Getting active

Activity doesn’t necessarily mean exercise – it means anything that we do – but most activity involves physical movement. Many people will not be able to take part in what we normally think of as ‘exercise’ but there many different activities that use different muscles and joints in the body. For example, singing exercises the diaphragm, and standing up uses balance and uses our bottom and leg muscles. 

Regular activity improves health

• General fitness levels
• Muscle strength and joint mobility
• Balance, posture and coordination.
• Bone density
• Skin integrity
• Appetite
• Sleep pattern and quality 
• Blood pressure and the potential for thrombosis and embolism diminishes 
• Urinary continence
• Blood circulation and breathing patterns
• Immune system.

Regular activity improves wellbeing

• Sense of belonging and purpose
• Self-esteem and self-worth
• Social connectedness- friendships
• Empowerment – a sense of choice, dignity and control
• Maintaining old roles and learning skills
• Confidence in abilities
• Alertness to environmental stimuli increases
• Concentration and memory 
• Outlet for emotions and self-expression 
• Relieve stress and feelings of boredom and agitation
• Daily living function. 

Myth no. 1 

Frail, older people cannot do exercise – not true! 

There is increasing evidence that even frailer older people age 85+ can take part in regular physical activity and rebuild some of their strength. 

It needs to be done gradually and within pain limits, and with some caution for certain conditions (maybe just in bouts of 5–10 minutes a few times a day at a lower intensity). 

For some people, chair exercises are the only option possible. These can improve balance and trunk flexibility, while working on shoulders, arms and wrists. For ideas, visit the NHS webpage on sitting exercises.

Myth no. 2 

We don’t have time to fit in exercise with all our other tasks – not true! 

Think about your existing routine and fit exercise in around it. In a typical day, how many opportunities are there for people to get up and get moving? For example, residents could be encouraged to go to another part of the lounge for refreshments, rather than the trolley coming to them.

Myth no. 3 

We are not experts in exercise – true! But…

There are plenty of resources out there to get ideas and you can bring in an exercise instructor, a physiotherapist or an occupational therapist who can teach a safe routine.

If someone is experiencing pain then they should stop.

Moving into a care home is a major life event. Everybody differs – some people will adjust easily, and others will find it harder. Their personality, coping mechanisms and whether they made the choice to move will all impact on the way they adapt to this next chapter in their life. 

The culture of the care home will also affect how motivated people are to live an active life in their new home. (Also see Motivation and communication).

The Alzheimer’s Society (2013)^[1] estimate that 80 per cent of people living in care homes have dementia. Given this high number, it’s important for every care home, of every type, to create the right environment for people with dementia. 

Getting the design right will:

• Support people to be involved in daily activities
• Help people find their way around the home
• Reduce confusion and distress.

This right environment will provide:

• Small-scale living units
• Familiar features and a homely style
• Age-appropriate furniture and fittings
• Opportunities to be involved in ordinary day-to-day activities
• Good signage and ‘cueing’ features
• Space for daytime activities
• Choice of areas with varying levels of stimuli
• Small dining rooms with a homely atmosphere
• Bedrooms with photographs and personal items that can be seen as they enter and from the bed. It is important that when the person wakes up and goes to sleep they recognise that this is their home.

References

1. Alzheimer’s Society (2013) Low expectations: attitudes on choice, care and community for people with dementia in care homes. London: Alzheimer’s Society.

The way a person sits or lies all day can make a huge impact on their independence, especially if they spend long periods of time sitting or lying in bed. 

People who are unable to change their position without help are vulnerable to contracture (making their muscles shorten). To make sure a person is well positioned and comfortable over 24 hours, you need to regularly change their position. 

Positioning includes looking at how they sleep, the chairs they sit on for meals and the chair they spend most of their time in. Making sure a person has a suitable pressure mattress needs to go hand-in-hand with how they are positioned in bed.

Good positioning can:

• Increase a person’s awareness of what is going on around them and help their communication
• Improve their reach and ability to do activities.

Correct seating can:

• Prevent skins problems (like pressure ulcers)
• Help with eating and improve digestion
• Help breathing and cardiovascular function
• Reduce the risk of falls.

A chair is a good fit when:

• It feels comfortable
• A person is sitting on their bottom and not their coccyx (tail of the spine)
• The depth of the seat allows the person to sit right back in the chair and there is two fingers’ width between the seat and the back of the person’s knees
• The back of the chair supports the natural curve of the person’s back
• The width of the seat allows a hand to slide either side of the person
• The person can rest their feet comfortably on the floor
• The arms of the chair provide support when the person gets up or sits down (Soft and receding arms don’t provide sufficient support)
• The weight of the person’s arms is comfortably supported through the elbows, forearms and wrists by the armrests.

Chairs should have a pressure relieving cushion. If possible, this should be part of the chair. Many people in care homes have suitable mattresses on their bed, but they are much more vulnerable in a chair, as their weight is concentrated in a smaller area. Blood supply is almost completely inhibited when sitting on a normal cushion.

Wheelchairs

Changes in posture are common in older people. Standard wheelchairs may not be comfortable or offer enough support, especially if the person has a number of musculoskeletal limitations. 

If a person spends long periods of time in a wheelchair, it is important that they use one that has been assessed to match their needs. Correct seating encourages people to sit upright; provides symmetry; offers lower back support and correct positioning of hips, knees, feet and shoulders.

Remember! People are different heights and sizes so make sure that  seating in the communal areas caters for all shapes and sizes.

All care homes are responsible and accountable for meeting national guidance and legal requirements for safeguarding adults. This is to protect older people from harm, abuse and neglect.

When supporting people to be active, safeguarding includes:

• Protecting people from being hurt by unsafe or unsuitable equipment
• Depriving someone of stimulation, company, adaptations, equipment or communication aids. 

Neglect can occur if you do not fully understand a person’s needs.

Please talk to the care home manager if, for example, you:

• Have concerns about how equipment is being used and maintained, e.g. a wheelchair or a hoist
• Feel a person is not being given opportunities to have company or to take part in daily activities.

There may be a reasonable explanation (the person might choose to be alone, or wheelchair maintenance might be already organised), but it is important to have that conversation.

Most people enjoy keeping in touch and spending time with family and friends. But it’s not always easy when living in a care home. Their friends may have died or family may live far away and can’t often visit. 

It can be difficult to make friends in a care home, especially:

• If a person has impaired mobility and so does not move around the home, then they do not ‘bump’ into other residents to be able to get to know them
• If a person has difficulty hearing or seeing it can be difficult to communicate with others, especially if the other person has problems too 
• If a person has dementia: they may not be able to remember the other person’s name, or what has just been said. Or they might not be able to communicate verbally any more. 

The environment can also make it difficult. For example the traditional picture of a care home, where everyone sits around the edges of the room. 

You can help by:  

• Encouraging opportunities to chat, such as afternoon tea around a table 
• Drawing people together with similar interests by running groups or supporting shared hobbies (see Ideas for activities) 
• Encouraging contact with family and friends by telephone, messaging or email. Adaptations for telephones and computers are available to help people with impaired senses or dexterity
• Welcoming visitors into the care home and having private space(s) where residents can entertain
• Recruiting volunteers to spend time with people who do not have family or friends who can visit them.