Care for bed ridden elderly, whether they are in bed rest temporarily or bed ridden for the long term, can make all the difference. Geriatric patients can benefit a lot from the kind of help a home caregiver can provide. Being a caregiver can be challenging but some simple measures will not only ease their job of helping old age people but also ensure elderly loved ones are well cared for during those times when they are particularly fragile.
[This is a part of series of articles on bed ridden patient care. Read more about 5 Kinds of People Prone to Bed Rest ]
What are the signs that need careful attention for bed ridden elderly?
Due to complete absence of movement, a bed ridden patient is likely to develop following symptoms or complications. These need to be taken care of continuously.
- Bed sores
- Depressive thoughts
- Back pain
- Disturbed sleeping patterns – waking up tired and listless
- Loss of appetite – food seeming tasteless
How to care for elderly bedridden patients?
Here are the five areas one should care for bedridden seniors at home:
- Grooming & immediate environment are worked to suit the patient
- Breathing & circulation of blood to be maintained to support bodily functions of the patient
- Movement should be supported to avoid bed sores and regain independence
- Food to be planned to ensure proper nourishment as well as feeding times
- Confidence of patient to be built by a healthy mix of empathy and support to regain movement & ability to do basic activities independently.
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Continue reading to understand each of these 5 elements in detail, to care for the seniors at home.
1. Care for Elderly: Grooming & Patient’s environment
One of the best things you can do to help any bedridden patient is to make sure that their basic hygiene and grooming needs are being addressed. This includes:
A. Personal Hygiene
- Bathing – Using wet wipes or towel wet with luke warm water is an acceptable way to giving a bed bath every day, in case the patient is unable to take a proper shower / bath in the wash room. Ensure that the back of the patient is also rubbed clean every time to avoid bed sores.
- Dental care – Ensure regular cleaning of teeth even if it needs assistance.
- Change the patient into fresh, clean clothes on a daily basis.
- Keep fingernails and toenails trimmed to avoid inadvertent scratches and ingrowth or infections.
- Comb- Keeping hair, beards, and mustaches trimmed, brushed, and clean is a good way to discourage problems of itchiness, lice, skin issues.
B. Environment of the patient
- Ensure the room is aired and well-lit, with natural light if possible – sunlight is a natural disinfectant!
- An easy access to things like light switch / bed lamp, alarm, phone, book, and water from the patient’s bed makes the individual feel comfortable and less dependent on others.
- Use a clean bed sheet of soft material and change it every 2-3 days. Since bedridden individuals spend most of their time in bed, it is critical that bed sheet and pillowcase be changed.
- The room should be kept clean and clutter free for movement to & from bathroom.
2. Care for Elderly: Breathing and Circulation
With bed-ridden patients, each day immobilized in bed can increase the chances of additional complications involving various body systems, from musculoskeletal issues to pulmonary problems. Thus early mobility is very important. Prolonged bed ridden patients are prone to muscle atrophy, contractures, disused osteoporosis, degenerative joint disease, bed sores and breathing difficulties. The stamina reduces significantly due to no movement. You will need expert geriatric care for these.
A physiotherapist can guide you to avoid all these complications for the elderly with the following:
- Chest Therapy: It is very important for patients that are more likely to develop lung infection (older patients, smokers, patient that have already been in bed for a long period, patients that will probably have to stay in bed for a long time). Ask a physiotherapist for daily practices of Chest therapy, which will help to prevent respiratory problems.
- Passive mobilization: Passive mobilization aims to prevent muscle retraction and decrease of ROM as well as other complications such as bedsores and blood circulation problems.
- Positioning: Positioning means to put the patient in a good position. The family should always keep in mind that any position, if it is kept for two long, will lead to complications (such as bedsores and muscle contracture). That is why, even if a position, for some specific reason, is good for a patient, the position has to be changed every two hours.
[Click here to read What is the best position for bed rest? ]
A ReLiva Physiotherapist will start with simple exercises on bed to improve circulation, respiration and basic movement in the bed. They will then slowly work to build the power and endurance in the muscles. Gradually activities are focused at bed mobility and transfers. The final goal is to make the patient moving on his/her own feet.
3. Care for Elderly: Movement
Muscles that aren’t actively contracted lose strength at a rate of 10 percent to 15 percent per week. After four weeks, a patient may only have 50 percent to 60 percent of his total strength left.
When patients are confined to bed rest, the main goal is to get them to recover and get up and moving as quickly as possible. But the movement needs to be started gradually. Sudden and abrupt movements can lead to further consequences. As the bed ridden patient is getting up first time from the bed there can be orthostatic hypotension, sudden fall in blood pressure can cause collapse.
In addition to the activities for chest & circulation, a ReLiva Physiotherapist will work with the bed ridden elderly to initiate movement with the following:
- Active mobilization: Active mobilization aims to prevent muscle weakness and muscle retraction, as well as blood circulation problems.
- Strengthening exercises: Strengthening exercises aim to prevent muscle weakness. Importance should be given to strengthen lower limb’s muscles important for walking (hip extensors, hip abductors and knee extensors) and to the upper limb muscles important for walking with crutches and transfers (shoulder adductors shoulder abductors, elbow extensors
- Muscle stretching: If limitations of range of motion is already present, stretching exercises can be done to stretch the muscles or, at least, to prevent the muscle shorter from becoming worse.
These activities will help the bed ridden senior to stay fit even during bed rest.
In case of stroke and paralysis, the demand for care is far more than just movement. ReLiva, the physiotherapy specialist offers physiotherapists for IPD care in hospitals as well as home care for the bed-ridden. Holistic care for stroke sufferers is available at a dedicated in-patient stroke rehab center for patients in Mumbai, Thane and Navi Mumbai. You may call +91 99209 91584 or email to contact@reliva.in with your specific requirement and we will connect you to a physiotherapist near you.
4. Care for Elderly: Food & Nutrition
What, when and how much food, can be a very important aspect of caring for a bed ridden elderly family member. Follow these tips to ensure you are caring well:
- Feed a balanced diet, paying attention to doctor’s orders for any dietary restrictions.
- Make sure the patient has plenty of fluids throughout the day.
- Avoid feeding the patient when lying down flat, as this increases the risk of patient chocking and the food particles entering into the wind pipe. Make sure to prop up the patient’s head and give very small bites or sips. If they can sit up, use a back rest for support.
- Don’t rush. Feed the patient at a slow pace. Offer food in small morsels and let them to chew well before swallowing.
5. Care for Elderly: Build confidence with empathy & support
Caring for a loved one can be very difficult. Even with the best of intentions it can be easy to lose patience, not feel appreciated, or become a little overwhelmed. Here are some ideas on how to avoid or handle those feelings when they hit you:
- Expect things to take longer than they would normally. Everyday tasks will require more energy from both your loved and yourself, and trying to rush things will only cause frustration and could even wind up hurting the patient.
- Watch for signs of fatigue in yourself, and understand your own limits. If you need to take a few moments for yourself to avoid potential conflicts or anger, it is better to do so than to lash out or nurse bad feelings.
- Being attentive to the patient’s needs and helping to prevent or reduce pain will go a long way during this time.
- Allow the patient to perform some of the activities of daily life on their own, even if they are initially clumsy. Support them wherever needed. This will help them regain confidence and self-esteem.
- Encourage the patient to indulge in a passive hobby like reading, puzzles, music etc.
- Encourage other family members to spend some time with the patient regularly so they continue to feel a part of the normal household.
- Don’t hesitate to ask for help to ensure best care is offered to your loved one at home. You can call +91 992099 1584 to book a ReLiva physiotherapist to care and treat your elderly at home.
How long it takes to get a bedridden patient to move again?
Remember that it takes time to regain strength after a period of immobility. A good rule of thumb: It takes twice the length of the period of immobility in a relatively healthy patient, and even longer in a clinically sick patient. Much of the strength improvement in the first one to two weeks after remobilization is due to central neurological “resynchronization.” After that, strength increases are primarily due to muscle hypertrophy.
It is best that caregivers use assistance of a qualified physiotherapist right in the early stages of bed rest and execute the above actions before patient’s muscular health begins to decline rapidly.
[This is a part of series of articles on Bed ridden patient care. Read more about 5 Kinds of People Prone to Bed Rest ]
This article is based on inputs from Dr Swati Sangolkar (PT) and Dr. Mouzzam Kaglawala (PT). Dr Swati (PT) is a senior physiotherapist with ReLiva with experience with a variety of orthopedic and bed-rest recoveries. Dr Mouzzam (PT) has experience with neuro recoveries in the USA and works closely with ReLiva’s in-patient stroke Rehab center.
