Are you able to provide the slow stream rehabilitation that many older people with deconditioning require? #physiotalk 6th June

Our next chat is with AGILE – Chartered Physiotherapists working with Older people, @AGILECSP. It will be on Monday 6th June at 8pm BST – as usual just follow along using the #physiotalk hashtag.

As a result of the COVID-19 pandemic, a new healthcare problem has become increasingly evident amongst our older adult population – deconditioning. Restrictions on social activity and reduced face-to-face healthcare input from March 2020, has led to a significant increase in deconditioning and frailty. Deconditioning is described as a “syndrome of physical, psychological, and functional decline that occurs as a result of prolonged inactivity and associated loss of muscle strength” (1). The consequences of deconditioning have been extreme with an increased number of falls, hospitalisations, self-neglect, social withdrawal, and reduced quality of life as collected during a survey in 2021 by AGE UK (2). Unfortunately, it is often not until patients are in a primary or secondary healthcare setting, that the extent of their deconditioning is evident at which point, the need for slow stream rehabilitation is required (3). Evidence suggests that one way to prevent and reduce deconditioning is to safely implement strength and balance exercises targeted at the correct level for the individual (3).

Prior to the pandemic, there were group classes and community services aimed at addressing this need amongst older persons. At this point the NHS Right Care Community Rehabilitation toolkit had also been implemented to attempt to meet the already significant need for rehabilitation resources (5). While there has been a gradual implementation of resources again, it still appears uncertain that this will counteract the last two years (2). As physiotherapists, we face many challenges in addressing deconditioning when services are not always conducive in allowing time and resources to support the reconditioning of patients (6). The purpose of this chat is to bring to light ways that we can all address deconditioning amongst older persons and overcome the barriers in providing the appropriate level of rehabilitation to our patients.

Chat questions

Q1. Does your locality provide appropriate rehabilitation for your older patients?

Q2. What type of services are available in your area that enable long term rehabilitation of your deconditioned patients?

Q3. Are council-run wellbeing schemes a suitable service for plugging the gap in rehabilitation services?

Q4. What are the challenges associated with acute hospital rehabilitation and gym spaces, and how do you overcome them?

Q5. What are the most effective ways of reducing the risk of deconditioning in a hospital, for patients awaiting social care support in the community?

Q6. How often do you advise patients who are requiring minimal physiotherapy input in hospital about resources to prevent future deconditioning?

References

1. Public Health England. ‘Wider impacts of COVID-19 on physical activity, deconditioning and falls in older adults’, 2021

2. Age UK Research. Impact of Covid-19 on older people’s mental and physical health: one year on. 2021

3. Sarah De Biase, Laura Cook, Dawn A Skelton, Miles Witham, Ruth ten Hove, The COVID-19 rehabilitation pandemic, Age and Ageing, Volume 49, Issue 5, September 2020, Pages 696–700, https://doi.org/10.1093/ageing/afaa118

4. Public Health England. ‘Strength and balance quality markers: Supporting improvement through audit’, 2019 5. NHS Right Care Community rehabilitation toolkit, 2020

6. Centre for Ageing Better. ‘Raising the bar on strength and balance: the importance of community-based provision’, 2019

Resources

British Geriatric Society: Deconditioning information for providers of services to older people and the public

Chat hosts

AGILE is a Professional Network of the Chartered Society of Physiotherapy and is for therapists working with older people – whether qualified physiotherapists, assistants, students, or associate members of an allied profession.

AGILE’s mission is ‘To deliver the highest possible physiotherapy practice with older people’ by:

● Promoting high standards in physiotherapy with older people through education, research, and efficient service delivery

● providing a supportive environment for its members by facilitating the exchange of ideas and information

● encouraging, supporting and co-ordinating relevant activities regionally and nationally

Chat transcript

If you missed the chat you can catch up here

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