Bed rest and deconditioning

I have been working with a 94 year old lady for two weeks now. Being on my cardio placement ward we see a variety of cases. She was admitted to the hospital for back pain which turned out to be crush fractures. Therefore pain and mobility are her largest issues at the moment. She was living independently prior to her admission. She is a small and frail lady, strength and confidence are areas we are working on as she needs lots of encouragement during our sessions.

Last Friday her daughters and I were very happy with her progress and the plan was for her to return home. I knew she would not receive physiotherapy treatment over the weekend as she did not fit the criteria for weekend physiotherapy therefore I wrote out and drew up an exercise program for her and asked the nurses to take her for walks so she could maintain her current level. Monday afternoon I came to take her for our scheduled walk and checked her medical chart to find she had a temp of 34. It was obvious she was not doing well. I asked her if she was out of bed and doing her exercises over the weekend? She said no. Due to her lack of confidence and motivation she sat in bed or chair all weekend. She did not do her exercises because she forgets them despite my handout. I think she walked with the nurses to toilet couple times but that was it. Everyone on the team became concerned at this rather quick decline. Worse of all she became even less motivated and said she had enough that everything is too hard. Therefore discussion started for placement into high care.

Over the week she stabilized and through lots of convincing by her daughters and I, we got her out of bed again. She had lost so much from being in bed for four days. In class they tell us how bad rest in bed is for the body and how quickly people can de-condition but I have never really experienced it first hand until this week. It was sad and frustrating at the same time because she lost everything we gained the previous week and was so close to heading home. But the good part to the story is that due to the good relationship we developed she agreed to try again. She has improved still not to the level we had previously attained but they are now discussing rehab with her and low level care is the goal. She will be unable to go home which was the original plan but low level is better then high level care.

My supervisor pulled me aside and said she was very happy with what I was doing with this lady and said that I have played a large role in her looking at low level care. With the doctor, nurses and social worker she vocalized she had enough and did not want rehab which would have lead into high level care. But with me she is willing to continue working.

This event reinforced for me, the importance of physiotherapy in the hospitals as well as the importance of building rapport with your clients.