1. Maintaining Functional Capacity During and Following Hospitalization to Improve Mobility Kristine M. Todd DNP, FNP-BC, RN-BC Steve E. Brodnicki MS, PT, GCS, CBIS

2. Objectives Describe the physical changes associated with aging that affect mobility and balance Describe key concepts of a physical design of a hospital to maintain functional capacity State rehabilitation measures implemented to maintain or improve balance, mobility, and function Define recommendations of future level of care at discharge to prevent further decline in balance, mobility and function 2

3. Holistic Approach Senior adults are unique and their well-being comprises physical, psychological, intellectual, social, cultural, spiritual, emotional and sexual dimensions. 3

4. Hazards of Hospitalization Bed rest leads to loss of strength and reduction Sensory devices (glasses, hearing aids) are taken Food presented when you are not hungry or available Bathroom is certainly different from home Bed rest leads to loss of strength and reduction and breathing capacity Less sleep Overstimulation due to noises (alarms, lights, etc.) Dehydration due to lack of access to water 4

5. Hazards of Hospitalization 15% of hospitalized patients aged 70 and older will experience a decline in their ability to perform basic self- care activities 20% of hospitalized patients will discharged without getting back to their baseline pre-admission 15% will be discharged to a nursing home Only about 12% of patients who go to a nursing home return to home 5

6. Physical Changes Associated With Aging Visual changes –Decreased visual field and peripheral vision –Greater increase of glaucoma, cataracts, and macular degeneration –Distorted depth perception –Decreased vision in low light –Eyes adjust to changing light levels with greater difficulty and more slowly –Lenses may yellow with age –Color vision may decrease –Ability to contrast surfaces is decreased 6

7. Physical Changes Associated With Aging Hearing changes –Decreased hearing ability –Greater sensitivity to high frequency noises –Poor ability to distinguish different pitch levels –Background noise causes problems 7

8. Physical Changes Associated With Aging Cognitive Changes –Ability to reason and think in the abstract is reduced –Ability to focus on pertinent details is reduced –Ability to form new associations is impaired –Memory decreases –Information process is slowed –Difficulty with orientation, time and place 8

9. Physical Changes Associated With Aging Skeletal/Muscle Changes –Reduced muscle strength Grip strength Ability to reach –Reduced flexibility –Reduced coordination with fine motor skills –Decreased balance with loss of equilibrium –Reduced reaction time and reflexes –Increased joint stiffness –Decreased ability to respond to temperature changes 9

10. Goal of a Senior Friendly Hospital Provide care to the hospitalized senior adult with a specialized team that has advanced knowledge, that works together to help each person reach optimal function and independence in an environment of dignity. 10

11. Key Components of Senior Friendly Hospitals Physical environment and approach to care that specializes in expert care for senior adult Early identification of risk factors and problems to prevent or reverse an actual problem Respect for the senior adult’s ability to make choices about services they receive Recognition of lifelong patterns and family relationships 11

12. Physical Environment at the Hospital Minimize glare with soft lights Avoid blue and green color combination or yellow green combination Use contrasting colors to highlight doors and change in surfaces Avoid bold patterns on walls and floor Handrails should be a contrasting color Carpeting is better to reduce noise and glare Avoid glossy finishes on floors Use matte finish on walls 12

13. Reception Area 13

14. 14

15. Family and Patient Area 15

16. Family and Patient Area 16

17. Physical Environment at the Hospital Door handles should be lever-style and not twisting style Increased wall space, less clutter Avoid long hallways or have rest benches Patient controlled window blinds Handrails as much as possible Decrease volume controls of paging system Keep sensory devices at bedside (better to be on ) 17

18. Hallways with Benches/Siderails 18

19. 19

20. Contrasting Colors 20

21. Handrails 21

22. Sensory devices near the patient (better to have them on!!) 22

23. Physical Environment at the Hospital Install vertical and horizontal grab bar in bathrooms Locate furniture to promote barrier free access Have wheelchair accessible showers Raised toilet seats Locate furniture to promote barrier free access Have wheelchair accessible showers 23

24. Bathroom Design 24

25. Bathroom Design 25

26. Bathroom Design 26

27. Hello….I am right here!!!! Senior adults have the right to be involved in decisions affecting their care and environment!! 27

28. Supporting Personal Request 28

29. Rehabilitation in the Acute Care Hospital Prescription of Rehabilitation Services Evaluation by Rehabilitation Professionals Rehabilitation Treatments Education Nursing involvement in the Rehabilitation Process Recommendations for Discharge 29

30. Prescription of Rehabilitation Services Functional Screen performed by Nursing Physician order based on diagnosis Request from other disciplines on case Includes: Physical Therapy, Occupational Therapy, Speech/ Language Pathology 30

31. Evaluation by Rehabilitation Professionals 31 Mobility –Bed mobility –Transfers (in/out bed/chair) –Gait –Stairs –Balance Swallowing Cognition Activities of Daily Living –Bathing –Dressing –Toileting

32. Rehabilitation Treatments 32 Mobility –Practice specific transfers –Ambulation with best possible device –Bed mobility training –Balance training activities –Stair training Therapeutic Exercise –Bed Exercises –Chair Exercises –Standing Exercises –Home Exercise Program

33. Rehabilitation Treatments (cont) 33 Activities of Daily Living –Fine motor control –Sequencing –Functional Mobility and balance training –Performance of shower, bath, dressing and grooming tasks –Energy conservation Swallowing –Trials of different consistencies of food/ liquid –Exercises to increase ability to swallow –Advancement of diet

34. Equipment Used in Hospital 34 Gait Devices ADL devices

35. Education Rehabilitation specialists provide education to both patient and families that include: –Home exercise program –Safety issues –Energy conservation –Home modification –Equipment needs at home –Follow-up therapy care: outpatient, home care, sub- acute rehab, acute rehab –Training caregivers on proper assistive techniques 35

36. Nursing Involvement Assist patients with ambulation Educate patients on importance of movement Determine if patients are medically ready for rehabilitation Encourage proper diet and consistency of foods/ liquids Medicate patients in order to ensure reduced pain to participate with rehabilitation Get patients out of bed –chair –bathroom –shower –commode 36

37. Equipment used with Nursing Liko Lifts Commodes 37

38. Recommendation for Next level of Rehabilitation Care Home Outpatient Rehabilitation Home Health Care Sub-acute Rehabilitation Acute Rehabilitation 38

39. LET’S KEEP MOVING!! 39

40. References Brown, C., Redden, D., Flood, K., & Allman, R. (2009). The under-recognized epidemic of low mobility during hospitalizations of older adults. Journal of the American Geriatrics Society, 57, (9), 1660-1665. Bongort, L. (2010). The elder-friendly hospital environment. Improving outcome for older adults. Facility Management, August 2010, 12-15. 40