For many nursing home and assisted living residents, living with medical diagnoses and their related treatments poses less of a challenge than living with the effects of those conditions. Limitations in physical activity is one such consequence, and unfortunately, one that significantly affects general health status and quality of life for residents.
The term deconditioning is used to describe the multiple changes in the body systems that occur as a result of inactivity. Impaired physical mobility, immobility, and disuse syndrome are terms that are sometimes used to describe deconditioning.
There are two forms of deconditioning: acute and chronic. Acute deconditioning occurs rapidly as a result of a sudden cessation of usual activity. This can occur when a person fractures a hip, is hospitalized, and is inactive for a period of time. Chronic deconditioning is a slower process in which there is a gradual reduction in activity over time. This can develop when a person reduces ambulation due to increased arthritis pain, or when grief causes a person to withdraw and reduce activity. The potential for psychosocial factors to contribute to deconditioning reinforces the importance of performing comprehensive assessments on residents to identify all factors that could impact health status.
For older adults, maintaining active physical function becomes highly challenging due to sarcopenia-a decrease in muscle mass and/or function, resulting from a reduction of protein synthesis and an increase in muscle protein degradation. Immobility and lack of exercise, increased levels of proinflammatory cytokines, increased production of oxygen free radicals or impaired detoxification, low anabolic hormone output, malnutrition, and reduced neurological drive have been advocated as being responsible for sarcopenia.1 When added to the impaired capacity for muscle regeneration that occurs in late life, this can lead to disability, particularly when compounded by diseases or organ impairment.
Effects of deconditioning
Virtually every body system is affected by immobility. There is an increase in heart rate, cardiac output, and stroke volume, and a reduction in maximum oxygen uptake which reduces exercise tolerance. Muscles atrophy and joint range of motion declines, leading to the formation of contractures. Inactivity also promotes bone loss and increased fracture risk. Lung volume decreases, as does the strength of respiratory muscles, making it easier for pneumonia to develop. Appetite tends to diminish when a person is less active. Decreased activity reduces movement of material through the gastrointestinal tract, which can lead to constipation and fecal impaction. Immobility interferes with complete emptying of the bladder, which can promote urinary tract infections and the formation of renal stones. Metabolism decreases when an individual is immobile, as does glucose intolerance. As most long-term care staff know, immobility facilitates the development of pressure ulcers. This not only affects residents who are confined to bed, but those in wheelchairs as well who may not have the strength to shift positions to relieve pressure.
In addition to the physical consequences of immobility, there are psychosocial effects. Cognitive function can be impaired. Social isolation, depression, and altered self-image can result.
Nurses' knowledge, attitudes
A challenge in preventing and improving deconditioning may be related to nurses' knowledge, beliefs, attitudes, and confidence. In a study of a group of RNs, responses reflected substantial gaps in their knowledge and theoretical understanding of deconditioning, and a strong belief in the need for more education on the prevention of it.2 The study revealed that barriers to deconditioning care included lack of education, low staffing levels, and a lack of valuing prevention efforts. These findings support the need for education to enhance the competencies of nursing staff in addressing deconditioning and staffing patterns that provide for restorative care.
The deconditioning effects of inactivity are significant to older adults and exaggerate the effects of sarcopenia, so every effort must be made to maximize their activity level.
A reconditioning program can aid in restoring fitness and improving function. These programs typically consist of cardiac endurance exercises and flexibility and strength training. A rehabilitation specialist can develop a reconditioning program that is safe and appropriate for the individual resident. These plans need to be communicated and consistently followed by all members of the team.
Learning about residents' interests can assist nurses in identifying activities that will be familiar and enjoyable. Plans should include any activity that will enhance movement. It is important that frontline caregivers be reminded of the importance of allowing and encouraging residents to be as independent and mobile as possible, even if it requires the investment of more time.
A challenge in preventing and improving deconditioning may be related to nurses' knowledge, beliefs, attitudes, and confidence.