Should we still give physio to residents with advanced dementia?

Gerontologist and registered nurse with Community Home Australia, Nicole Smith, recently posed the question, “Should you bother doing physio on someone with advancing dementia?” in a post on social media.

“Absolutely yes!” was her answer.

However, physiotherapy is often not made a priority for those living with advancing dementia in residential aged care. 

When the resident can no longer follow instructions or lacks motivation, they often miss out on important treatment, Smith said.

“If someone cannot follow instructions, they are overlooked for rehab post fall or operation, and/or everyday physio to stay fit and healthy,” she explained.

Smith would like to “challenge that viewpoint” and encourages aged care service providers to begin “thinking outside the box” to get residents engaged in exercise and physio, as Community Home Australia has.

A dementia care expert and advocate responded to the post saying people with dementia are not expendable and should continue to move their bodies and receive physio.

“Just because you have dementia does not mean you can be thrown away,” she said.

Another responded to say her father is living with dementia and physio has “kept his body active, which keeps his mind active”. 

“It would be terrible to see him bedridden,” she commented.

Smith said when aged care management denies physio to residents with advancing dementia they are “writing them off”.

Benefits are well known

Simon Kerrigan, managing director and physiotherapist with Guide Healthcare, told HelloCare, “There’s no doubt” physio should be “a priority” for aged care residents, including those living with dementia. 

“These [benefits] don’t diminish because a person has a cognitive impairment. 

“Exercise may assist a person with advancing dementia to maintain their mobility and motor function, lower their falls risk, improve mood, increase social interaction and even facilitate better sleeping patterns.”

Physical exercise is also “essential for maintaining adequate blood flow to the brain and may stimulate brain cell growth and survival,” Kerrigan said.

Motivation is key

Unfortunately, residents with a diagnosis of dementia or other cognitive impairments often don’t receive equal access to physiotherapy and other exercise-based programs.

The reasons are complex, but include the resident’s physical and mental health, the fact that physio is a “limited resource” in aged care and the ACFI funding model does not encourage it, there can be a “lack of education” among staff in aged care homes about the benefits of exercise and physio for residents experiencing cognitive decline, as well as environmental and organisational factors.

Activities have to be “engaging, appropriate and enjoyable” to maximise outcomes, says Kerrigan. Finding the “motivation” for each person is key. 

If residents are “unmotivated”, Smith suggests the care team “should use … all the resources around them” to find what will unlock motivation for each person.

In Kerrigan’s experience, “Physical activities that are familiar are often the most engaging or successful.” 

Stationary cycling, boxing, ball games and dancing are popular with aged care residents, and “reactionary” activities – like throwing and catching a ball – can “increase engagement and reduce the need to ‘follow instructions’”.

Walking also shouldn’t be overlooked, Kerrigan said, noting that it is often discouraged for those living with dementia, owing to concerns about falls and “the prevalence of ‘wandering’ as a perceived behaviour”.

“Wherever possible, we should be facilitating opportunities to walk and supporting our residents to walk more frequently.”

Kerrigan noted that it’s important to consider the environment when planning exercise and physio for those living with dementia. 

“Each person’s program needs to be considerate of what environment the person feels most comfortable in. This may mean limiting the number of participants, the noise or other distractions within the room.” 

Effort, duration and skill level should also be considered.

The benefits of ‘habitual physical activity’

In a webinar held this week titled ‘Physical activity for people with dementia’, Dr Riona McArdle from the UK’s University of Newcastle said even in the early stages of dementia, people become less active. 

Those living with dementia are more likely to take part in habitual physical activity because it’s not as strenuous as many other forms of exercise, it’s low cost and accessible.

Dr McArdle noted a New Zealand study, which found that aged care residents generally have “very low” intensity in their physical activity, and it is usually limited to about 10 minutes a day with little variation. By comparison, older people living with dementia in the community took part in a greater amount of movement, and it was more variable.

“Quality of care is a gift we will all want”

Smith said there is a cultural shift underway in aged and dementia care: “change is coming – and catching”, she said.

Vicki Cain, residence manager at Arcare Aged Care, is also pursuing a more positive culture for residents, including those living with dementia.

Eighteen months ago, a 96-year-old woman living with dementia moved into Arcare Pimpama after falling and breaking both her neck and her hip. The assessment at the treating hospital was to put her in a hard neck collar, meaning she was non-mobile. 

“We welcomed this incredible woman into our home,” Cain shared. 

The woman was encouraged to remain mobile with the support of a physio, and she now walks with a wheelie walker, wears no collar, and goes out on social leave. 

Cain said, “Quality of care is a gift we will all want when it’s our turn.”