When you first think of living environments that are the most safe for seniors, you might imagine a place with level floors and wide doorways. A neutral but aesthetic palette of colors, sensible furniture, and wide open hallways and thoroughfares… an environment built for safety.
Back at home, your senior hung on to the backs of chairs and corners of walls to get around. He cruised on the furniture like a toddler learning to walk, and you cringed each time he pulled up on the edge of the table to stand and launched himself toward the credenza just to take the first step.
But the assisted living place you toured is much safer. Here, there is room to use his walker so that he won’t have to navigate between those narrow gaps in the furniture. He can essentially get from point A to point B in a straight line, hands on the walker where they should be, instead of groping the walls for stability.
And… guess what else they have? A gym! The facility has a great fitness gym with a bike and some weights, and an activities rooms where seated exercises are offered for those who can participate.
So here’s the problem: Dumbbells and leg press machines may strengthen muscle groups, but they don’t allow for movement through a natural, functional pattern of motion- and for a natural purpose. We tend to force seniors into bimanual, midline postures (Hands on the walker! Arms up, arms down.) and forget that pushing and pulling, lifting and carrying, and reaching and rotating are far more natural movements.
Universal design, where the environment is designed to meet the least restrictive and most enabling standards, is a good thing. However, ease of movement does not necessarily equal quality of movement.
Promoting quality movement is as simple as promoting natural, meaningful movement- standing, walking, climbing, creeping, cruising, rocking, reaching, and rotating… with challenging, gradable options. A simple chore like wiping a table, for example, requires a weight shift, unilateral lengthening of one side, proximal stability (core strength), a change in hand placement, and best of all- a coordinated series of planned movements initiated by the brain and executed by the body. The problem solving feels good. The job of the facility would be to allow for the possibility of such an action. But maybe that’s too much to ask…
The F Word
Many senior facilities are designed around sitting. Comfortable sofas and chairs, wheelchair access, tabletop activities. And every possible barrier has been removed to make the environment easier to roll throughout.
Why? Because gravity is the enemy of safety. And wheels are safer than feet. Or so they think.
The problem with standing and walking is that it usually requires sufficient strength and joint integrity to withstand the forces of gravity. Lucky for us, humans were designed to do exactly that.
Senior living centers fail to hit the mark when it comes to allowing or assisting people to move. This is probably due to issues such as concerns over liability and lack of finances and staff to ensure the safety of the residents. Prevention of falls is a paramount goal of most facilities. And rightfully so… falls can kill.
But promoting sitting is akin to promoting weakness, both mentally and physically, due to lack of weight bearing, sensory input, and movement. Prolonged sitting leads to a reduction in standing and walking skills. This can put residents more at risk for falling than for enabling safe mobility in the first place.
So senior living environments are built to keep residents safe and comfortable, and if that means confined to couches and wheelchairs, or limited to wide open, flush surfaces and assistive devices, then many of the risks are mitigated.
But would it be so hard to build a “standing station” near a window? Or put a set of parallel bars in a hallway so that the “pullers” (some folks who are unsafe while pushing walkers are much better at pulling on stable surfaces with their upper extremities while walking) could get some steps on their FitBits?
As a rehabilitation provider for more than 25 years, I know the handoff from therapy to caregiving staff can be steep and fateful. There simply isn’t the staff or time to implement a specialized mobility program for every resident. So activity programs do the best they can to address the least common ability of its residents… parachute, bowling, balloon batting… from a seated position. Over time the resident loses strength and cycles back in to therapy.
So where is the best use of healthcare dollars?
Repetitive falls and rehab admissions?
Or intentional mobility programming with additional caregiving staff?
Or a restorative or maintenance program with dedicated staff?
Or an exercise physiologist/personal trainer on staff?
Let’s design care settings with pro-movement features instead of barrier-free features. Let’s invest in coaching, fitness, and wellness initiatives in these environments, and work to keep residents on the move instead of on the couch.