January 7, 2023
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I've been working as a physiotherapist for the past 7 years and the large majority of my clients express a simple desire: to remain at home for as long as possible. The desire is easily expressed. Unfortunately, the reality is that many people are fighting a losing battle as they age and their health deteriorates.
This begs the question: what can be done to help a person remain in their own home for as long as possible? Let me discuss some of the most effective interventions available based on my own experience as a physiotherapist.
Intervention Number 1: Exercise
The bread and butter of physiotherapy intervention is exercise prescription. Simple aerobic and / or resistance exercises every day can keep you safe and happy in your own home for longer by reducing falls risk and improving independence.
Falls are one of the most common causes of nursing home admission due to the risk of injury and associated fear that can cripple a person’s confidence. According to the World Health Organisation (see https://www.who.int/) approximately 30% of people over the age of 65 will have a fall in any given year, and for those aged 75 years and older the number is even higher. Also, the older we get the more likely we are to suffer a potentially life threatening injury as a result of a fall.
Luckily there are a number of interventions that can reduce falls risk, with exercise being one of the most important. A well thought out exercise program can result in substantial increases in strength, balance and general mobility, resulting in reduced risk of falling. For example: the Otago exercise program is a simple aerobic and resistance training program that can be performed comfortably at home and was shown to reduce falls by 30-60% amongst frail older adults.
Another beneficial by-product of exercise is improvements in personal independence. A persons ability to perform activities of daily living without the need for assistance is crucial in helping people avoid the nursing home. This is partly due to improvements in mobility, and partly due to improvements in mood and cognition. There is also plenty of evidence to suggest that exercise can slow down the progression of many aged related diseases, including dementia and Parkinson’s Disease.
Intervention Number 2: Environment Modification
Another important factor to consider is the suitability of the home environment. A safe and easy to access home environment will also reduce falls risk and improve independence. Modifying the home environment is often a multidisciplinary task, involving physiotherapist and occupational therapists. If more substantial modifications are required (such as renovation work to make a bathroom more accessible and safe) tradespersons may also be involved.
In saying that, many simple modifications can often make a big difference to safety and accessibility. Some common examples include equipment installation (such as railing and grab bars) and the purchase of ready-made equipment (such as over toilet frames, adjustable seating, anti-slip mats and walking frames). Also, simply rearranging furniture or decluttering a room to open the walkways can make a huge difference to safety and ease of access.
Intervention Number 3: Treating Impairments
In many cases, a person may need more than a generic exercise program to improve mobility. Oftentimes there is a specific impairment that may be preventing a person from living a safe, independent life at home. This is where a physiotherapists knowledge and experience can really come into play.
Maybe you're still recovering from a fracture. Perhaps you've had a stroke and require more specific interventions to address your movement impairment. Maybe you need to be assessed and prescribed a walking aid. Even 'non-physio' related impairments such as reduced vision, hearing and cognitive ability can be identified by an experienced physiotherapist, then appropriate treatment can be sought.
Other Considerations
Let me briefly discuss some other common concerns.
Multiple medications (especially 4 or more medications) can cause mobility issues and negatively impact a persons decision making abilities. Often a simple GP review is all that’s required to make sure your medications are effective and not compromising your safely. Book in to see the GP today if you are worried about your medication intake.
Also, incontinence often increases falls risk. When a patient is recounting their falls history it’s all too common to hear “I had a fall as I was rushing to go to the toilet.” Home modification and exercise can help improve toilet access. Incontinence training, where you can train your bladder and bowels to make toileting more regular and predictable, can also help.
Wearing bi-focal glasses when you’re mobilising can also increase your risk of falls. You may want to consider booking an appointment with your GP and optometrist if you are mobilising with bi-focals and consider switching to single vision lenses.
Finally, people are often surprised to learn that walking bare-feet is a falls risk. The safest option is to wear well-fitted, supportive shoes when walking and avoid bare-feet, thongs, sandals and socks.
If you would like any further information about our mobile physiotherapy services or would like to book an appointment give us a call on 0491 920 660 or email us at stayathomehealthgroup@gmail.com
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