Posted 28 April 2021 - 08:00
Posted 28 April 2021 - 08:00
Practice question
How can further deconditioning be prevented in older people after COVID-19?
Nurses can help counter the physical and cognitive decline of older people
Nurses can help counter the physical and cognitive decline of older people caused by their isolation during the pandemic
Throughout the COVID-19 pandemic, social distancing guidelines have been the foundation of infection control measures, mitigating the transmission and spread of the virus.
Reduced movement because of social isolation and cessation of non-essential services have consequently increased the risk of deconditioning in the general population. This risk has been the greatest for people considered vulnerable and advised to shield, with older, frailer members of society being the most significantly affected.
Adverse effects of restrictions have been profound
Across all care settings, restrictions on visits from relatives, entertainers and services such as hairdressing have been enforced. Access to input from healthcare professionals and support services has also been greatly affected.
Day care facilities, falls prevention groups and befriending services have also had significant restrictions imposed, meaning that vulnerable older people have spent more time alone, with much less interacting and socialising with others.
The adverse effects of these restrictions have been profound, causing cognitive decline, depression, malnutrition, accelerated sarcopenia (loss of muscle mass and strength) and increasing frailty (Maltese et al 2020). Acute sarcopenia, caused by prolonged immobility, is recognised as a main contributor to deconditioning in older adults (Welch et al 2020).
Although barriers to service provision continue to impose challenges for nursing staff, simple measures can be implemented in day-to-day practice to reduce the risk of deconditioning for older adults across hospital, community and care home settings.
With evidence suggesting early rehabilitation is effective in improving functional outcomes (Horgan et al 2019), secondary care providers have engaged with campaigns, such as #EndPJparalysis and #Red2Green, encouraging patients to get up, dressed and moving every day during their hospital admission (Dolan 2017).
Nurses need support to facilitate the early mobilisation of patients
Nurses are vital to a patient’s rehabilitation and reconditioning process, through empowering individuals to maintain their independence with activities of daily living as much as possible.
Nurses must also feel supported to facilitate the early mobilisation of patients where safe and feasible, while awaiting input from therapy teams. This will contribute to reducing unnecessary delays in discharge and further decrease deconditioning risk.
Supporting the reintroduction of visiting in nursing and residential care homes is likely to reduce the adverse effects of social isolation, with beneficial effects on reversing associated deconditioning (Abbasi 2020). Where safe and feasible, the reintroduction of having relatives visiting should be facilitated at the earliest opportunity.
Tips to prevent further deconditioning in older people
Encourage patients to visit bathroom facilities for washing, bathing and toileting wherever possible, rather than using bedside facilities. Establish regular toileting regimens to promote continence and further encourage mobility
Encourage physical mobility rather than the use of wheelchairs and encourage simple chair-based exercises to improve muscle strength and reduce falls risk
Following local infection control guidance, relatives should be encouraged to provide clothing, appropriate footwear and sensory aids, plus reading materials and/or puzzles to support cognitive function
Social eating can support maintenance of good nutritional status and social interaction, and develop companionship (Watkins et al 2017), and older people should be encouraged to sit on bedside chairs or at dining tables to ensure an adequate position for eating and drinking and to optimise oral intake
Allocated activity time should be used as much as possible, and although this is understandably difficult due to staffing pressures and lack of external entertainment support, staff can aim to encourage communal social and physical activities, particularly in care home settings, including puzzle games and reminiscence activities
Practice Question is written by members of the Nurses and AHPs Council of the British Geriatrics Society
Further resources
- Chartered Society of Physiotherapy (2018) Never Too Late! Physiotherapy Advice for Maintaining Strength as We Age
- Health Innovation Network, South London (2020) Activities for Older Adults During COVID-19. A Guide to Online Resources for Those Providing Care for People with Dementia
- University Hospitals of North Midlands NHS Trust (2016) A Campaign for Deconditioning Awareness – “Sit Up… Get Dressed… Keep on Moving…”
References
- Abbasi J (2020) Social isolation – the other COVID-19 threat in nursing homes. JAMA. 324, 7, 619-620. doi: 10.1001/jama.2020.13484
- Dolan B (2017) Mindset shift on PJ paralysis. Nursing Standard. 31, 47, 32. doi: 10.7748/ns.31.47.32.s29
- Horgan A, Carr M, Murphy A (2019) 135 The impact of an early mobilisation initiative evidence from an acute care setting. Age and Ageing. 48, Suppl 3, iii17-iii65. doi: 10.1093/ageing/afz103.80
- Maltese G, Corsonello A, Di Rosa M et al (2020) Frailty and COVID-19: a systematic scoping review. Journal of Clinical Medicine. 9, 7, 2106. doi: 10.3390/jcm9072106
- Watkins R, Goodwin VA, Abbott RA et al (2017) Attitudes, perceptions and experiences of mealtimes among residents and staff in care homes for older adults: a systematic review of the qualitative literature. Geriatric Nursing. 38, 4, 325-333. doi: 10.1016/j.gerinurse.2016.12.002
- Welch C, Greig C, Masud T et al (2020) COVID-19 and acute sarcopenia. Aging and Disease. 11, 6, 1345-1351. doi: 10.14336/AD.2020.1014