on a lower area such as ground or floor It is the leading cause of morbidity and mortality in the people 65 and above The rate of death-related-falls has risen over the last decade It is considered a quality indicator of care Falls are symptoms of a problem © Ma'en Aljezwi 13  Falls In institutionalized settings, iatrogenic factors such as limited staffing, lack of toileting programme, and restrains and side rails also increase fall risk Root causes for falls include: 1- Inadequate staff communication and training 2- Incomplete patient assessment 3- environmental issues 4- incomplete care planning 5- inadequate organizational culture of safety © Ma'en Aljezwi 14  Consequences of falls Hip fractures: - 95% are caused by falls in elderly - Associated with considered morbidity and mortality - Associated with: limitations in mobility, decline in bone density, lean body mass, pain depression, decrease quality of life © Ma'en Aljezwi 15  Consequences of falls Traumatic brain injury - Highest among those 75+ - Even with minor head injuries, old age negatively affect the outcome - Factors that place older adults in greater risk for TBI: presence of comorbid conditions, use of anticoagulants, changes in the brain with age © Ma'en Aljezwi 16  Consequences of falls Fallophopia - Loss of confidence that leads to decrease activity - Risk for future falls - nurses must not decrease confidence in their patients, instead they must do a fall risk assessment © Ma'en Aljezwi 17  Factors contributing to falls Disturbance in visual acuity Cognitive impairment Chronic pain Orthostatic (postural) hypotension Cardiac arrhythmias Uncontrolled diabetes Depressive symptoms Lower extremity weakness © Ma'en Aljezwi 18  Gait disturbances Not a disorder by its own Can result from: arthritis, ligamentous weakness, muscle in hyperparathyroidism, osteomalacia, hypophosphatemia, diabetes, Parkinson's, stroke, alcoholism, vitamin B deficiency © Ma'en Aljezwi 19  Interventions Exercise - Must be at least for 10 weeks of specialized training - Must be individualized - Must target strength, gait and balance measures to increase mobility © Ma'en Aljezwi 20  Medication review Important aspect in falls prevention Risk increases with particularly the use of neuroleptics and benzodiazepines All medications should be reviewed (including herpes and those over the counter) and those absolutely essential kept © Ma'en Aljezwi 21  Environmental modifications Check for slippery floors Proper illumination and functioning of light Tables, beds are sturdy and in good shape Adaptive aids are in good conditions Bed rails do not collapse when used Patient clothes do not cause tripping IV poles are sturdy if used during ambulation © Ma'en Aljezwi 22  Behaviour and education As a single strategy Behaviour and education programmes do not reduce falls but are recommended as a part of multifactorial intervention programme © Ma'en Aljezwi 23  Assistive devices Reduces risk in falls Training on there devices is important Device prescribed must be suitable for limitation and condition of the patient © Ma'en Aljezwi 24  Principles of assistive devices use Place the cane firmly on the ground Wear low heels shoes First step-up with the none affected leg When using a walker stand upright and lift or roll the walker with both hands Every assistive device must be adjusted to individual height Chose a size and shape of a cane handle that fits comfortably © Ma'en Aljezwi 25 © Ma'en Aljezwi 26