Each week Jessie Snowdon’s team at On the Go Physio visits 20 aged care facilities around Christchurch and their main focus is elderly clients and the unique stage of life they’re at.
We tend to become more sedentary as we age and illnesses like the flu can take a heavy physical toll. Health issues like diabetes, Chronic Obstructive Pulmonary Disease (COPD), cardiac problems, Parkinson’s Disease, arthritis, and early cognitive changes can all combine to affect our balance and mobility.
“The age at which your mobility changes is really different for everyone,” Jessie explains. “I meet 90-year-olds who are active and well and I meet 60-year-olds who aren’t. The real crux of everything we know about aging well is related to being physically active.
”Moving into a residential care facility can often decrease the opportunities for exercise as people don’t do as much housework, gardening, or walking as they once did. “A lot of aged care facilities are fabulous at keeping people moving but if the cup of tea is now coming to you instead of you getting up to make it, you can lose a lot of your daily incidental exercise.”
Working as a physiotherapist in aged care requires broad skills and knowledge in the fields of neurology, dementia, orthopaedics, respiratory and general medicine.
“Physios must also understand the different life factors that come with aging and be able to relate well to an older person. It can be an incredibly rewarding job and from the outside look fairly straightforward, but don’t underestimate the clinical knowledge and reasoning required!”
Jessie says employing a registered physiotherapist is a great way for clinical and facility managers to support their own staff. The more physically able residents are, the less assistance they will need from carers. Jessie and her team provide moving and handling training for aged care staff, and recommend what equipment is required to help residents maintain their mobility. “Often people are using walking frames that are too high or too big for them. And sometimes just changing the height of an armchair can make a huge difference to their function and gives them back some independence as well as decreasing their care needs.
”Employers have a responsibility under our health and safety laws to minimise the risk of injury to staff, which is why correct advice around moving and handling is so important.
“Sometimes staff will put themselves last but if they’re not looking after themselves then the residents aren’t safe either. We can do a simple risk assessment after staff have done any moving and handling by asking them ‘was that heavy?’ If it was, then it's too heavy and it’s not safe. That’s when we need to explore other options relating to the way people are transferring or whether additional moving and handling equipment can be used.”
Jessie says there are several opportunities to improve residents’ function and safety with physiotherapy. Not every admission needs an assessment but there are some clear indicators for physiotherapy input. These include changes in mobility, a fall or increased risk of falling, a period of immobility following illness, the development of a pressure injury, or after a medical event such as a stroke, heart attack, or flare-up of a chronic condition.
“Often referrals come in too late when staff are really struggling to assist someone. Ideally, staff should be alert for early changes such as difficulty standing up from a chair or doing something that was previously simple,” she says.
Physio can also help people recover from surgery and strokes. “One myth is that people who have had a stroke only have a small window of rehab. People whose stroke was more than six months ago can often show improvements with the right intensity of input. They also need to maintain their fitness or they will lose those rehab improvements so general fitness is just as important.”
Jessie says a lot of balance and strength losses are reversible. “People of any age, even if they’ve got physiological and health changes, can still improve strength and balance in most cases.
”Physiotherapy interventions can be complex (such as training in cueing strategies for people with Parkinson’s), or involve simple strengthening and balance exercises such as repeated ‘sit to stands’, calf raises, sidestepping and backwards walking.
“Exercises that actually imitate what the person needs to do in everyday life are best,” Jessie says. “The ability to stand up from a chair or the toilet is vital to maintaining independence. And if you think about walking through a busy mall, that can be terrifying if your balance isn’t good and you don’t have that ability to step to one side or backwards out of someone’s way. That’s when you fall.
Carers and family members can underestimate the physical potential of residents and shouldn’t shy away from encouraging them to be active.
“We can be very protective and caring of our older adults. But realising that as long as we’re taking account of their medical conditions, it’s actually okay to get them working hard. It’s okay for them to be puffing. And it’s good to challenge them and if they’re tired that’s okay. Because that’s what exercise does, it tires you out.”
Jessie says one basic principle is to let residents do as much for themselves as possible. Keeping them moving, keeping them safe, recognising their potential, and supporting staff are the other key areas to be mindful of.
An ideal ratio for facility managers to consider is to allocate one hour of physio per week for every four to eight residents on-site at the hospital level of care. Assigning a carer to be a ‘physio assistant’ will also ensure services are delivered in an efficient and cost-effective manner.“If you’re going to spend the money on a physio you need an assistant to implement the programmes and do the exercises with the residents,” Jessie says. “We do the initial assessment, provide advice and set up the exercise programmes and then the physio assistant can then implement those with regular review and oversight from the registered physio.
”Having worked as a physiotherapist for 20 years (and focussed on elderly clients for the past decade), Jessie loves her job and the difference physio can make to people’s lives.“I really value the relationships we develop with residents, nurses and caregivers. Those individual moments, when somebody wasn’t expected to improve and they do, are really gratifying. And seeing care done well and safely is also important to me. Putting in an equipment solution that keeps people safe is really satisfying.”