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Mobilization

Mobilization. An introductory module for clinicians. Dr. Barbara Liu , Geriatrician, Executive Director of the RGP of Toronto, and Program Director Geriatrics, University of Toronto.

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Mobilization

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  1. Mobilization An introductory module for clinicians Dr. Barbara Liu, Geriatrician, Executive Director of the RGP of Toronto, and Program Director Geriatrics, University of Toronto Dr. Paul Oh, Medical Director of the Cardiovascular Prevention and Rehabilitation Program and a Scientist at the Toronto Rehabilitation Institute

  2. This module is part of the sfCare approach Patient Handout 8.5 x 11 Poster PowerPoint Presentation

  3. Objectives Identify the negative effects that immobility can have on older adults Describe mobilization recommendations for non-frail, pre-frail, and frail older adults Give examples of mobilization ideas that you can recommend for your older adult patients Apply a senior-friendly approach to mobility Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions

  4. Importance of mobilization We lose muscle mass as we age, and immobility compounds the effect of age Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions Each day, older patients without mobilization lose 1 to 5% of muscle strength (Annals Int Med 1993;118:219-23) At 65, you’ve potentially lost between 8% and 27% of your muscle mass

  5. Importance of mobilization Older adults may have high risk profiles and poor baseline fitness. With immobility comes: Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions Negative health complications Decrease in functional capacity and independence Increased mortality

  6. Hazards of immobility* • Respiratory System • Decreased lung volume • Pooling of mucous • Psychological • Anxiety • Depression Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions • Circulatory System • Loss of plasma volume • Loss of orthostatic compensation • Gastrointestinal System • Reflux • Loss of appetite • Genitourinary System • Incomplete bladder emptying • Formation of calculi in kidneys and infection • Musculoskeletal • System • Weakness • Muscle atrophy * Cunningham 1997; Lexell 1998; Vandervoort 1986; Bassey 1989; Manton 1993; Paterson 2004

  7. Importance of mobilization Fitness is important for longevity, function and independence Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions Exercise Physical Activity Sit less and move more “Exercise is the medicine to reverse or mitigate frailty, preserve quality of life, and restore independent functioning in older adults at risk of frailty.” + ONLY The average adult spends 20% 10 of adults get enough physical activity hours per day sitting Exercise prescription to reverse frailty. Nick W. Bray, Rowan R. Smart, Jennifer M. Jakobi, and Gareth R. Jones Appl. Physiol. Nutr. Metab. 41: 1112–1116 (2016) www.participaction.com/en-ca/benefits-and-guidelines/adults-65-plus

  8. Exercise There are three determinants of dependence in older adults – which of these is modifiable? Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions • Older age • Comorbidity • Lower fitness PatersonJAGS 2004;52:1632-1638

  9. Exercise The benefits of being active include: Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions • Reduced rates of: • All-cause mortality • Coronary heart disease • High blood pressure • Stroke • High cholesterol • Type 2 diabetes • Breast cancer • Colon cancer • Depression • Falling Paterson JAGS 2004;52:1632-1638

  10. Exercise and frailty The benefits of being active include: Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions • Improvements in: • Falls • Mobility • Balance • Functional ability • Strength • Body composition • Frailty Paterson JAGS 2004;52:1632-1638

  11. Mobilization recommendations Non-frail older adults should follow the Canadian Physical Activity Guidelines for Older Adults (2011) as a basic exercise recommendation: Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions • 150 minutes per week of moderate to vigorous aerobic activity, in bouts of 10 minutes • muscle and bone strengthening exercises 2 days per week • those with poor mobility should add exercises to enhance balance and prevent falls Moderate Vigorous • Sweat a little, breath harder • Brisk walking • Bicycling • Sweat and be out of breath • Cross-country skiing • Swimming Appl. Physiol. Nutr. Metab. 41: 1112–1116 (2016) Canadian Physical Activity Guidelines for Older Adults (2011) www.csep.ca/CMFiles/Guidelines/CSEP_PAGuidelines_older-adults_en.pdf

  12. Mobilization recommendations Pre-frail older adults should: • Exercise 3 times a week for 45-60 minutes per session at an intensity that is moderate-vigorous • Do various exercise modalities that includes aerobic, resistance, balance, and flexibility activities. 30 - 40 minutes of training time should be dedicated to resistance and balance-training activities RESISTANCE TRAINING Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions 2-3/week 80% of 1-RM 20 min AEROBIC 2-3/week 3-4 RPE 10 min TOTAL ACCUMULATED TIME: 60 min/session FLEXIBILITY BALANCE 2-3/week 3-4 RPE 10 min 2-3/week 3-4 RPE 20 min Appl. Physiol. Nutr. Metab. 41: 1112–1116 (2016)

  13. Mobilization recommendations Frail older adults should: • Exercise 3 times a week for 30 - 45 min at an intensity that is moderate-vigorous • Do various exercise modalities that includes aerobic, resistance, balance, and flexibility activities. 10 - 20 min of training time should be dedicated to aerobic training RESISTANCE TRAINING Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions 2-3/week 80% of 1-RM 10 min BALANCE 2-3/week 3-4 RPE 8 min TOTAL ACCUMULATED TIME: 45 min/session AEROBIC FLEXIBILITY 2-3/week 3-4 RPE 7 min 2-3/week 3-4 RPE 20 min Appl. Physiol. Nutr. Metab. 41: 1112–1116 (2016)

  14. Even if you mobilize, there is increased mortality with increased sedentary time Quartile 1 Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions Most Sedentary Quartile 2 Quartile 3 Quartile 4 Least Sedentary Annals Intern Med 2017;167:465

  15. Physical activity 30 minutes of mobilization a day is not enough. What are we doing with the rest of our day? Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions Too much sitting is also hazardous to our health

  16. Physical activity Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions “...rest in bed is anatomically, physiologically and psychologically unsound. Look at a patient lying long in bed. What a pathetic picture he makes! The blood clotting in his veins, the lime draining from his bones, the scybala stacking up in his colon, the flesh rotting from his seat, the urine leaking from his distended bladder and the spirit evaporating from his soul.”

  17. Physical activity Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions Walking is man’s best medicine Hippocrates (460 – 370 BC)

  18. Physical activity All older adults should minimise the amount of time spent being sedentary (sitting) for extended periods Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions Sitting less and moving more — how?

  19. Mobilization ideas • Stand up during commercial breaks • Put the remote control next to the TV • Stand up when finishing a book chapter • Extend the time to complete chores • Use the stairs • Stand up to eat breakfast • Do some exercises while waiting for a meal to cook • Stand up to meet friends Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions

  20. Mobilization ideas • Stand up to wait for the bus • Park car further away from shopping centre • Break up your nightly routine • Walk around / dance while listening to music • Stand up after each hand of bridge • Drink more water • Walk to the movies to compensate for extra sitting Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions

  21. Summary Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions • Seniors may have high risk profiles and poor baseline fitness • Fitness does improve significantly and importantly regardless of age • Important for longevity and independence • Exercise training is safe and readily available

  22. The senior friendly approach How all healthcare providers can address mobility using a senior friendly care approach Ask leaders to removing barriers to care, and provide education for staff, patients and caregivers. Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions Organizational Support Organizational Support Creating a mobility care plan is essential. Address mobility as a health issue. Emotional & Behavioural Environment Emotional & Behavioural Environment Processes of Care Processes of Care Not actively promoting mobilization in older adults is unethical. Ethics in Clinical Care and Research Ethics in Clinical Care and Research Ensure your organization is not only accessible, but also senior friendly (i.e., remove falls hazards). Physical Environment Physical Environment

  23. Discussion questions • What are some creative ways to encourage older adults to stay active? • What is the best way to encourage all staff to share the responsibility of mobilizing an older adult? • What are some of the most effective mobilization strategies you have used in your work? Objectives The importance of mobilization Recommendations Mobilization ideas Summary Senior friendly approach Questions

  24. The sfCare Learning Series received support from the Regional Geriatric Programs of Ontario, through funding provided by the Ministry of Health and Long-Term Care. V1 July 2019

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