Exercise and mobility programs for elderly nursing home patients

Nursing

Improving nursing care requires a consideration of the basics which can improve outcomes for patients and nursing care staff. In the present organization, nursing care staff is required to provide care to elderly patients with dementia. Although this type of care requires consistent monitoring, a review of nursing practice in the organization also indicates that nursing practice requires considerable physical involvement with the patient. Because a majority of the patients are elderly, nursing staff are required to facilitate moving the patient, often requiring them to assist in basic activities such as helping the patient out of bed and providing assistance for walking and other daily activities.

With the realization that patients in the current care setting require so much assistance with physical mobility and meeting basic physical requirements for daily needs, there is a direct impetus to consider what methods could be employed to improve outcomes in this area. Using this as a basis for investigation, this research considers the development of an exercise/mobility program for patients. The central argument is that by providing patients with this type of program, healthcare providers will be able to improve the mobility of patients and improve the overall level of care provided. Further, regular exercise/mobility may have mental health benefits for elderly patients, improving overall quality of life.

Review of the Proposed Program

Overview of the Program

The proposed program for this investigation is an exercise/mobility program that should provide elderly nursing home patients with improved quality of life. A critical review of the current literature on the utilization of exercise programs for the elderly suggests that these programs can have a number of notable benefits for this population. For instance, Chen, Li, Lin, et al., (2007) report that exercise programs for the elderly can improve physical stamina and facilitate greater movement. In terms of physical results, exercise programs can exhaust patients and improve quality and quantity of sleep. Improving sleep can have marked implications for both physical and cognitive functioning. Additionally, Luukinen, Lehtola, Jokelainen, et al., (2006) report that physical exercise for the elderly can improve strength and flexibility, decreasing the impact of chronic health conditions which can limit physical mobility. These authors report that this can result in greater independence and quality of life for the patient.

Kato (2006) has also considered the benefits of an exercise program for elderly nursing home residents. According to this author, research on the impact of institutionalization on the elderly individual demonstrates that "The muscle strength of the institutionalized individuals was 50% lower than that of the community-dwelling persons" (p. 108). Further, balance of institutionalized nursing home residents was significantly lower than that reported in a community sample. Deteriorations in muscle strength and balance can increase the incidence of falls and bone fractures for the elderly. Kato insists however that the application of a regular exercise program in this setting can improve health outcomes and reduce the number of falls associated with institutional care.

Finally, research on exercise programs for elderly nursing care residents suggests that these programs can have a number of psychological and mental health benefits as well. For instance, regular exercise for elderly individuals has been associated with a decrease in depressive symptoms for the elderly patient (Tsang, Fung, Chan, et al., 2006). Further, research in this area suggests that regular exercise in the elderly can help promote cognitive function and reduce some of the negative impacts of dementia (Exercise..., 2006). Based on this data, it becomes evident that the development of exercise programs for the elderly patient suffering with dementia can have a number of physical and mental health benefits that can markedly improve overall quality of life.

Generalizability of the Findings

Based on the data provided above, it seems reasonable to argue that, in theory, the development and implementation of an exercise program for elderly nursing home patients suffering with dementia would be a feasible undertaking. Research that has been conducted in this area has considered: elderly individuals, elderly individuals that have been institutionalized and elderly individuals suffering from dementia. In all instances, the research indicates that there are positive physical and mental health benefits that could improve the overall quality of life for the current population. Thus, in theory, there is a direct impetus to consider the further development of the program.

Risk Assessment

Risk assessment for the program would need to consider the specific physical impact of the program on individual participants. Consultation with a professional that provides exercise and mobility services for the elderly will provide a clear indication of the overall risks associated with program implementation. With appropriate consultation and the development of a program that is safe for all program participants, it is reasonable to assume that the risk posed by the proposed program will not be any greater than the risk posed for the patient engaged in occupational therapy. Additionally, the focus of the program is to improve health and quality of life outcomes for the patient such that risk in other areas -- i.e. falls related to getting out of bed, etc. -- are effectively reduced. Proposed benefits of the program must be considered when examining overall risk posed.

Engage with Stakeholders

Arguably, the development and implementation of a new exercise program to promote wellness among patients will required a coordinated effort on the part of the organization. Leaders and managers will need to engage occupational therapists and nursing staff to provide support for this program. In addition, nursing staff and therapists will need to engage patients to actively participate in the program. To achieve this goal, the organization may need to consider the development of the program as an integral component of service provided to all patients. Much like assisted living and healthcare care, the exercise program will be a regular component of service. Thus, patients will be required to engage in the program to the best of their ability. Although patient resistance may be high in some instances, the proposed benefits appear to far outweigh the unwillingness of the patient to participate.

Secure Funding

The proposed program can be carried out with minimal funding. If funding is required, it is possible that the organization could obtain funding from a government grant or through the assistance of a non-profit organization. The most challenging issue created in this context is that of insurance. Although the organization currently holds insurance for providing occupational therapy for patients, it is possible that the organization will need additional coverage to implement a regular exercise program. If the organization chooses to develop the program as an integral part of its service, the cost of the insurance could be passed to patients. Overall, this cost should be minimal, allowing the organization to provide this service and ensure that patient safety is protected.

Plan the Change

The proposed program will first require approval from top leaders and administrators in the organization. Once this approval has been granted, funding for the program must be secured and the specific exercise program must be developed. Concurrent with program development should be staff training to implement the new exercise program. This will include scheduling for the exercise program and a review of the specific role that each member of the staff will need to serve in implementing this program. Once the funding has been secured and the staff has been trained, it will then be possible to begin the program with patients.

Evaluation

Evaluation of the program will take place utilizing baseline patient and organizational data. With respect to organizational data, number of falls will be the most pertinent tool for program assessment. Patient falls should decrease by improving patient strength and balance. With respect to patient data, quality of life, mobility and disability will be used as baseline and ongoing measures. Aggregate data on the entire patient population should demonstrate improvements in each of these areas for all patients. Finally, employee assessment of the program will be considered through the use of program satisfaction surveys. This data will provide information that could be used to improve the program and make it easier for the staff to use.

Benefits

While improving patient quality of life is the most pertinent benefit that can be garnered from the application of this program, it is evident that this program could have implications for other aspects of the organization's operations. For instance, if the program reduces falls, this may serve as the basis for reducing overall insurance rates for the facility. This could have marked implications for the organization's bottom line. The cost savings could be passed along to patients and their families, reducing the overall cost of care at a time when healthcare costs are increasing. Finally, the program should improve the overall function of the patient, enabling healthcare professionals to do their jobs more easily. Patients may require less assistance in basic daily activities reducing the overall level of physical care that is provided by nursing staff. This may increase job satisfaction and overall job performance.

Reference List

Chen, K., Li, C., Lin, J.N., et al., 2007. "A feasible method to enhance and maintain the health of elderly living in long-term care facilities through long-term, simplified Tai Chi exercises," Journal of Nursing Research, vol. 15, no. 2, pp. 156-163.

Exercise alleviates dementia in elderly," 2006. Nurse Practitioner, vol. 31, no. 3, pp. 51.

Kato, M., 2006. "Development of an exercise program for fall prevention for elderly persons in a long-term care facility," Japan Journal of Nursing Science, vol. 3, no. 2, pp. 107-117.

Luukinen, H., Lehtola, S., Jokelainen, J., et al., 2006. "Prevention of disability by exercise among the elderly: A population-based, randomized, controlled trial," Scandinavian Journal of Primary Health Care, vol. 24, no. 4, pp. 199-205.

Tsang, H.W.H., Fund, K.M.T., Chan, a.S.M., et al., 2006. "Effect of a qigong exercise program on elderly with depression," International Journal of Geriatric Psychiatry, vol. 21, no. 9, pp. 890-897.