Professor Lynda Holt, CEO of Health Service 360, co-host of #EndPJparalysis Global Summit
Here’s a horrifying statistic – people over 70 can lose up to 5% of their muscle power after just 24 hours of immobility and 20% after a week. If you are over 70, a few days in bed, a hospital visit, and being looked after by those who love and care for you, can quite literally cost you your independence. Once lost this can take several years to rebuild – and most people never get back to their pre-immobility state. That’s a high price to pay.
The evidence around deconditioning has been around for 70 years, yet our emotional need to ease suffering gets in the way. Every day, in our eagerness to keep people safe, to act kindly, and to help where we can, we risk causing harm through avoidable deconditioning. This risk is exacerbated because early signs of deconditioning are often written off as inevitable old age.
It’s normal to lose strength as you age – at a rate of around 1-2% a year. When this happens more rapidly – as a direct result of deconditioning, it is often put down to ill health, cognitive decline, or lack of social engagement, when in reality the reverse is often the case – deconditioning results in the above.
For clarity, deconditioning is the medical 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 falling
- 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
- Increasing discomfort when attempting to mobilise.
Of course, prevention is better than cure, but many of the older people we care for are already deconditioned. Long periods of isolation, staying home and inactivity over the Covid period haven’t helped, and neither have our risk-averse hospital and healthcare systems, where some of the actions used to prevent harm, like falls monitors and encouraging patients to wait for assessments before attempting mobility actually worsen deconditioning.
As carers, we need to both act to prevent deconditioning, and look to help people actively recondition. The activity and areas to focus on are similar for both, just keep in mind those who are reconditioning, may need more help and could be at greater risk of falling or injury, depending on their level of deconditioning.
Start with these three areas:
- Physical activity
- Cognitive or intellectual stimulation
- Social interaction
People get the best results when activity adds value, either socially or functionally, so keep this in mind when planning exercise or activity. In terms of physical activity involving exercise, resistance and gravity exercises are the most effective. This might include standing, using pedal exercises, and walking – depending on the person’s ability. Make it purposeful through function, like walking to or from the loo, rather than using a wheelchair, walking to meals, or making a drink, again depending on ability.
Here are a few things to remember – even though they may seem obvious. Ensure people have the equipment they need, from glasses & hearing aids to well-fitting footwear, sticks, and frames as well as appropriate supervision. Encourage people to stay hydrated and ensure they don’t have health contraindications to the activities you propose.
Don’t underestimate the social impact, even for those who are cognitively impaired, try to make activities fun, and competitive and you will quickly tick all three of the above.
Across the #EndPJparalysis campaigns there are many examples of this, for example, pimp my Zimmer -– the cognitive activity of designing and decorating your frame, the competitive elements of creating the best frame gave social element, and mobility from using your frame. Key reasons cited for not mobilising were being unsure which frame belonged to them and the risk of conflict with others over frame ownership.
In summary, deconditioning is a very real risk for older people, as carers, we have a responsibility to prevent it whenever we can, to take steps to help people retain their independence where possible, and to maintain the best quality of life possible. You do this little action by little action.
For more info go to www.endpjparalysis.org
The #EndPJparalysis campaign (link: www.endpjparalysis.org/join) is a global social movement committed to reducing deconditioning by sharing best practices, research, and expert talks. It is hosted by Professor Lynda Holt & Professor Brian Dolan OBE
Lynda is a prominent leadership voice, author and change activist in the healthcare sector. She established Health Service 360, an award-winning development consultancy, back in 2001 and spends her time helping leaders and health professionals to lead courageously, make tangible change, value themselves, and empower their people.
She believes it is each of us, not big organisations, religions, or governments, that change the world, – little action by little action, and as a Professor of Social Leadership at the University of Salford, Lynda helps to equip people with the skills and mindset needed to act and create social change.
