Frequently Asked Questions
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Q: Many of our residents cannot walk but could get around in their wheelchairs more than they do. How can we encourage residents to propel their wheelchairs more?
A: Of the estimated 1.8 million nursing home residents in the United States, more than half are incapable of independent ambulation. For these residents, wheelchair propulsion is their only means of mobility. Wheelchair use also increases feelings of independence and fosters a sense of physical and emotional well-being, say residents (1). But for all these advantages, few nursing homes formally assess or evaluate residents for a wheelchair, and too often the staff assumes that wheelchairs are meant to be pushed, not self-propelled (2). The upshot is that most residents in wheelchairs rarely take those chairs for a spin (2). But you can help increase their mobility with a few easy-to-implement strategies:
Q: How can we tell if residents are spending too much time in bed?
A: Try this: Stroll down your facility’s hallways at 10 a.m. and again at 4 p.m. on the same day. Each time, note the names or room numbers of residents whom you observe in bed. Compare the two lists to identify those residents observed in bed at both times.
Our research indicates that these residents spend an estimated 16 or more hours a day in bed (3). And that’s too much, even for very frail residents. Our research also indicates that the more time residents spend in bed during the day, the more they sleep during the day, the more socially isolated they are, and the less they eat (3). These findings are in keeping with other studies showing that excessive time in bed is associated with detrimental outcomes, including under-nutrition, pressure ulcer development, pneumonia, and urinary incontinence.
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Q: Is it likely that residents who participate in the FIT program will eat more as a result of being more active?
A: We thought it might, but upon examination, it didn’t. For this study, we enrolled 89 incontinent residents in two nursing homes (4). Half the residents participated in the FIT program, receiving regular incontinence care and exercise. The other residents, the control group, received usual care.
At the end of 32 weeks, the FIT group showed significant improvements or maintenance across all measures of daily physical activity, functional performance, and strength compared to the control group. But there were no differences between the two groups in the amount of food and fluids consumed. Both groups consumed an average of 55% of all meals, with no change over time.
There was also no change in the frequency of bowel movements in either group. Based on these findings, we believe a feeding assistance intervention aimed specifically at increasing mealtime (and/or between-meal) consumption is likely to be much more effective than physical exercise alone in helping residents maintain and increase weight. Our Weight Loss Prevention Module, presents protocols for a feeding assistance intervention proven effective for increasing daily food and fluid intake and weight in nursing home residents.
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Q: If residents exercise more during the day, will they sleep better at night?
A: Our research suggests that increased physical activity alone will not improve residents’ nighttime sleep, but exercise combined with a nighttime noise and light abatement program will (5,6).
The noise and light abatement program centered on common sense procedures such as closing doors to residents' rooms, fixing squeaky equipment, turning off unattended TVs and radios (and turning down the volume of those in use), and using table lamps instead of overhead lights when providing incontinence care.
In one study, daytime exercisers who received the nighttime noise and light abatement program were in bed less during the day and showed less agitation than residents who received only the nighttime program (5). A second study showed that an exercise program alone did not improve nighttime sleep for residents (6).
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Many of our residents cannot walk but could get around in their wheelchairs more than they do. How can we encourage residents to propel their wheelchairs more?
- How can we tell if residents are spending too much time in bed?
- Is it likely that residents who participate in the FIT program will eat more as a result of being more active?
- If residents exercise more during the day, will they sleep better at night?
A: Of the estimated 1.8 million nursing home residents in the United States, more than half are incapable of independent ambulation. For these residents, wheelchair propulsion is their only means of mobility. Wheelchair use also increases feelings of independence and fosters a sense of physical and emotional well-being, say residents (1). But for all these advantages, few nursing homes formally assess or evaluate residents for a wheelchair, and too often the staff assumes that wheelchairs are meant to be pushed, not self-propelled (2). The upshot is that most residents in wheelchairs rarely take those chairs for a spin (2). But you can help increase their mobility with a few easy-to-implement strategies:
- Residents who need or want to use a wheelchair should be assessed by a physical therapist or occupational therapist for the most appropriate type of wheelchair.
- Customize the wheelchair so that it fits the resident. Consider seat width, back cushions, ankle positioning aides, leg-rest panels, foot supports, headrests, and head supports.
- Make sure the resident can reach and release the chair’s brakes. A PVC pipe can be fitted to a chair’s brake as an extender so that the brake is easier to reach and release.
- Show residents how to use their wheelchairs. Demonstrate how to operate the brakes and foot pedals, where to place their hands and legs, how to use their hands and/or legs to propel the chair, and how to get up from and sit back down in the wheelchair.
- Pay attention to residents’ safety behaviors. For example, does the resident lock the wheelchair and move the foot pedals before standing?
- Regularly check wheelchairs for defects and, if found, promptly repair them.
- Label each wheelchair so that it stays with the right resident.
Q: How can we tell if residents are spending too much time in bed?
A: Try this: Stroll down your facility’s hallways at 10 a.m. and again at 4 p.m. on the same day. Each time, note the names or room numbers of residents whom you observe in bed. Compare the two lists to identify those residents observed in bed at both times.
Our research indicates that these residents spend an estimated 16 or more hours a day in bed (3). And that’s too much, even for very frail residents. Our research also indicates that the more time residents spend in bed during the day, the more they sleep during the day, the more socially isolated they are, and the less they eat (3). These findings are in keeping with other studies showing that excessive time in bed is associated with detrimental outcomes, including under-nutrition, pressure ulcer development, pneumonia, and urinary incontinence.
Back to Top
Q: Is it likely that residents who participate in the FIT program will eat more as a result of being more active?
A: We thought it might, but upon examination, it didn’t. For this study, we enrolled 89 incontinent residents in two nursing homes (4). Half the residents participated in the FIT program, receiving regular incontinence care and exercise. The other residents, the control group, received usual care.
At the end of 32 weeks, the FIT group showed significant improvements or maintenance across all measures of daily physical activity, functional performance, and strength compared to the control group. But there were no differences between the two groups in the amount of food and fluids consumed. Both groups consumed an average of 55% of all meals, with no change over time.
There was also no change in the frequency of bowel movements in either group. Based on these findings, we believe a feeding assistance intervention aimed specifically at increasing mealtime (and/or between-meal) consumption is likely to be much more effective than physical exercise alone in helping residents maintain and increase weight. Our Weight Loss Prevention Module, presents protocols for a feeding assistance intervention proven effective for increasing daily food and fluid intake and weight in nursing home residents.
Back to Top
Q: If residents exercise more during the day, will they sleep better at night?
A: Our research suggests that increased physical activity alone will not improve residents’ nighttime sleep, but exercise combined with a nighttime noise and light abatement program will (5,6).
The noise and light abatement program centered on common sense procedures such as closing doors to residents' rooms, fixing squeaky equipment, turning off unattended TVs and radios (and turning down the volume of those in use), and using table lamps instead of overhead lights when providing incontinence care.
In one study, daytime exercisers who received the nighttime noise and light abatement program were in bed less during the day and showed less agitation than residents who received only the nighttime program (5). A second study showed that an exercise program alone did not improve nighttime sleep for residents (6).
Back to Top or Proceed to Related Studies
