Preemptive Measures Boost Wellness For Long Term Care Residents
A provider’s wellness program champions lower-body strength as one way to prevent injury and boost independence.
Kelly Stranburg, M.Ed
10/1/2010
According to the National Center for Injury Prevention and Control, fall-related injuries are the leading cause of injury deaths and disabilities among older adults. Hip fractures are considered the most serious fall injury, with less than half of all older adults hospitalized for hip fractures regaining their former level of function.
Hip fractures are also expensive. Using existing data as a guideline and taking inflation into account, a 1990 study in the Journal of the American Medical Association estimates the total annual cost of hip fractures in the United States could reach $82 billion to $240 billion by the year 2040.
These statistics and more spurred Charlotte, N.C.-based Senior Living Communities (SLC), a continuing care provider that utilizes wellness programs throughout each of its care settings, to create a program that would help its members stay mobile and independent longer by reducing their risk of injury.
SLC’s lower-body exercise program known as CLIMB—an acronym for Confidence, Longevity, Independence, Mobility, and Balance—was born after two research studies on a pilot program found very encouraging results. In fact, the two studies, conducted by SLC’s research partner Wake Forest University, were so positive that the company is implementing
CLIMB throughout all of its 11 communities.
Preliminary Research Positive
The first study was conducted with members from all 11 SLC communities, while the second utilized members from Homestead Hills, SLC’s Winston-Salem, N.C., community. Both found a majority of residents had deficits in lower-body strength and were responsive to exercise interventions lasting as little as six weeks.
Twenty-nine Homestead Hills members were selected to participate in the follow-up study and were randomized into two groups: a control group whose members maintained their normal daily routine and a progressive resistance exercise group that met for about 30 minutes, three times per week, for six weeks.
To develop a baseline, all 29 adults were evaluated at the beginning and end of the six-week intervention. Their lower-body strength and physical function were measured by a one-repetition strength test using leg extensions and leg curls, a timed 400-meter walk test, and the Short Physical Performance Battery that tests walking speed, balance, and lower-limb strength.
The progressive resistance exercise group completed a variety of exercises designed to increase leg strength. Residents wore weighted vests for resistance while performing toe raises and step-ups on an aerobic step and used strength-training equipment for leg extension and flexion exercises.
Strength Improves Confidence
Preliminary results showed that adults who participated in the lower-body strength training exercises had an average increase in leg extension strength of 51 percent and an average increase in leg curl strength of 31 percent, while the strength of those in the control group did not change.
Members in the control group were encouraged by their peers’ results and requested the introduction of a lower-body-specific exercise program into their daily wellness offerings at Homestead Hills.
Easy and affordable to implement, CLIMB will span 16 weeks and include a variety of exercises hand-picked from other wellness classes. Residents who participate in the program will focus on improving their mobility to reduce their dependence on spouses, children, or other informal caregivers.
Research suggests that the strength-training exercises will also help members improve their balance, reducing the likelihood that they will suffer a catastrophic event like a fall, which may lead to disability, hospitalization, or other negative complications.
Residents Praise Program
Ruth Kessler, a member of the progressive resistance exercise group, is all too familiar with the side effects of a catastrophic fall. The Homestead Hills member fractured her left femur two years ago, and the recovery has been long and difficult.
“At the beginning of the six-week period, it was extremely difficult for me to get up from a seated position,” Kessler says. “After I finished the sessions, I progressed from lifting 40 pounds to lifting 70 pounds with my leg curls, and I can do five chair-stands now when I couldn’t even do one before.”
Roburta Trexler, a retired physical therapist, also reports increased confidence in her walking ability. “I feel like I’m definitely making some improvements,” Trexler says, while resting in between exercises inside Homestead Hills’ wellness center.
“I exercise regularly on my own, but I was losing my balance at times,” she says. “The CLIMB program has definitely made a difference. I plan to continue with the exercises because I would like to walk with a feeling of confidence, improve my posture, and stand up without hurting.”
During the implementation process, wellness coordinators at each of SLC’s communities evaluate residents to establish a baseline for that individual’s lower-body strength.
Coordinators collect data on each resident’s progress throughout the 16-week period, and problem areas are targeted for improvement.
Although numeric data will be collected to accurately measure each resident’s progress, quality-of-life indicators such as the ability to walk further distances or go up and down stairs will also be considered signs of success.
Prevention Is Key
Preventive health programs such as CLIMB will no doubt enjoy greater popularity as the baby boomer population ages. Medicare reimbursement continues to shrink, and providers will be required to implement affordable rehabilitative solutions that produce quick results.
Simultaneously, many older adults and their children will find the cost of long term care prohibitive. This trend is already showcased by an increase in the number of home health agencies and geriatric care managers offering services that allow seniors to remain in their own homes as they age.
With data collected from each community, residents will likely spread the word to their friends and neighbors about the relationship between exercise, strength training, and future independence.
Homestead Hills member Sally Bost agrees that preventive wellness programs like CLIMB are beneficial for seniors and thinks the amount of effort people put into the program is directly related to the benefits they will receive. “It’s too easy to say, ‘Oh, you’re getting older, this is what you should expect,’” Bost says. “But I say, no way, you can’t quit just because you’re older!”