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.