As we age it is vital that we continue to be involved in the activities we have been engaged with throughout our lives, be that reading, knitting, card games or even running or cycling. This is even more important if you have a diagnosis of dementia, as although it is a progressive condition you can live a meaningful life with carer support. Research indicates that purposeful activity supports:
There is also evidence that shows that reduced activity leads to occupational deprivation, resulting in residents being withdrawn and fatigued, agitated or violent.
The National Institute for Clinical Excellence (NICE 2013) recognised the need for activity in their quality standards, which include the following statements;
(1) Older people in care homes should be offered opportunities throughout their day to participate in meaningful activities that promotes their health and mental well being.
(2) Older people in care homes are enabled to maintain and develop their personal identity.
However, for a resident to be engaged in activity when their mobility or standing is impaired, means that they are often restricted to completing all their activities in a seated position and this can be challenging. The chair they use then becomes critical, as it must meet their individual needs be this via a bespoke chair or perhaps through your home having a suite of adaptable chairs that can be modified simply for any of the residents.
When choosing seating for your residents, keep four key factors in mind,
1. Seat Depth – Our femurs need to be well supported and allow for pressure across the whole of the thigh. If the chair is too deep, it will lead the resident to sit on the edge of the chair to place their feet on the floor and therefore provide no back support. If the chair is too short, there will be excessive pressure on the mid-thigh causing discomfort and possible pressure sores.
2. Seat height – To be able to engage in activity we need to have our feet planted firmly on the floor or a stable footrest. This allows residents to have good balance and enables them to engage their core muscles to keep a straight upright position, which makes engaging in activities much easier.
If the seat height is too high, a resident is liable to slump in the chair to try and get their feet on the floor. This increases pressure on the bottom and requires the head to flex forward, thus reducing field of vision.
If the seat height is too low, the knees are pushed upwards causing significant pressure on the Ischial Tuberosity and making it uncomfortable to sit whilst carrying out an activity.
3. Seat width – If the seat is too wide the tendency is for a resident to slump to one side. Not only does this cause additional pressure to one hip, but it also locks in the arm on the slumped side reducing the ability to carry out a chosen activity bilaterally.
4. Reduced transfers – Hoisting residents with dementia can be a very traumatic experience as it is an alien activity and can cause agitation and challenging behavior. Therefore, reducing the moves to a minimum maybe essential, and a chair with the ability to porter from room to room could be considered. There is also evidence that playing music which a resident associates with a positive event can be played during transfers to reduce anxiety levels. By reducing the stress levels, it is easier to engage a resident in purposeful activity.
Repose believes that every client is different and therefore has a range of chairs to meet the requirements of every resident. Some models are adaptable depending on which resident is using it and also bespoke made chairs for those with more complex needs. They work closely with health professionals in care homes, hospices and hospitals to develop seating solutions that improve health, comfort and lifestyle.
The National Institute for Clinical Excellence (NICE) (2008) recommends ‘older people should be offered regular group and/or individual sessions to identify, construct, rehearse and carry out daily routines and activities that can help to maintain or improve their health’. However, without appropriate seating this recommendation will not be achievable.
Repose supply over 5000 chairs annually. They are going into care homes, hospitals and hospices as well as for people to use in their own homes. Creating innovative, bespoke seating solutions by working closely with healthcare professionals has ensured Repose is one of the leading suppliers of seating in the health sector.
Kate Sheehan is a director of The OT Service and is one of the leading Independent Occupational Therapists in the UK
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