practical living
resilient and adaptable to the stresses placed on it. Also, ensure that
the more comorbidities you have, the more you engage with an
appropriate health professional, like a physiotherapist, to grade that
exercise up. the more comorbidities someone has, the more they should be
referred to a physiotherapist.
Why is there ageism associated with seniors and exercise? That’s a big question. Most of my work at present is across residential
care, but also a lot of work in home care in the community. So I’ll
speak to residential care first. Almost all aged care facilities will have
a physiotherapist on site, at least doing some assessment and care
planning. A part of that care planning practice should be engaging
with staff – and that can be care staff, recreational activity officers
and so on; it depends on the individual facility and what resources
they have. I’m at a residential care facility this morning, and we have
some volunteer-run group programs here. We worked with them
when we first came into the facility to look at what they were doing,
how we could keep it fun, and how we could weave some of the
evidence base in there for some challenging balance exercises too,
because we know that for falls prevention, balance exercises need to
be challenging – they can’t be simple.
Also, we looked at what sort of resistance exercises, strength
exercises, we could do in that environment. So we’ve got volunteer-
led groups and some individual one-on-one work. This facility’s
lucky to have a physio aide, so the aide does that work as well.
It depends on the resources of the facility, but to keep it simple,
engage with the physiotherapist onsite and ask those questions.
What are we doing to attack falls? What are we doing to look
at managing osteoporosis and osteoarthritis with strength and
resistance exercises?
With home care it’s a little easier, mainly because the funding there
is not a friction point between what we do in terms of care and how
we’re funded. So it’s easier to engage a health professional to come
out, and whether they work with that person weekly or fortnightly or
monthly or whatever their need, or depending on the resource of,
say, their home care package, they might have care staff funded with
that. So we’re doing some things where we can leave paper-based
programs that care staff or family can follow. We certainly have
some family working with their loved ones at home, and there are
some fantastic exercise-based apps now that care staff can use. The
physiotherapist can put those exercises in the hands of the care staff,
and they can feel confident looking at a quick video of how to do
that exercise and help their person with it.
So the takeaway from that question is, when in doubt, ask: What
are we doing to improve the exercise outcomes of older adults in
residential care and in the community? And make sure you’ve got a
policy and procedure on how you’re achieving that.
I think there’s ageism against lots of populations, not just older
adults. Sometimes we see it towards younger people. Although most
of my practice is with older adults, we certainly get members of
the community asking: What sort of exercises are safe for younger
people? Are heavy weights not suitable for adolescents? So, there’s
a lot of confusion out there about which exercises are safe for which
groups of people.
I think a lot of it comes from some health professionals not
keeping up with the evidence base. There’s a lot of literature out
there that says certain health professionals are 20–30 years behind
the evidence base. So, you have poor education coming from
certain health professionals, and you have articles like this Reader’s
Digest one that propagate that message.
Certainly, in residential care, it can get more complex, but I think
I can speak for physiotherapists when I say that we know where
the evidence base is for exercises that are safe, meaningful and
appropriate for older adults in residential care. However, at the
moment, we have a funding tool that somewhat restricts how we
can put that evidence in to practice. So you could almost say that
the funding tool at the moment is ageist against exercises for older
adults in residential care.
How important is it to base physical activity on need rather
than age?
We’ve touched on this a little bit, and always with these
conversations it’s a broad bird’s-eye view that we’re taking of
things. So I guess I can empathise with Reader’s Digest – they
were trying to put out some information and they’ve got someone
writing there who took a little bit of information from one or two
health professionals. Maybe what the Reader’s Digest could’ve
done a bit better was engage with the peak body in their country
of origin. So APA would’ve been a good body in Australia to talk to,
and they could’ve got someone doing research on exercise and
osteoarthritis, like Christian Barton, who would have been able to
talk to that subject a little bit better.
But when thinking about exercise, you’re looking at those
broad topics of physical activities. The Australian government
has a fantastic online resource on that – just search for “physical
activity Australian government guidelines”. This is a nice resource
you can use to talk to consumers, members of the public, or even
use yourself.
Exercise is medicine, we all know that. Whatever health conditions
people are dealing with, and often older adults have multiple
comorbidities, there are many things to understand – for example,
polypharmacy and drug interactions. So, the more comorbidities
going on, the more you want to engage with a health professional so
they can tailor things to suit that.
For example, someone with osteoporosis comes in to see a
physiotherapist, versus someone that comes in with osteoarthritis,
and let’s just keep it simple: they don’t have comorbidities. There
are going to be key choices relative to the evidence base that
the physio is going to recommend in terms of which exercises
they should start to look at. So the key message for the general
public and health professionals would be to look at that resource
if you don’t know what those physical activity guidelines are, and
How can aged care or nursing staff encourage clients and
patients to exercise?
What final message do you want to tell people reading this?
For older adults over 50, exercises and challenging strength exercises
are safe. Your body is resilient, robust and will adapt to the demands
you place on it.
If you want to get stronger, do certain resistance exercises that
are challenging. These sorts of challenging strength exercises,
and also cardiovascular exercises, are in the best interests of your
health outcomes as you age. You will live longer and you will have
better mood. The interactivity between physical activity and
mental health is well documented. For osteoporosis, it’s going
to strengthen your bones. For osteoarthritis, it’s going to help
you with the pain. It goes on and on, and no matter what health
condition or conditions you’re living with as you age, exercise
needs to be your first medicine, and everything else is secondary
in our mind. ■
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