Mobility & Safety

What is mobility?

Mobility is a state or quality of being mobile or movable

What are the 4Ms Framework?

• What Matters

• Medication

• Mentation

• Mobility

What does the “what matters” section mean?

Know & align care with each older adult’s specific health outcome goals & care preferences including, but not limited to, end-of-ife care, & across settings of care

What does the “medication” section mean?

If medication is necessary, use age-friendly medication that does not interfere with What Matters to the older adult, mobility or mentation across settings of care

What does the “mobility” section mean?

Ensure that older adults move safely every day in order to maintain function & do What Matters

What are parts of the body that are required to be mobile?

Brain, muscles, spinal cord, bones, joints, nerves, etc.

What are the attributes that contribute to mobility?

• Range of activities that require mobility

• Strength

• Endurance (how much strength and how long our muscles can go)

• Coordination (ability for our brain to tell muscles to do something to effectively achieve a task

  • Balance is important

What is the scope of mobility?

Full independent mobility

Partial or impaired mobility

Immobility

What is the common activity associated with mobility?

Walking

What is impaired physical mobility?

A state in which a person has a limitation in physical movement but is not immobile

What causes partial or impaired mobility?

Change in General Health

Muscuskeletal, Neurologic, & Neuromuscular Conditions

Medical Procedures/Diagnostic Tests

What is the consequence of impaired mobility & immobility in the cardiovascular system?

• Reduced cardiac capacity

• Orthostatic hypotension

• Blood clots

What is the consequence of impaired mobility & immobility in the respiratory system?

Reduced lung expansion

What is the consequence of impaired mobility & immobility in the musculoskeletal system?

Atrophy, bone demineralization

What is the consequence of impaired mobility & immobility in the integumentary system?

Risk for skin breakdown

What is the consequence of impaired mobility & immobility in the gastrointestinal system?

Constipation

What is the consequence of impaired mobility & immobility in the urinary system?

Renal stones and infection

What is the consequence of impaired mobility & immobility in the psychological system?

Depression, anxiety

What is disuse syndrome?

Predictable adverse effect of sedentary life on tissues and function

What is deconditioning?

A loss of physical fitness due to not maintaining physical activity

Can bed rest cause decodnitionnig?

Yes

• Decreases the physiological ability to adapt blood pressure to positional changes

• Decreases calcium absorption in the bone and leads to decreased bone mass (increases risk of fractures)

• The negative consequences of bed rest are independent of disease or disorder

What is the physical abnormality resulting in difficulty walking or impaired walking?

An abnormal gait

What is human gait?

It is the patterns of walking -- walking involves balance and coordination of muscles so that the body can be propelled forward with rhythm and human gait is the patter

What is an abnormal gait?

It is when a person is unable to walk in a normal way -- there are numerous possibilities to affect normal gait

What are the causes of an abnormal gait?

Illness, genetic factors, injury, shin splints, birth defects, infection in inner ear, cerebral palsy, stroke, tendonitis

How do you diagnose an abnormal gait?

Medical history, symptoms, observations of walking, tests for neurological damage or injuries

What are the treatments to abnormal gait?

Physio, physical therapy, assistive devices like walkers and canes, etc

What are the different types of abnormal gait?

Spastic (drags feet while walking), scissors (whose legs bend inwards when walking), steppage (person points toes towards ground while walking), waddling (moves side to side), propulsive (walks with their head and neck pushed forward)

Identify parts of the body that are affected by osteoarthritis and explain what it is

Joints

• Inflammation of the joints which causes them to be smaller thus the cushioning between bones are smaller and causing the bones to rub against each other which causes friction and leads to pain and inflammation

what is Parkinson's disease? - -A neurodegenerative disease causing a movement disorder
-affects the substantial nigra (located just above where the spinal cord meets the midbrain)
-it is the gradual loss of dopamine producing brain cells of the substantial nigra (70-80% loss of dopamine)
-dopamine has a key role in intentional movement
-has an effect on other non movement related symptoms (sleeping, smell and thinking)
-L dopa is given to see for diagnostic purposes but has to be given at a certain time as it has a specific peak absorption time -- if it gets better then it is parkinsons

What is the ICF model? - A person's condition is made up of many interactions including: body structure/function, activities, participation as well as personal and environmental factors that can effect those interactions.

identify a model that describes the impact of changes in the body functions/structures on functioning, disability, and health - ICF model
(international classification of functioning)

How can someone with osteoarthritis or parkinsons exemplify immobility and complete mobility? - some people have these diseases and do not show symptoms
-it is when the older adult experiences physical decline that results in restriction in the ability to perform ADL's when they start to become immobile and dependent

what is disuse syndrome? - deterioration of body systems as a result of prescribed or unavoidable musculoskeletal inactivity
-basically condition that describes the effects of the body and mind when a person is sedentary -- not using our body leads to deterioration of many body functions

What is deconditioning? - Involves physiological changes following a period of inactivity, bed rest, or sedentary lifestyle.
-refers to all the physical, mental and social consequences associated with inactivity
-its effects are generally reversible but the effects it has on a person can impact their autonomy

what causes deconditioning? - bed rest and sedentary lifestyle whether prescribed or inactivity

how can bed rest cause deconditioning? - -decreases physiological activity to adapt blood pressure to positional changes
-decreases calcium absorption in the bone and leads to decreased bone bass (increase risk of fractures)
-negative consequences of bed rest are independent of disease or disorder

how can environment and health impact mobility? - can cause disuse syndrome and deconditioning

identify factors that contribute to the risk for impaired mobility for the older adult - -age related changes affecting muscles and bones
-risk factors for impaired mobility increases such as pathological conditions that affect the muscles and bones (i.e., osteoarthritis and parkinsons) and their fear of falling

what is impaired mobility? - impaired mobility is associated with poorer health outcomes and negative functional outcomes

why is there more reported changes in mobility in women than in men? - -women tend to be more concerned with their ability to be independent as well as doing their ADLs in comparison to men

what are age-related changes associated with mobility? - musculoskeletal system is responsible for movement, responses to the environment and maintenance of posture
-mobility is affected by strength, flexibility, postural stability, vibratory sensation, cognition and perceived stability
-changes are influenced by age, sex, genetics and environment
-age related changed are not life threatening but could impact function
-proper management of chronic illness and maintenance of health lifestyles can forestall the onset of mobility limitations for the older adult

what are age-related changes to the musculoskeletal system? - -changes in the ligaments, tendons, and joints have the most effect on function -- they become dry, hardened, and less flexible. The joint space can also decrease which can cause arthritis
-bone mass decreases -- their bones lose their strength and becomes more brittle which increases risk for breakage and fractures -- can cause kyphosis
-muscles have reduced strength and flexibility, ROM becomes more limited, Sarcopenia can occur

What is kyphosis? - Slouch back (shoulders roll forward)

what is sarcopenia - loss of muscle mass strength and function associated with frailty

How can gain change with age? - -narrowing of standing base
-wider side to side swaying when walking
-slower reaction time (can lead to injuries)
-a greater resilience on proprioception (the sense of movement and position of the body in space which is independent of vision)
-proprioception can be reduced
-steps are slower
-decrease in height step
-changes are more pronounced in people with sedentary lifestyle

how can pathological conditions such as osteoarthritis and osteoporosis increase risk for immobility? - -osteoporosis and osteopenia is the loss of bone mineral density. The peak bone mass hits around a persons 30s. Women tend to have greater loss of bone mass especially around menopause. This is the silent disease and causes fragility fracture. 1/3 women and 1/5 men experience an osteoporotic fracture in their lifetime
-Osteoarthritis is the degenerative inflammatory disease affecting joints and attached muscles, tendons, and ligaments, pain, swelling and limited movement. It is the extreme progression of age-related changes

what is the prevalence of osteoarthritis - -most common type of arthritis
-1/10 Canadians have it -- higher in women and indigenous peoples and less in asian people

tell me about osteoarthritis - -stiffness greater in the morning and relieved with activity
-pain associated with increased use of the joint
0disease progression is associated with increased pain including at rest
-joint instability and crepitus (describes a popping, clicking or crackling sound in a joint) causes joint deterioration
-joints can enlarge and decrease the ROM
-most common joints associated: knee, thus, lower back, fingers, and hips

tell me about parkinsons disease - -insidious onset
-must rule out other causes first
-an umbrella term that describes conditions that cause: rigidity (severe muscle cramps, cog wheeling, micrographia), tremor, bradykinesia, postural instability

what is cogwheeling - It is a jerky feeling in your arm or leg that you (or your healthcare provider) can sense when moving or rotating your affected limb or joint. It is an early effect of Parkinson's disease
-intermittent resistance to movement

what is micrographia - talking quietly

what is bradykinesia - slow movement or not using the full range of motion

what are other symptoms of parkinsons disease - moo, apathy, pain, cognitive impairment, constipation, urinary incontinence, sexual dysfunction and reduced sense of smell

how can you identify cues and altered mobility in parkinsons? - presence of 2.4 symptoms:
resting tremor or bradykinesia, asymmetrical regular and rhythmic, rigidity and postural instability, fait (festination -- very short steps or shuffling and minimal arm movement), postural reflexes lost, freezing, involuntary flexion of the head and neck (a stooped posture and a tendency to fall back), off balance

how does the person experience parkinsons? - -life altering but not threatening
-leading source of disability
-affects roles, responsibilities, and social participation
-tremors may produce embarrassing moments
-changes in facial expression and movement may be interpreted as depression or disinterest
-may appear as cognitively impaired when they are not
-undesried facade (trapped in a body that no longer responds)

what is a fear of falling - a persons anxiety towards usual or normal walking or mobilizing, with the perception that a fall will occur

describe nursing assessments for risk of impaired mobility and for falls - -maintain mobility
-reduce risk for falls
-reduce risk of injury from falls

what is a fall? - an unexpected event in which the participant comes to rest on the ground, floor or lower level

what is a geriatric syndromes? - A collection of signs and symptoms in an older client that means something more.

• sleep disorder -problems with eating

• incontinence

• confusion

• evidence of falls

• skin breakdowns

this is an interaction between an extrinsic factor (env) and intrinsic factor (related to person)

medications are a significant factor in contributing to falls

what can contribute to a fall that is not associated with age - -poor footwear
-inadequate assessment and communication with patient
-environmental safety
-UTIs associated with falls
-insomnia

what is the goal of care for falls? - minimize the risk factors and decreasing the serious injuries associated with falls

what are the associated assessments of risks for falls? - -comprehensive geriatric assessment/multidisciplinary assessment
-recognize risks by assessing mobility (walking speed, TUG, and ADLs and IADLs)
-recognize risk by assessing potential adverse medication effect that impact mobility
-recognize risk by applying a mobility and fall risk assessment toold
-recognize environmental risk

what are clinical assessments of intrinsic and extrinsic factors associated with falls? - -fall history
-question fear of falling
-vision
-postural blood pressure
-balance and gait
-targeted neurological examination
-targeted musculoskeletal examination
-targeted cardiovascular examination
-evaluation of home hazards

what medications have adverse effects that can impair mobility? - -antiarrhythmics
-anticholinergics
-anticonvulsants
-diuretics
-benzodiazepines and other hypnotics
-antipsychotics
-antidepressants
-alcohol

what are assessment tools to assess fall risks? - Hendrick fall risk model
-fall risk assessment tool (FRAT)
-berg balance test

what sets FRAT apart from other assessment tools? - -identifies whether patient is male
-gives some areas more weight than others based on its relevance
-out of 20 -- 16-20 is high risk, 12-15 is medium and 5-11 is low

what are the 8 risk factors assessed in Hendricks Fall Risk Assessment Model - -cognition
-symptomatic depression
-altered elimination
-dizziness or vertigo
-gender
-medications
-get up and go "rising from the chair"
-balance

what indicates in the Hendrick fall risk assessment model that a pt is at risk of falls? - having 5 or more factors out of the 8 listed

how to assess orthostatic blood pressure - 1) older adult will be in supine position for greater than five minutes 2)take the older adults blood pressure immediately after standing 3) take the older adults blood pressure two minutes after standing 4) a drop of greater than 20mmHg in systolic pressure immediately or 2 minutes after indicates orthostatic hypotension

what is the berg balance scale - A 14-item objective measure designed to assess static balance and fall risk in adult populations
-assesses balance on functional tasks
-includes the minimum data set -- history of falls

what are hazards for falls in institutions? - -lighting can be dark and glare and shadows
-hallways are cluttered
-bathrooms lack grab bars
-staff are too busy, inadequate number and can be their attitude
-walking surface where there's higher potential for spills
-furniture may not be the right height
-shoes are too loose, or badly worn

what is the policy regarding physical restraints? - the use of restraint shall be the least restraint possible and of the best interest of the resident and consistent with the overall therapeutic goal

when should physical restraint never be used? - -as a convenience for the staff of the PCH
-as a standing order
-while the resident is on a commode or toilet
-as a form of punishment or discipline

what are neighbourhood characteristics impacting mobility - -safety from traffic (traffic speed, volume and distracted drivers)
-safety from crime (strangers, drunken people, crime rate)
-physical environment (light conditions, drainage ditches, maintenance of streets)
-social environment (walking and biking neighbours and social support)

what should a post-fall assessment include? - -description of the fall
-medication review
-physical examination (VS, pain, skin, bone, neurological, ROM, Glasgow coma scale -- ask to monitor for 3 days after fall)
-functional assessment
-environmental assessment

discuss interventions that promote the safe mobility of the older adult - 1) primary prevention -- keeping active
2) environmental modification
-medication review
-assistive devices
-education
-monitoring in LTC

what are primary preventions for falls - -optimizing exercise
-optimal nutrition nd adequate fluid intake
-adequate rest
-preventing injury including reducing environmental hazards
-manage obesity

what are the benefits of keeping mobile through activity? - -reduced mortality, prevents cardiovascular disease and diabetes
-reduced risk of breast cancer and colon cancer
-reduce risk of stroke
-reduces risk of dementia and improves the physical health of those with dementia
-helps maintain functional status and improves quality of life
-helps foster a sense of individual mastery, self-esteem and improves social interaction

identify and describe the physical activity guidelines for older adults - -moderate to vigorous aerobic physical activities with the accumulation of 150mins per week
-muscle strengthening activities using major muscle groups at least twice a week
-PA challenging balance
-getting 7-8 hours of good quality sleep on a regular basis
-limiting sedentary time to 8 hours or less

what is the percentage of older adults attaining the proper amount of exercise? - 12% meet the recommended levels of aerobic and muscle-strengthening activity

what are individual barriers and environmental barriers to achieving exercise guidelines? - Individual:
-ability to engage
-education
-equipment
-language barrier

environmental:
-access
-social env
-fitness instructor oriented to younger people

what kind of exercise can reduce frailty? - resistance training, balance exercise, etc

what is frailty? - Common clinical syndrome in older adults, leaving person vulnerable to falls, functional decline, disability, disease, and death

Women have bigger issue w/ frailty than men

what are interventions to promote mobility and safety? - 1) treat cause and chronic conditions (evaluate for reversible causes of cognitive impairment like delirium, reevaluate risk factors after treatment of conditions, conduct medication review) 2) education of client on the risks associated with condition 3) therapeutic exercise -- strength and balance training 4) Sensory -- provide hearing and vision assessment and referral while making sure the aids are worn and are suitable 5) modify environment by removing environmental hazards -- ensuring clothing and footwear is appropriate, no side rails and having fall mats, bed at low height 6)Fear of falling assessment -- encourage individuals to verbalize feeling and strengthen self-efficacy related to transfers. Proving a plan for ambulation and verbal encouragement 7) communicating risk of falls to other workers -- identify the client as being at risk for a fall and communicate risk by use of a visual identifier

what are the goals of care and interventions for osteoarthritis? - -maintain healthy body weight
-stay physically active
-protect joints from injury and overuse
-therapeutic exercise
-weight management
-pain medications may be helpful at times
-supportive devices: canes and walkers
-joint replacement for knees and hips in severe cases

what are the goals of care and interventions for parkinsons disease? - -address gait impairment
-relieve symptoms (l dopa, pain management, treat postural hypotension, incontinence, GI distress, depression, sleep disturbance and constipation)
-increase functional ability
-prevent excess disability
-decrease risk of injury
-supporting the coping of the person living with parsons and their intimate others