The Wellness Approach
You have probably heard the story often: an active, self-sufficient elderly woman loses her balance, falls and fractures her hip. Not only is it painful, but it also requires hip replacement surgery, and months of rehabilitation. While her dream of living independently may be compromised, it doesn't have to mean a loss of independence.
The health care industry has made great strides in providing the kind of wellness and rehabilitation programs that assist seniors in remaining in or returning to their homes or apartments to continue living as independently as possible. For seniors, avoiding falls and staying healthy are crucial factors in creating positive outcomes with their health. As health care providers, one of the main goals is to help the elderly maintain their highest level of physical, emotional and social well being. Wellness and rehabilitation programs are essential components for achieving these goals. Wellness focuses on teaching senior citizens how to stay healthy. Rehabilitation is crucial for bringing older patients back to optimal health if injury or illness does occur.
Prevention: Importance of Senior Wellness
To ensure optimal health and quality of life, seniors need to be encouraged to incorporate physical activity such as wellness programs into their daily routine. These programs can help people stay active and vigorous far longer than those who lead a sedentary lifestyle.
Research in the wellness and rehab industries has shown that seniors who stay healthy and retain the ability to perform daily activities for themselves, have a better chance of aging in place, growing old in their lifelong home. This concept is more than a buzzword, for the elderly, aging in place can be vital to their quality of life. Having the opportunity to function independently in their activities, and in a familiar environment, is essential for self-esteem.
How do wellness programs help? We know that aging causes many changes, including reduced mobility, stamina and strength. Wellness programs provide a basic understanding of how the body changes as we age, how to decrease the progression of the changes, and how to adapt to the changes that are inevitable. This can help prolong the ability to stay independent.
Seniors can be taught wellness techniques and given information that can be put to use in their own homes to keep them healthy longer. This is a relatively new approach for the health care industry that has traditionally focused most of its energies and resource dollars on the treatment and care associated with sickness or a specific disease. Over the past 25 years, there has been a more proactive approach to health care, with a greater emphasis on prevention. Disease causes can now be correlated with lifestyle choices. Today we are seeing that an ounce of prevention is truly worth a pound of cure.
Life spans have increased substantially, so keeping people well has become important to enhance their lives.
Education is another important piece of any wellness program. When activities are combined with education, teaching clients how to carry nutrition and exercise into their daily lives, they are much less likely to lose what they have gained through the wellness programs. Education and training are helpful for dealing with specific issues the elderly face, such as illness, incontinence, back pain or recovery from surgery. Information to assist them with lifestyle changes such as smoking cessation and weight loss helps improve health. Techniques for better breathing, modifying an activity to conserve energy, improving posture and simplifying work, can be vital aspects of living independently.
Senior Mobility: Use it or lose it
Experts in the wellness industry have continuously proven that exercise helps seniors stay healthy longer. A proper exercise program offers numerous benefits including:
Improved general health and well being
Increased cardiovascular endurance
Enhanced joint flexibility
Increased physical capacity
For these reasons, exercise helps seniors remain active by allowing them to take a measure of control over their physical health. And, it helps them maintain the highest practical level of functioning.
For the elderly, loss of physical strength and flexibility are some of the most serious problems they face because strength and flexibility are needed to perform many daily activities. As we age, inactivity causes loss of muscle mass, strength, endurance, balance and flexibility. Eventually that loss takes a toll, reducing the older person's ability to perform functions on their own, which in turn requires dependence on others and for many, a loss in quality of life. Lost flexibility, for example, reduces the ability to dress and bathe oneself or reach for items.
Seniors can help to maintain or even restore some of these losses through exercise. What kind of exercise helps? Like anyone else who begins an exercise program, seniors need a program that will keep their interest. Programs can involve:
Strength exercises to build muscles and increase metabolism;
Endurance exercise to increase breathing and heart rate, improve stamina, or to contend with or prevent diabetes, heart disease and stroke;
Balance exercise to help prevent falls;
Flexibility through stretching to keep the body limber, and to improve and maintain fine motor skills.
Fitness, walking, water aerobics and yoga are all very beneficial, along with interjecting out of the ordinary activities such as golf and Tai Chi. At RehabWorks, we have seen positive results from these types of programs.
A structured program of water aerobics and pool activities has helped many patients who suffer from balance and strength issues. Using the water for resistance while wearing a buoyant vest and jogging or walking in the water, or performing specific arm and leg movements while sitting on a bench, has helped elderly patients regain strength and balance.
Water programs are especially beneficial for arthritis and osteoporosis, which are very common for the elderly. Generally, people who have difficulty maneuvering on land enjoy the buoyancy and ease-of-movement that water provides. Walking in the water adds some resistance for strengthening, but it also makes the exercises and activities easier to accomplish and prevent injuries. It provides a soothing and social environment, and gives the participant a sense of accomplishment.
Many of our patients notice the difference after just one session, finding that it's much easier to move on land after spending an hour exercising in the pool.
Therapists can evaluate a client's swing and utilize this as a screening tool to identify areas of the body that require toning, all while the patient is having fun and getting exercise.
Seniors incorporate the various Tai Chi body movements, which help them become better conditioned while having a good time. Tai Chi focuses on moving the body in a controlled way. It is relaxing for the participant and can be an integral part in improving flexibility, balance and strength.
Walking not only embraces mobility, but it also promotes wellness in many of the major body systems, including cardiovascular, musculoskeletal, digestive and respiratory.
All of these programs can be carried out at home or at a neighborhood facility such as swimming pool or park. All are important for increasing flexibility, balance and strength critical for seniors to remain active and as healthy as possible.
Treatment: When Injury or Illness Occurs
Even seniors who are active, exercise regularly and have good nutritional habits, may become injured, ill or need surgery. That is when rehabilitation programs become the vital link to recovery, and the chance to continue living on their own.
Each rehab patient must be handled as an individual case, said Julie Berkowitz, RehabWorks physical therapist. Especially with the elderly. They can have so many other issues that affect the therapy they receive, such as breathing or swallowing problems, or other illnesses.
Physical Rehab Works:A Case in Point
At a RehabWorks clinic located at Twining Village, a continuing care retirement community in Holland, Pa., 83-year-old Jennie Abate was treated. She needed to overcome several obstacles in addition to recovering from her cardiac bypass operation. She had severe osteoporosis (upright posture) as well as difficulty swallowing, that affected her eating habits and caused a more pronounced decline in her activity level and energy. As a result, she couldn't stand for more than a few seconds.
The first goal was to get her to stand for longer periods of time. Then she worked on bed mobility, being able to move from sitting to standing and learning the most energy-conserving ways to get in and out of bed. As time went on, Jennie started practicing more with her rolling walker and doing a variety of strengthening, balancing and reaching exercises to get her ready to go back to her independent living apartment. Within two months she could walk all the way outside and back again without stopping, and within a few more weeks she was able to return to her apartment.
"Rehab programs are designed to help patients reach their maximum functional level and maintain or re-attain their independence," Berkowitz said. "Once they're ready to go on their own, some patients are given home programs that may include exercises for strengthening upper and/or lower extremities and balancing activities to decrease the risk of falling."
Hip replacement is another common surgery among the elderly, requiring both physical and occupational therapy for rehabilitation.
The occupational therapy component focuses on helping the patients learn to do as much as possible on their own, RehabWorks Occupational Therapy Assistant Patricia Kolman.
This includes bathing, dressing, and getting themselves out of bed and into a wheelchair. Therapeutic exercises and activities for strengthening, wheelchair pushups, and activities for grasping are also included.
When it's needed, a home program can be recommended with daily exercises to enhance strengthening. The program may also include teaching clients to use adaptive equipment such as sock donners, long-handled reachers, shoehorns, back sponges, and dressing sticks. This kind of equipment makes life a lot easier for recovering hip replacement patients and helps make them more independent.
A Case in Point
A hip fracture resulting from a fall in her apartment last March changed June Horowitz?s life dramatically. This former nurse and very active senior suddenly faced the reality that she couldn't continue in her assisted living apartment.
Moving temporarily into a facility that offered more care, as well as rehab therapy, put her on the path to recovery. A rigorous therapy schedule brought back her strength and taught June the capabilities that allowed her to go back to her assisted living apartment in three months, while still maintaining some of her independence.
The goal with occupational therapy is to help clients regain their function, so they can be as independent and functional as possible, Kolman said. Even if they need to use adaptive equipment, they are still doing it themselves. That's the difference between having to be in a health care setting and being in their own home or apartment.
Wellness and rehabilitation programs are designed to ensure that seniors can maintain independence longer. Those that can be incorporated into the person's lifestyle will help them stay healthier, avoid accidents and preserve their independence.
Many wellness and rehab programs have been designed to be adapted for continuing use in the home, allowing more seniors to age in place. To be successful, these programs need to address the various health concerns of the aging population in a way that provides adequate resources and learning opportunities for seniors to maintain or improve their fitness, flexibility and quality of life.
RehabWorks, Inc., the nation's largest contract therapy provider, has over 25 years of experience in establishing successful rehabilitation programs. Providing services in more than 39 states, RehabWorks offers physical therapy, occupational therapy and speech language pathology services to the entire healthcare continuum from Pediatrics to Geriatrics. For more than five years, the company has offered its Recapture the Strength Senior Wellness Programs, combining physical activity and health education to enhance the quality of Iife for seniors across the country.
The company can be found on the Internet at www.rehabworks.com.
This article originally appeared in the October 2003 issue of HME Business.