Seating & Mobility Senior Style

Incorporating Change: Q&A with Jay Brislin, MSPT

Mobility Management: When does the aging process begin? In other words, when we can expect to start noticing age-related changes in seating & mobility clients?

Jay Brislin: It can certainly depend on somebody’s activity throughout their life. At the age of 55 or beyond, that’s when you start seeing different things occur. But if you were an athlete, that onset can be earlier on.

It can be occupation driven, too. If you have somebody who was a laborer or a construction worker, that can certainly accelerate the process of joint deterioration, cartilage deterioration, skeletal deformities, etc.

Personal history is probably more important than somebody’s age. What somebody did throughout their life can really make a difference as to what you expect to happen — and it can also give you an idea of what they can expect from themselves, what they think they should be able to do.

MM: What aging processes can we expect to have an impact on seating & mobility considerations?

JB: The first thing that would come up would be bowel or bladder concerns, and a person’s reaction time.

Going into a mobility device is very similar to a driver’s test. Being able to react to a situation quickly is really important from a safety perspective. It’s not only vision or hearing that can play a factor in what kind of product you put them in, but also what their reflexes are. Other things, too, would be transfers and fatigue. As you grow older, fatigue plays a very huge factor, as well as the way somebody transfers to and from different seats.

Just the amount of time it may take somebody to go to the restroom versus the time it took them 10 years ago can really be a factor. If it took them two minutes to go to the bathroom 10 years ago, and now the full process takes them 15 or 20 minutes, is that person continent enough to do that? Are they functional enough to be able to do that on their own?

Range of motion also plays a large role. For instance, transferring into the bathtub: For years, they’ve been doing it, but now that height is a little too high for their hip fl exion or knee fl exion. That’s why it can be hard for somebody to get their leg up and over and be able to transfer into that tub safely.

MM: It sounds as if a lot of changes can be necessary, even if the client has been living in the same home for a long time.

JB: Absolutely. I feel everyone should have a home assessment, and a lot of our funding sources also say that. Home assessments are so important when you get into older age groups.

From a mobility perspective, when you start to look at these changes, you want to look at a product that’s going to help maintain their function. But you also want to make sure those assistive devices aren’t promoting more of a sedentary lifestyle. The more you sit or stay in the same position all the time can certainly have an adverse effect on somebody’s strength and range of motion. There’s a fine line we have to walk, to make sure we’re providing something that’s going to help with their function, but won’t also (stop) promoting function.

MM: How can weight loss impact equipment decisions?

JB: You certainly need a history of (a client’s weight), because anytime you have a loss of weight, it’s going to expose more of those bony prominences to the possibility of skin breakdown or pressure sores.

An individual that’s starting to lose weight in their bony prominences, but also losing range of motion and strength, is more in contact with whatever seating surface they’re on. The fact that they may not be able to do the weight shifts that they were used to, or aren’t able to get into the position they were used to to relieve some of that pressure, can accelerate skin ulcer issues or concerns.

MM: What can clinicians and providers do to help clients with emotional issues that arise from experiencing the aging process?

JB: Being able to educate and talk them through the process before you come right out and say, “This is what you need to do” is extremely important.

And it’s something you should do immediately. If you have somebody in the K0005 ultralightweight, to give an example: One of the educational things to do with the client would be to talk them through all the muscles they’re going to be using all the time to be able to push the chair as well as do weight shifts: “Here are the joints you’re going to be using that are going to be stressed throughout your daily activities.”

You should make sure those clients are recognizing any physical changes they may have, too: “If you start to have shoulder and joint pain for a couple of days, you should immediately go see your clinician.” A person in that situation, their upper body is usually really strong, and you need to educate them that it’s OK if they lose a little bit of strength. But the way we’re going to preserve that is if they immediately bring that to the attention of their doctor or their therapist.

Talk the patient through what the progression usually is: It happens to everybody, whether they have a mobility device or not. Every single person is going to go through it.

This article originally appeared in the July 2011 issue of Mobility Management.

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