Articles Posted in Physical Therapy

The prevalence of age-related frailty is high in older adults, ranging from 7% to 16.3%.  The prevention and treatment of frailty has long been a major concern in geriatrics, especially in the clinical medicine.  Frailty is the primary determinant of longevity and quality of life in the older adult population.  Frailty is defined as an age-related, biological syndrome that causes a reduction of biological reserves due to the dysfunction of various physiological systems, which increases an older adult’s vulnerability to minor stressors, and is related to adverse health outcomes (such as disability, hospital admission, and death).  Frailty is a stronger indicator for negative outcomes in older ages than chronic disease.  It is important to note that frailty is reversible in its early stages.  Importantly, a frail person can become nonfrail if frailty is identified and addressed at the onset.

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It is well known that the older population is increasing worldwide and that Alzheimer’s disease is one of the leading forms of dementia experienced by older adults. It has also been well established that physical exercise enhances health and well-being in older adults by improving mobility, physical and cognitive function, mood, and preventing falls. 30% of older adults with dementia reside in nursing homes due to the debilitating effects and loss of independence related to the cognitive disease. The types of physical exercise that are most appropriate for this vulnerable population are important to know to ensure that the physical therapy they are receiving is evidence-based and engages the individuals with dementia both physically and cognitively.

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The term ‘sarcopenia‘ is used to describe the loss of muscle mass as a result of aging. Because sarcopenia progresses with age, it is very common in skilled nursing facilities. Studies that have been conducted on the treatment of sarcopenia generally focus primarily on nutrition. One recent survey titled “Effectiveness of Nutritional Supplementation on Muscle Mass Treatment of Sarcopenia in Old Age” reviews numerous such studies between 1991 and 2012. The review found that nutritional treatment of sarcopenia has been overall effective.

It is extremely important that you monitor your loved one’s nutrition, especially if he or she resides in a nursing home. In understaffed facilities, it is very common for patients to be neglected and become malnourished. For example, some residents may not receive the assistance with feeding that they require and will consequently experience severe weight loss. Proper nutrition can also help maintain skin integrity and prevent pressure ulcers. Patients who are at high risk of developing pressure ulcers should be given nutritional supplements, such as iron and protein.

Unfortunately, many nursing homes do not have your loved one’s best interest in mind and will not work to ensure that he or she does not lose significant muscle mass. This may lead to decreased mobility. Instead, nurses may use physical restraints for purposes of convenience. This, however, is a direct violation of the Patients’ Rights and has been proven to actually accelerate sarcopenia and a decrease in mobility. While caregivers frequently use the argument that physical restraints improve resident safety and helps to prevent falls, specialists assert that the risks and consequences associated with the use of restraints outweighs any benefits. Past studies have shown that the use of physical restraints does not decrease incidences of falls in nursing homes over the long run.

Instead of using restraints, nurses should ensure that residents are engaging in physical exercise. One type of exercise called resistance training, has been shown to effectively improve muscle strength. This therapy involves exercises that are performed against an opposing force. As the patient’s muscle strength improves, the opposing force increases. Resistance training has also been shown to improve overall mental well-being in the elderly. This current review actually concluded that nutritional treatment of sarcopenia is most effective when it is coupled with physical exercise.

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Recently, the Wall Street Journal published several articles about the maintenance of physical health through old age. One article, published in the “Health Matters” column discusses how to stay healthy even through old age. The article specifies middle age as the critical time to prevent physical decline. Although it may be apparent that exercise is a key factor in staying healthy, specialists emphasize that it is important to modify daily exercise routines in order to minimize injury. Studies have shown that many middle age adults eventually injure themselves from exercise routines, and consequently stop exercising altogether. It is important to address any pain that is experienced with a physician, as this may be a precursor to more serious problems that will eventually lead to physical decline.

The Wall Street Journal’s “Health Blog” featured a related article titled “Preventing Physical Decline in Middle Age Helps Preserve Good Health Later in Life.” This article was inspired by a study that is currently being conducted by the Center for Medicare and Medicaid Services and the Bloomberg School of Public Health at Johns Hopkins University. The study is called the National Health and Aging Trends Study (NHATS) and observes the dependency of elderly adults upon others for assistance in activities of daily living. Such activities include walking, showering, dressing, and getting out of bed. The study hopes that its findings will help to improve quality of life for elderly adults in the future. Statistics today actually show that trends of disability levels among the elderly are declining. These optimistic results can be attributed to the many studies that have focused on improving the physical health of the elderly.

For example, the development of a new exercise regime called resistance training has led to a range of benefits, both mental and physical, for elderly adults. Resistance training involves exercises that are performed against an external, opposing force that increases as muscle strength improves. Various studies have proven that physical therapy can also have many unexpected benefits, including improvements in incontinence and mental well-being.

While skilled nursing facilities should be implementing these physical exercises into their residents’ daily routines, many homes, unfortunately, are so understaffed that they are unable to supervise such activities. Instead, many resort to the use of physical restraints, which has actually been linked to a decline in mobility in elderly adults. Not only is the use of physical restraints harmful to your loved one, however, but it is a direct violation of his or her rights as a patient if not used properly, such as when its done for the convenience of the nursing staff, and not the benefit of the patient.

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The February 2012 of Clinical Interventions in Aging published an article titled “Effect of Physical Training on Urinary Incontinence: A Randomized Parallel Group Trial in Nursing Homes.” While previous studies have proven that physical training and resistance exercises are effective in improving muscle strength, the significance of physical training in improving urinary incontinence was unknown thus far. After three months, the study was concluded and showed results to suggest that physical training does indeed have a positive effect on improving urinary incontinence in elderly adults.

Incontinence is a common, serious problem in skilled nursing facilities that is recognized as a loss in control of the bowel or the bladder. Regardless of the different diseases that sometimes contribute to the onset of incontinence, the nursing home is obligated to provide its patients with proper incontinence care, as to avoid the progression of any additional health complications, such as pressure ulcers and urinary tract infections.

Because incontinence often marks a decline in the ability to perform activities of daily living, incontinent patients must rely on the nursing home staff to maintain their hygiene and help them use the toilet. Therefore, it is absolutely necessary that the nursing home is not understaffed, so that incontinent patients can receive the care that they need. Furthermore, the mental well-being of incontinent patients is reliant on mental support from the nursing home staff. Because incontinence can often make patients feel embarrassed or ashamed, nurses must be encouraging to patients in order to help them maintain their dignity.

The study confirms that incontinence in nursing homes, unfortunately, worsens over time when left untreated. More optimistically, however, the study also reveals that it is possible to control or reverse the progression of incontinence. For this reason, it is extremely important that the nursing home staff begin treatment early. In addition to physical therapy, some other treatments include prompted voiding, pelvic muscle exercises, and changes in nutrition fluid intake. The patients in the study, however, were exclusively participating in physical training and not using any of these other treatments. The study suggests that in the future, a combination of physical therapy with these other, more established treatments may lead to even better results. Furthermore, the study strives to eventually develop and experiment with a physical training program that directly targets incontinence care, with the hope that such a program will improve incontinence even more.

Because the future of incontinence care appears to be so optimistic, as improvements in treatments are continually being discovered and implemented, there is no reason that your loved one should be denied of his or her proper care. In fact, inadequate incontinence care is an act of nursing home neglect and elder abuse that is in direct violation of your loved one’s rights.

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Falls are becoming an increasingly prevalent problem in today’s skilled nursing facilities. Because the consequences of fall-related injuries are so detrimental to the health of elder adults and the costs associated with treating these injuries are so high, many recent studies have focused on fall prevention techniques. Many of these techniques center on improving the muscle strength of patients, since cardiovascular deterioration is one cause of falls in the elderly population.

The 2012 issue of The Journal of Nutrition, Health & Aging recently published an article titled “Physical Function Predicts Improvement in Quality of Life in Elderly Icelanders after 12 Weeks of Resistance Exercise.” The study reinforces the benefits of resistance training in elderly adults, while discovering some additional advantages that this new treatment has to offer. Before progressing with the study, however, the article outlines the underlying causes of the decline in muscle strength that is experienced by all elderly adults.

Although a weakening of muscles is inherent with old age, especially after the age of sixty, certain factors can accelerate this condition. One of the most basic causes is malnutrition. Because the body receives its energy and strength from nutrients that are in food, it is very important that your loved one is receiving nutritional meals at his or her skilled nursing facility. However, even in nursing homes with the healthiest meals, malnutrition is a likely possibility in understaffed facilities. In choosing a home for your loved one, we advise that you visit at various times throughout the day, as there is often a discrepancy between the staffing levels of different shifts. As it is one of the busiest and most hectic times of the day, it is crucial for you to ensure that your loved one’s facility is employing an adequate level of staff during mealtimes.

Another cause of muscle deterioration is inactivity, which is the area studied by the article. The study proposes the use of resistance training, in which participants perform exercises against an opposing force. As muscle strength improves, the opposing force is increased. While some studies have already proven that resistance exercises improve muscle strength, this study focuses on the effect of this treatment on overall health-related quality of life.

With 204 participants, the study proceeded by enrolling each individual into resistance training classes. The study was conducted over a period of twelve weeks. For three nonconsecutive days of each week, the participants attended their resistance exercise classes in groups of twenty to thirty. Three sets of exercises were repeated six to eight times and increased by five to ten percent each week. Over the course of the study, some tests, such as a walk that recorded the distance that the participant could walk in six minutes, were used to measure improvements in muscle strength.

Health-related quality of life was determined by a questionnaire that inquired about both psychological and physical functions, including functional status, vitality, social function, physical pain, emotions, general health, and mental health. The results of the study show that resistance training does more than simply improve the muscle strength of elderly adults. Overall, participants experienced an increase in health-related quality of life. This included improvements in mental health, such as an alleviation of mild depressive symptoms and anxiety symptoms.

While most nursing homes install railings in hallways to prevent falls and call buttons in case falls do happen, rehabilitation exercises are often overlooked as fall prevention techniques. However, these exercises are actually very effective in preventing falls because they directly address the loss of muscle strength experienced by the elderly that is one of the fundamental contributing causes of falls.

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Loss of muscle strength in elderly adults is an extremely serious problem because it occurs within the entire elderly population. Between the ages of fifty and seventy, adults lose thirty percent of their muscle strength. As they approach the age of seventy, elderly adults experience a loss in muscle strength of 1.5 percent per year. Because loss of muscle strength is associated with physical frailty, increased dependency, and a decline in strength, balance, coordination, reaction time, flexibility, and muscular and cardiovascular endurance, it is important to prevent or delay its onset for as long as possible. Lower muscular endurance and balance, specifically, are directly responsible for the occurrence of falls.

Fortunately, treatments and exercises exist to increase and improve muscle strength in elderly adults. One treatment, called progressive resistance training, was recently studied by the American Medical Directors Association and published in the November issue of its journal. Progressive resistance training involves exercises that are performed against an external, opposing force that increases as muscle strength increases. The study proved that this type of exercise is effective in improving muscle strength in elderly adults.

It is important to ensure that your loved one’s skilled nursing facility is not only providing treatments and exercises to prevent loss in muscle strength, but also preventing avoidable injuries, such as falls. Although exercises can improve muscle strength, a gradual decline in strength is, unfortunately, sometimes inevitable in elderly adults. It is therefore the responsibility of the skilled nursing facility to prevent falls from occurring. The key to preventing falls is to draft an individualized care plan for each resident. More importantly, nurses must abide by this care plan in their daily caretaking. However, nursing homes are often understaffed, which makes it difficult for nurses to carry out care plans. Unfortunately, therefore, preventable falls occur much too often in nursing homes.

Sometimes, skilled nursing facilities utilize physical restraints, in order to reduce the risk of falls. However, recent studies have shown that the use of restraints, over time, does not effectively decrease the rate of falls in nursing homes.

Furthermore, the use of physical restraints can lead to an array of health problems, such as pressure sores, incontinence, and depression. It is also a direct violation of Patients’ Rights, which state that restraints may only be used for medical purposes, and even under such circumstances, patients may refuse treatment.

Because falls are avoidable through proper prevention techniques, it is completely inexcusable that falls occur so often in nursing homes. If your loved one has suffered injuries from a fall that eventually led to death, you may be able to make a Wrongful Death claim. Such claims are warranted when a nursing home’s neglect is directly responsible for a resident’s death.

Nursing homes must encourage residents to partake in activities and exercises to increase their muscle strength. Although progressive resistance training has proven effective, elderly adults still remain at a high risk for falls. Therefore, skilled nursing facilities must also take precautions to lower the risk of falls.

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Often times, what begins as an estimated two week visit to a Skilled Nursing Facility for rehabilitative services after a serious injury or surgery turns into an extended stay. Post-injury patients with cognitive disabilities face the greatest risk for lengthy stays at nursing homes. According to a recent study, specifically tailored rehabilitation programs play a crucial role in the post injury recovery of such patients.

According to an article published in the July 2011 edition of the Journal of the American Medical Directors Association efforts towards research in rehabilitating cognitively impaired elders are minimal, despite the rise in the elderly popultion.

The report investigates the differences in functional recovery for cognitively impaired patients and cognitively unimpaired patients. The article, entitled “Postacute Rehabilitation in Cognitively Impaired Patients: Comprehensive Assessment and Tailored Interventions,” is available for purchase online. The authors, Francesco Landi MD, PhD, Rosa Liperoti MD, MPH and Roberto Barnabei MD, highlight the crucial role that tailored rehabilitation programs play in aiding those with cognitive disabilities as they recover from acute injuries.