Maintaining and impr oving mobility in long- te r m c ar e home - PowerPoint PPT Presentation

Maintaining and impr oving mobility in long- te r m c ar e home s Caitlin Mc Ar thur , PhD, MSc PTBSc (KIN) Re g iste re d Physic al T he rapist and Po st-Do c to ral F e llo w, Ge riatric E duc atio n and Re se arc h in Ag ing Sc ie nc e Ce ntre (GE RAS), Mc Maste r Unive rsity mc a rthurc @ hhsc .c a @ Mc ArthurCa itlin F e br uar y 22, 2018

Your moderator  Pro fe ssio na l a nd pe rso na l e xpe rie nc e s in L T C  Advo c a te K a te Duc a k, MA, CPG T his we b inar is b e ing funde d b y the Ontario Go ve rnme nt thro ug h the Ce ntre fo r L e arning , Re se arc h and I nno vatio n in L o ng -T e rm Care (CL RI ) ho ste d at the Sc hle g e l-UW Re se arc h I nstitute fo r Ag ing as part o f a fre e we b inar se rie s to impro ve q uality o f c are in Ontario lo ng -te rm c are ho me s. T he vie ws e xpre sse d in the we b inar do no t ne c e ssarily re fle c t tho se o f the Go ve rnme nt o f Ontario .

About me ... • Re g iste re d physio the ra pist • Po stdo c to ra l fe llo w • Wo rke d in L T C • Re se a rc h fo c us: impro ving re ha b ilita tio n a c ro ss the c o ntinuum o f c a re Ca itlin Mc Arthur, PhD, MSc PTBSc (K I N) mc a rthurc @ hhsc .c a @ Mc ArthurCa itlin

T e ll me a bout you!  Wha t is yo ur prima ry ro le ? A. Re side nt o r fa mily me mb e r B. Physio the ra py, kine sio lo g y, o r e xe rc ise / fitne ss C. Nurse (NP, RPN o r RN), PSW, o r me dic a l do c to r D. Re c re a tio n, life e nric hme nt, o r a c tivitie s/ pro g ra ms E . Othe r (L T C sta ff o r le a de rship, e duc a to rs, re se a rc he rs, e tc )

T e ll me a bout you!  Wha t se c to r do yo u wo rk in the ma jo rity o f the time ? OR  I f yo u a re a re side nt o r fa mily me mb e r, whe re do yo u live o r whe re do yo u visit? A. L o ng -te rm c a re B. Re tire me nt ho me o r a ssiste d living C. Ho me c a re o r a t ho me D. Ac ute c a re (e .g ., ho spita l) o r inpa tie nt re ha b E . Othe r (c o mple x c o ntinuing c a re , e tc )

T e ll me a bout you! Wha t a re ho ping to g e t o ut o f the we b ina r to da y?

Obje c tive s:  1) disc uss c urre nt e vide nc e fo r stra te g ie s to ma inta in a nd impro ve re side nt mo b ility  2) pre se nt pra c tic a l so lutio ns fo r putting e vide nc e a b o ut mo b ility into pra c tic e in lo ng -te rm c a re ho me s  3) e xa mine wa ys to mo dify sug g e stio ns fo r diffe re nt physic a l a nd c o g nitive a b ilitie s.

L ong- T e rm Ca re (L T C)  625 lic e nse d L T C ho me s in Onta rio :  77 477 lo ng -sta y b e ds, 617 c o nva le sc e nt b e ds, 355 re spite b e ds  7.1% o f o lde r a dults o ve r the a g e o f 65 live in spe c ia lize d c a re fa c ilitie s, like L T C  T he Onta rio g o ve rnme nt ha s pla ns to a dd 5000 mo re L T C b e ds o ve r 4 ye a rs http:/ / www.c b c .c a / ne ws/ c a na da / ha milto n/ se nio rs-a nno unc e me nt-1.4390828 https:/ / www.o ltc a .c o m/ o ltc a / OL T CA/ L o ng T e rmCa re / OL T CA/ Pub lic / L o ng T e rmCa re / F a c tsF ig ure s.a spx# L o ng - te rm%20c a re %20ho me %20pro vinc ia l%20a nd%20L HI N%20da shb o a rds%20(Oc to b e r%202016)

Re side nts in L T C ofte n ha ve : o Co mple x c o -mo rb iditie s o 25.0% ha ve dia b e te s, 4.4% ha ve c hro nic o b struc tive pulmo na ry dise a se , 21.2% ha ve e xpe rie nc e d a stro ke o Physic a l impa irme nts: o hig h pre va le nc e o f sa rc o pe nia o Co g nitive impa irme nts: o Mo re tha n 80% o f re side nts in L T C ha ve so me de g re e o f c o g nitive impa irme nt o 56.3% o f re side nts ha ve a dia g no sis o f Alzhe ime r’ s o r o the r de me ntia s o Ac tivity limita tio ns:  95% o f re side nts re q uire so me a ssista nc e with a c tivitie s o f da ily living (ADL s)  mo re tha n 80% re q uire e xte nsive c a re  On a ve ra g e spe nd thre e q ua rte rs o f the ir wa king time in se de nta ry a c tivitie s Hirde s e t a l. Canadian Jo urnal o n Ag ing . 30.3 (2011): 371-

Wha t do yo u c urre ntly do in yo ur ho me to he lp re side nts ma inta in o r impro ve the ir mo b ility? OR I f yo u a re re side nt – wha t do yo u do to ma inta in o r impro ve yo ur mo b ility?

Re c omme ndations for e xe r c ise and physic al ac tivity in L T C

Re c omme ndations for e xe r c ise and physic al ac tivity in L T C De So uto Ba re tto e t a l. J Am Me d Dir Asso c . 2016, 381-392.

Re c omme ndations for e xe r c ise and physic al ac tivity in L T C De So uto Ba re tto e t a l. J Am Me d Dir Asso c . 2016, 381-392.

Re c omme ndations for e xe r c ise and physic al ac tivity in L T C De So uto Ba re tto e t a l. J Am Me d Dir Asso c . 2016, 381-392.

E xe rc ise to improve ADL s  E xe rc ise c a n ha ve a sma ll po sitive e ffe c t o n ADL s whe n de live re d:  45-75 minute se ssio ns  2-3 time s pe r we e k Crocker T, et al. Age Ageing . 2013;42(6):682-688.

E xe rc ise to pre ve nt fa lls  2012 Co c hra ne re vie w:  the e vide nc e surro unding e xe rc ise to pre ve nt fa lls in L T C wa s inc o nsiste nt a nd did no t de mo nstra te a n o ve ra ll b e ne fit.  e xe rc ise pro g ra mme s ma y inc re a se the risk o f fa lling fo r fra ile r re side nts, b ut re duc e the risk o f fa lling fo r le ss fra il re side nts.  inte rve ntio ns ta rg e ting multiple risk fa c to rs ma y b e e ffe c tive – spe c ific a lly g a it, b a la nc e , a nd func tio na l tra ining  2013 syste ma tic re vie w b y Silva e t a l.:  c o mb ine d e xe rc ise pro g ra ms (i.e ., multiple type s o f e xe rc ise ) tha t inc lude b a la nc e ta sks, a re c o mple te d fre q ue ntly (2-3 time s pe r we e k), a nd o ve r a lo ng -te rm (g re a te r tha n 6 mo nths) we re mo st e ffe c tive a t pre ve nting fa lls. Ca me ro n ID e t a l. Co c hrane Datab ase Syst Re v . 2012;12. Silva RB e t a l. J Am Me d Dir Asso c . 2013;14(9):685-689.e 2. do i:10.1016/ j.ja mda .2013.05.015. Stub b s B e t a l. Maturitas . 2015;81(3):335-342. do i:10.1016/ j.ma turita s.2015.03.026. Pa pa io a nno u A e t a l. Can Me d Asso c J . 2015;187(15):1135-1144. do i:10.1503/ c ma j.141331. She rring to n C e t a l. . Br J Spo rts Me d . Oc to b e r 2016. do i:b jspo rts-2016-096547 [pii].

E xe rc ise to pre ve nt fa lls  2015 umb re lla re vie w b y Stub b s e t a l.:  multifa c to ria l inte rve ntio ns we re the mo st e ffe c tive a t pre ve nting fa lls in L T C  2015 re c o mme nda tio ns fo r fra c ture pre ve ntio n in L T C:  b a la nc e , stre ng th, a nd func tio na l tra ining sho uld b e inc lude d fo r re side nts who a re no t a t a hig h risk o f fra c ture , while fo r tho se a t hig h risk, e xe rc ise sho uld b e pro vide d a s pa rt o f a multifa c to ria l fa lls pre ve ntio n inte rve ntio n.  2016 syste ma tic re vie w b y She rring to n e t a l.:  the re wa s no e vide nc e tha t e xe rc ise a s a sing le inte rve ntio n c a n pre ve nt fa lls fo r re side nts in L T C. Ca me ro n ID e ta l. Co c hrane Datab ase Syst Re v . 2012;12. Silva RB e t a l. J Am Me d Dir Asso c . 2013;14(9):685-689.e 2. do i:10.1016/ j.ja mda .2013.05.015. Stub b s B e t a l. Maturitas . 2015;81(3):335-342. do i:10.1016/ j.ma turita s.2015.03.026. Pa pa io a nno u A e t a l. Can Me d Asso c J . 2015;187(15):1135-1144. do i:10.1503/ c ma j.141331. She rring to n C e t a l. . Br J Spo rts Me d . Oc to b e r 2016. do i:b jspo rts-2016-096547 [pii].

MOST RE CE NT T he e vide nc e for e xe r c ise to pr e ve nt fa lls He witt, J. e t a l. 2018). Jo urnal o f the Ame ric an Me dic al Dire c to rs Asso c iatio n .

MOST RE CE NT T he e vide nc e for e xe r c ise to pr e ve nt fa lls  individua lly pre sc rib e d pro g re ssive re sista nc e tra ining plus b a la nc e tra ining  Gro up se tting  2x/ we e k, 1 ho ur se ssio n fo r 25 we e ks – fo llo we d b y a ma inte na nc e pro g ra m fo r 6 mo nths  Re sults:  De c re a se d fa lls (142 vs. 277) a nd fa ll ra te (1.31 vs. 2.91 fa lls pe r pe rso n-ye a r)  Simila r numb e r o f fa ll re la te d fra c ture s b e twe e n g ro ups (5 vs. 6)  Pa rtic ipa nts who a tte nde d mo re tha n 30 ho urs o f tra ining sa w impro ve me nt in fa lls o utc o me s He witt, J. e t a l. 2018). Jo urnal o f the Ame ric an Me dic al Dire c to rs Asso c iatio n .

Multifa c toria l fa lls pre ve ntion prog ra ms  sta ff a nd re side nt e duc a tio n  e nviro nme nta l mo dific a tio ns  supply/ re pa ir/ pro visio n o f a ssistive de vic e s  fa lls pro b le m-so lving c o nfe re nc e s  urina ry inc o ntine nc e ma na g e me nt  me dic a tio n re vie w Cro c ke r T e t a l. Co c hrane datab ase Syst Re v . 2013;2:CD004294. Pa pa io a nno u A e ta l. Can Me d Asso c J . 2015;187(15):1135-1144. do i:10.1503/ c ma j.141331. Je nse n J, L undin-Olsso n L e t a l. Ann I nte rn Me d . 2002;136(10):733-741. Be c ke r C e t a l. J Am Ge riatrSo c . 2003;51(3):306-313. do i:jg s51103 [pii]. Hua ng T -T e t a l. Ag ing Me nt He alth . 2016;20(1):2-12. do i:10.1080/ 13607863.2015.1020411.

Putting it into pr ac tic e Wha t is yo ur fa vo urite stre ng th e xe rc ise ?