Empowering movement in dementia care

This informal CPD article Empowering movement in dementia care was provided by Rebecca Hill, Marketing Manager at Arjo, who believe that empowering movement within healthcare environments is essential to providing quality of care.

Empowering movement in dementia care

The World Health Organization estimates that globally 50 million people have dementia, with approximately 10 million new cases annually. The projected prevalence for people living with dementia aged 60+ is 5 – 8%, while the total number of people is expected to reach 82 million in 2030 and 152 million in 2050.^{1 2}

Caring for people with dementia puts a significant burden on society, families, health and social care services³ with the annual cost to the UK economy estimated at £26.3 billion⁴.

The power of movement

According to the Social Care Institute for Excellence⁵, the worst thing you could say to someone living with dementia is ‘sit down’. They say that frequently people with dementia who are walking around are asked to sit down, yet when a person is moving, they are often expressing a need that should be met rather than dismissed.  Alternatively, resident empowerment places the individual at the centre of care that is inclusive and enables people to take control of their own health care needs, understand their condition and its effect on their body and mind, which in itself is a challenge for people living with dementia.

Mobility improves dignity, functional independence, and can lead to improvements in physical and mental well-being of the resident.⁶

So, what is dementia and how does it affect movement?

Dementia describes a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language. Initially symptoms could appear to be minor, but may affect the person’s activities of daily living, their mood and behaviour. Dementia is generally caused by damage to or disruptions of brain cells, particularly in the cerebral cortex, which controls memory, perception, consciousness, and language.⁷

 As dementia progresses, people may have difficulty concentrating and remaining mobile⁸, gradually losing their ability to walk, stand or transfer and are more prone to falls. In the latter stages of dementia the individual is reliant on caregivers to assist with all personal care and repositioning in bed.    

The impact of immobility

Elderly, vulnerable or frail residents with impaired mobility may have an increased risk of muscle weakness, confusion and reduced bone mass, they can also become demotivated, have increased dependency⁹ and are generally at a high risk of falling^{10 11}. The introduction of assistive technology during activities of daily living, can support the resident’s functional mobility level; improve their confidence; reduce the risk of healthcare-acquired conditions¹² and caregiver injury¹³.

Empowering movement

In dementia care, it is important to consider the residents cognition, responsive behaviours and functional mobility level to enable them to continue with activities depending on their capabilities For example, playing familiar music to a resident who appears passive may stimulate a positive and engaged response. 

Equally caregivers need to support the family to understand why an agitated or restless resident continuously walks around the care setting. Perhaps the person is trying to find something, someone or they may simply enjoy the sense of doing something purposeful. Whilst mitigating any actual or potential risk, it is paramount that we focus on and facilitate the activities of daily living that a resident can do, rather than those they can’t¹⁴.

The right environment, equipment and care skills can empower caregivers to provide person-centred care that reduces healthcare-acquired conditions; improves functional mobility levels; resident experience and prevents caregiver injuries, as well increasing workflow and operational efficiencies leading to reduced costs¹⁵.

Empowering movement through design

The physical environment can support or impede someone living with dementia, whether it’s in a person’s own home or a care home setting. Assistive technology, developing dementia-friendly communities and understanding risk, all play an important role in supporting residents and caregivers alike.¹⁶ This means not only establishing an environment, which presents a familiar or homelike appearance, using colour, contrast, textures and sounds to differentiate key features, but also creating enough space to allow for appropriate equipment to support care activities.

The design should be adaptable for residents with different levels of mobility and cognition, enabling the ergonomic use of mobility and transfer aids that supports a resident to participate in daily activities and personal care routines.

For the caregiver, it is important to be able to perform tasks as efficiently as possible while minimising the risk of injury. While the care situation may vary, each lift, transfer and forward bending activity poses some risk of physical overload, and a poorly designed environment only compounds this problem.

Empowering movement with purpose for residents living with dementia can help to improve their quality of life and dignity, while improving the clinical, financial and operational outcomes for the facility. 

We hope this article was helpful. For more information from Arjo, please visit their CPD Member Directory page. Alternatively please visit the CPD Industry Hubs for more CPD articles, courses and events relevant to your Continuing Professional Development requirements.

References

¹World Health Organization website https://www.who.int/news-room/fact-sheets/detail/dementia Accessed August 2022

²Public Health England: Health matters: midlife approaches to reduce dementia risk, 22 March 2016, https://www.gov.uk/government/publications/health-matters-midlife-approaches-to-reduce-dementia-risk/health-matters-midlife-approaches-to-reduce-dementia-risk Accessed August 2022

³Nichols E (2019) Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurology; 18: 1, 88-106

⁴Public Health England: Health matters: midlife approaches to reduce dementia risk, 22 March 2016, https://www.gov.uk/government/publications/health-matters-midlife-approaches-to-reduce-dementia-risk/health-matters-midlife-approaches-to-reduce-dementia-risk Accessed August 2022

⁵Social care institute for excellence, Movement and exercise for people with dementia https://www.scie.org.uk/dementia/living-with-dementia/keeping-active/movement-exercise.asp Accessed August 2022

⁶Musich S., Wang S., Hawkins K., et al (2018) The impact of mobility limitations on health outcomes among older adults https://www.sciencedirect.com/science/article/pii/S0197457217302057 Accessed August 2022

⁷Alzheimer’s Society, What is Dementia? https://www.alzheimers.org.uk/about-dementia/types-dementia/what-dementia Accessed August 2022

⁸Alzheimer’s Society, Mental and physical activities in the later stages https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-progresses/mental-and-physical-activities Accessed August 2022

⁹NHS England, Frailty resources https://www.england.nhs.uk/ourwork/clinical-policy/older-people/frailty/frailty-resources/ Accessed August 2022

¹⁰National Institute For Health and Care Excellence (NICE) (2016) Health and social care directorate. Quality standards and indicators. Briefing paper. Quality standard topic: Falls in older people: preventing a first fall Output: Prioritised quality improvement areas for development. 25 May 2016 https://www.nice.org.uk/guidance/QS86/documents/briefing-paper-2  Accessed August 2022

¹¹The Office of National Statistics August 2022

¹²Daragh A, et al. Safe Patient Handling Equipment in Therapy Practice: Implications for Rehabilitation. The American Journal of Occupational Therapy. 2013; 67(1):45-53.)

¹³Cromie JE, Robertson VJ, Best MO: Work-related musculoskeletal disorders in physical therapists: prevalence, severity, risks, and responses. PhysTher 2000, 80(4):336-351.

¹⁴Social care institute for excellence, Advanced dementia https://www.scie.org.uk/dementia/advanced-dementia-and-end-of-life-care/advanced-dementia/introduction.asp  Accessed August 2022

¹⁵Arjo Positive 8 – Arjo insights https://www.arjo.com/en-gb/insights/positive-eight/  Accessed August 2022

¹⁶Social care institute for excellence, Dementai-friendly environment https://www.scie.org.uk/dementia/supporting-people-with-dementia/dementia-friendly-environments/?gclid=EAIaIQobChMIxseSqKe18AIVwZ7tCh3oUAlKEAAYAyAAEgLSjPD_BwE Accessed August 2022