Senior Care Centers, LLC
Sara McVean Kyle, Ph.D.
02.10.14
NEEDS ANALYSIS
Numerous studies have shown that exercise training combined with resistance training can reduce physical frailty. Although most of the research is conducted with individuals not yet living in a skilled nursing setting, there is the potential for exercise and resistance training programs in the SNF area to maintain functional levels for a greater amount of time.  The possibility and belief allows for residents to function at higher levels and maintain more Activities of Daily Living (ADL) ability prior to becoming bed bound.

PURPOSE
The goal of this study was to understand the impact of lightweight resistance and potential ADL improvement in frail residents.

  • Lightweight resistance using 1-2lb handheld dumbbells and extra light to light weight resistance tubing were offered to residents.
  • All participation was voluntary and level of engagement was determined by resident.
  • Long-Term Resident focused

Description: Wellness and Life Enrichment Staff were encouraged to add  resistance equipment to range-of-motion movements already performed by nursing home residents during a 12-week group exercise program, held three times a week. Late-loss ADL scores measured by the Minimum Data Set (MDS) were collected two weeks prior to and two weeks after the intervention.

Late Loss ADL’s: There are eleven ADL’s that are listed on the MDS. They are bed mobility, transfers, walk in room, walk in corridor, locomotion on unit, locomotion off unit, dressing, eating, toilet use, personal hygiene and bathing. Four of these are considered “late loss ADLs” meaning that people retain their functional ability in these four areas the longest. The four late loss ADL’s are bed mobility, transfers, eating and toilet use.  A resident may lose the ability to dress himself or walk, but may still have the ability to turn in bed, get out of a chair, feed (Newell, 2012).
METHODS

  • Record quarterly late loss ADL assessment prior to beginning 12 week, 3X weekly movement centered exercise program.
  • Manually tracked resident participation. Residents must have attended at least 5 sessions to be eligible for post ADL measurements.
  • Record post late loss ADL scores and determine if functional ability improved, declined, maintained. If scores were recorded 2 weeks prior to exercise session beginning or after ending, then “no data” was assigned to such residents.
  • Suggested exercise movements were given to Wellness and Life Enrichment Staff to utilize and lead movements.
  • All participation logs were recorded and tracked by wellness staff and assumed to be accurate.

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CONCLUSIONS

  • Adding inexpensive equipment to common range of motion movements currently being done in nursing homes may help residents maintain function. Resident’s functional improvements do not have to be dependent on expensive equipment or wellness-specific areas in nursing homes.
  • Maintaining the current level of functioning is still a positive outcome when assessing last loss ADL’s in frail residents.
  • Adding inexpensive equipment and implements can easily bring excitement and change to common movements.

 

Additional studies need to be performed to determine what levels of participation (how actively the resident is participating) and what number of sessions attended yields greater increases in improving and/or maintaining late loss ADL scores.
Staff Training:

  • Certification needed for industry
  • Education – required degrees or nationally recognized certifications
  • Ongoing hands-on training and exercise demonstration
  • Safety precautions
  • RPE Scale v Talk Test

Sample Exercises
Dumbbells:

  • Wrist Curls
  • Biceps Curl (regular and hammer)
  • Triceps Extension
  • Front Shoulder Raises
  • Overhead Arm Raises
  • Diagonal Shoulder Raises

Resistance Bands:

  • Arm Curls with band under feet or wheelchair feet
  • Seated Row with band under feat or wheelchair feet
  • Lat Pull Down
  • Overhead Chest and Lat Extension
  • Single Arm Extension
  • Triceps Extension with band tied to immobile object
  • Abdominal Crunches with band behind  chair

(“Exercise and physical,” 2009)

REFERENCES
Brown, M., Sinacore, D.R., Ehsani, A.A., Binder, E.F., Holloszy, J.O., & Kohrt, W.M. (2000). Low-intensity exercise as a modifier of physical frailty in older adults.  American Congress of Physical Rehabilitation, 81, 960-965.

Centers for Medicare and Medicaid Services, (2010). Mds 3.0 nursing home comprehensive  (nc) (Version 1.00.5)Med-Pass.

National Institute of Health, (2009). Exercise and physical activity (09-4258)National Institute on Aging.

Newell, M. B. (2012, September 27). Accuracy with adl coding. McKnight’s long term care news & assisted living, Retrieved from Http://www.mcknights.com/accuracy-with-adl-coding/article/261144/