The Need for Preventative Health Care Practices in Long-Term Care
Although nursing care facilities have made considerable advancements in the quality of life offered, there still is substantial room for improvement. One of the areas that need to be focused on is creating a culture that nurtures greater activity and promotes health. In many facilities the esthetic improvements that have been made are great, but overall most nursing care facilities are still environments focused on tertiary care. It may sound counterintuitive, but nursing care facilities have to invest more of their resources in preventative care! You may be saying this sounds crazy. Since most individuals found in nursing care facilities often suffer from considerable levels of chronic illnesses, what importance can be gained from offering more preventative care services. Moreover, what other types of preventative services can be offered other than those normally offered, such as the influenza and pneumonia vaccines. Let me briefly address this matter in further detail.
Although there are many areas that I can address, the one that I am going to focus on here, albeit briefly, is the need for increasing the levels of physical and mental activity in the elderly. Even with advancements in the quality of living that we have witnessed in nursing homes in our country, today we still see most individuals in these setting relegated to a static and sedentary existence. Increasing the level of physical activity has tremendous benefits for advancing the health of the elderly, preventing unplanned hospitalizations, maintaining a stable census, reducing nursing home costs, and ultimately enhancing the quality of life of older adults residing in these facilities. Although nursing care facilities typically have physical, occupational and activity programs, many do not receive any physical and occupational therapy after they have exhausted their Medicare benefits and activity therapy is often too infrequent and frequently not targeted at preventative health care. Also, the care staff is often focused on the secondary and tertiary care needs of the residents and often have little training in providing preventative health care services for the elderly.
So what are these preventative services that I am mentioning in this paper. Most of them involve exercise, both physical and mental, which enhance the wellbeing of the older adult's daily functioning. Take for instance the problem of falls in nursing care facilities. This is an epidemic problem in long-term care and one that has continued to plague even the best nursing care facilities. One of the major problems is muscle weakness in the legs. The leg muscles are one of the largest groups of muscles in the human body and they are responsible for providing support and balance. In younger individuals who are active, walking frequently often will keep these muscles toned to prevent injury. However, as we age and engage in more sedentary activity, which is especially found in many nursing care facilities, muscles atrophy. First, greater levels of walking will help strengthen leg muscles, enhance balance, and prevent many unnecessary falls that often have the negative consequence of a fractured femur or hip. Staff has to be trained in encouraging more leg strengthening activity and walking is probably the best exercise to enhance leg strength and general health. However, what about leg squats! You may be saying that this exercise is only used by younger individuals that go to the gym, but this is not true. Think about moving up and done in a chair. Many falls happen when the elderly are getting up or setting done in chairs. One way to enhance leg strength is to encourage elderly, during the breakfast, lunch or dinner setting to sit up and down in a chair a few times. During your post meal cleaning of residents this can be part of nursing intervention.
What about something like arm strength? Older adults in nursing care settings loss a considerable amount of their upper body strength through disuse and sedentary lifestyles. Here again, simple clinical interventions frequently throughout the day, such as having them lift small weights or involving residents in other forms of frequent isometric or isotonic exercise can help strengthen the arms that often support movements that are frequently done in their daily activity.
Providing appropriate mental stimulation is important as well. Frequently many within the nursing home environment think that playing pleasant music or playing bingo is adequate for mental stimulation. However, here again, one has to wonder how much cognitive impairment happens in these types of environments due to not having adequate, challenging stimulation. The key word here is challenging. It is becoming evident that neurogenesis is often incumbent upon challenging the mind and that neurogenesis can happen throughout life. Providing clinical education to have nurses and nurse assistants use reminiscence therapy, pose challenging questions for residents to think about, ponder and answer, and having activities that challenge the cognitive abilities of older adults is critical for proper mental stimulation.
Many of these changes will provide a better quality of life through preventing injuries and illnesses that will happen through a static existence. Our bodies are built for movement and this axiom does not just apply to those who are younger, but it applies to those of all ages. Regardless of age, inactivity leads to weakness, frailty and preventable illnesses. For older adults the acceleration in the reduction of functionality is even more of a problem that has to be guarded against. This is an endemic issue in nursing care facilities. All too often many residents will demonstrate precipitous declines that are quite preventable with the appropriate active intervention. One has to wonder how many falls leading to fractures, slips leading to injury, illnesses due to compromised immune systems, confusion and delirium that is often attributed to age, and reduced ability in movement could be abated, forestalled or even prevented if greater levels of physical and mental activity would become part of the preventative culture of nursing homes. All too frequently many nursing home residents end up with preventable physical and cognitive declines as well as end up being discharged to hospitals from nursing homes, also frequently preventable, due to succumbing to the ill effects of inactivity. Turning our attention to not only treating disease, but also enhancing the health of the community is an important paradigmatic shift that needs to exist in nursing homes across the nation.