Getting senior residents, especially those with cognitive impairments, to participate in exercises can be challenging.
By Susan Saldibar
For residents with forms of dementia, loss of strength will almost certainly lead to a rapid decline in their quality of life. It often marks the beginning of a disconnect from those around them, followed by increasing isolation and depression.
And it doesn’t have to.
“Many times caregivers and residents become frustrated when trying to accomplish together functional tasks,” says Patricia McKenna, PT and Advanced Practice Specialist for Aegis Therapies, a Senior Housing Forum partner. “This is especially true with residents who are cognitively impaired. The burden of care for the caregiver is higher when they must move a resident themselves and the resident becomes more dependent.” And that, she warns, can add to further decline in strength and function. “Because, often they can do so much more to help themselves when given the opportunity,” she adds.
Steady Participation = Functional Gain
Getting senior residents, especially those with cognitive impairments, to participate in exercises can be challenging. This is where staff needs to use some creativity to introduce the idea of exercise in a way that fits the individual’s level of ability and temperament. Once participation is achieved, the resident is going to achieve the same strength gains and functional gains as those who are not cognitively impaired.
How to create an atmosphere that encourages participation.
There are 3 keys to achieve participation: 1) approach, 2) adaptation, and 3) observation. Let’s take a look at each of them:
Approach: For each resident, this may be different. How amenable are you to trying different ways of initiating an exercise session? According to Patricia, your physical demeanor and verbal language can give off a certain “vibe” that can increase chance of refusal or agitate a resident against any form of exercise. You need to be committed to take the time and effort from the start. Do your homework, Patricia recommends. Pay attention to their verbal and non-verbal cues as well. Keep trying different approaches until you find one that works. Perseverance pays as you enter their world of family and work experiences.
Adaptation: How can you adapt their environment to encourage participation? Aegis therapists have developed some very creative ideas. Obviously those individuals with a higher level of cognitive ability may work better doing standard strength building exercises individually or in groups. But for those with cognitive impairment, sometimes tapping into a resident’s past life can help identify a physical task associated with a job or hobby that they were used to doing back then. By creating exercises that reconnect them with something familiar, you may help stimulate movement. For instance, doing a strengthening program in a rehab kitchen for someone who was a housewife for many years.
Patricia cites another example of a man who was physically able to, but would not participate in an exercise program of lifting weights. After speaking with a family member, they found out that he had worked in a mill. His job was to load large balls of yarn and put them on a cart. So the staff pulled together a few props and let him recreate the task for himself. He would get up, load, push, unload. And, most importantly, he was getting exercise and improving his strength in the process. Another resident had been a night guard. So they set him up with a chain of keys and added weighted tasks as he locked and unlocked doors in the facility.
For those more cognitively challenged, it’s important to use physical cues, such as a touch on the shoulder to encourage movement. Some residents may respond better to bright colors. For them, you might use colored duct tape adhered to the floor and have the resident step over the colored tape.
Observation: It is important to regularly record your observations. Are they providing verbal or non-verbal cues that may indicate they are tiring? Did something grab their attention that might be more effective in stimulating movement? Consider asking a family member to observe as well. They may notice something you didn’t. Use your collective observations to make adjustments and measure your program progress.
Measuring Functional Gain
After you have engaged the resident in a regular regimen of strength building, you should expect to see a functional gain. How mobile were they before? How did they perform basic functions before and after strength building? For residents with more severe cognitive impairment, measuring the transfer process is key. Are they able to help the caregiver move them from their bed to a wheelchair? Can they assist at the toilet or sink? Are they able to either feed themselves or to help guide the utensil to their mouth? Strength training can help in every task, no matter how minor.
According to Patricia, senior living communities with a large population of cognitively impaired residents have learned to adapt their approaches and we can learn from them. Those with fewer cognitively impaired individuals can be challenged in finding ways of reaching the cognitively impaired using only traditional approaches.
Patricia has witnessed, firsthand, the way the successful CNAs and therapists work together with the residents to get cognitively impaired residents more active and engaged in daily activities. “They are taking more time upfront to find ways of connecting positively to the resident,” she says. “Once the connection is made, it is much easier going forward. Everyone is happier.”