Get up, Get dressed, Get moving by Amy Conley

Amy 1 hippocrates1-2x

Think about an older person, someone in their eighties – let’s say it’s your Granma…

Your Granma lives in her own house; she’s not quite so good on her feet anymore, but she gets about OK.  Stairs are difficult but she manages – and she manages to get up and dressed, make her breakfast and her tea, feed her cat, read the paper, get to Tesco in the car with you.

Then your Granma gets ill – she has say, a chest infection.  She is admitted to hospital.  You pack her bag – nightie, toothbrush, comb.  She is admitted to the ward – she is poorly, needs antibiotics and a drip for a few days. So, on goes the nightie and your Granma is in bed; that’s what you do in hospital – you are poorly and tired and you need to rest in bed.

Your Granma is in bed in her single room.  She needs the toilet but doesn’t think she should get up by herself – she is a patient in a nightie so needs help.  But she can’t see very well or hear very well and can’t find her glasses or hearing aids.  She can’t find the buzzer to buzz the nurses and she can’t hear when they are near.   She thinks maybe she could get herself to the toilet, but she can’t see her walking sticks and is scared she will fall. 

Time passes.  Your Granma is incontinent in the bed.  She is embarrassed and frightened – what will the nurses think?

Now she is scared to drink and eat because she doesn’t want to need the toilet and be incontinent again.  And she doesn’t want to bother anyone.  The physio comes to see her, tries to get her up.  But she is still embarrassed and frightened.  She has no clothes to wear.  And she has only those foam slippers she got from the nurse.  So it’s best just to stay in bed.

Your Granma stays in bed for longer and longer.  There is nothing to do.  There is a TV but she can’t see it or hear it without her glasses and hearing aids.   She is getting mixed up now; she can’t remember when she came here or why or what day it is.  She thinks she can see cats in the corner of her room.  She still won’t eat, so she has no strength and feels weak. She doesn’t want to get up.  Her bottom and back hurt.  Her leg has swollen up – they said it is a blood clot.

The physios keep coming back.  They try to get her up; two of them struggle to get her to stand.  She is stuck in bed. 

Your Granma’s chest infection has been treated and she has no acute medical illness, but now she is immobile, confused, dehydrated, incontinent, her muscles are weak and she cannot walk anymore, or get herself washed or dressed. 

Your Granma is not going to manage at home anymore; she has to go to a care home.

 

GET UP, GET DRESSED, GET MOVING

At DGRI, we are launching our campaign on Monday 23rd July– the aim is help our patients maintain their function, mobility and independence while in hospital, and for them to return home as soon as possible, as able as possible.

 

WHY HAVE THIS CAMPAIGN?

  • Most patients in hospital are over 65
  • In hospital, older people spend up to 83% of their time in bed
  • 65% of people’s functional ability declines during admission
  • 60% immobile older patients in hospital have no medical reason to stay in bed
  • If you are over 80, 10 days in hospital ages muscles by 10 years
  • 1 week of bed rest equates to 10% muscle loss
  • These changes are “deconditioning” –  “reconditioning” takes twice as long

Amy 5 pjsketch1Amy 7 sliipers sketch 2Amy 6 pjsketch2Amy 8 slippers sketch 4

WEARING YOUR PYJAMAS IN HOSPITAL

  • Affects your confidence and self-esteem
  • Changes how you interact with healthcare staff and other people
  • Is usually unnecessary no matter why you are in hospital
  • Doesn’t feel very dignified when you are trying to eat your dinner

 

STAYING IN BED IN YOUR PYJAMAS

  • Reduces muscle strength
  • Reduces confidence
  • Reduces function
  • Increases blood clots, delirium, pressure sores and infections
  • Leads to reduced appetite, low mood and anxiety
  • Reduces social interactions
  • Lowers pain thresholds
  • Can make blood pressure drop
  • Causes constipation and incontinence

Amy 4 patient in bed

WHAT CAN HEALTHCARE STAFF DO?

  • All of us can and should help patients get moving – nurses, doctors, AHPs, porters, domestic staff, pharmacists…
  • Ask the patients how they normally get about and what they normally do
  • Make sure patients can access buzzers, water, remote controls
  • Encourage patients to get dressed and sit up in the chair

 

WHAT CAN PATIENTS DO?

  • Tell us how you normally get about and get things done and what you need to help you
  • Try to do things that you do at home – wash and dress, eat and drink on your own if able
  • Sit up in your chair and for meals
  • Drink lots
  • If you can’t get out of bed, do little things – wiggle your toes, do a crossword – every little movement  helps

 

WHAT CAN VISITORS DO?

  • Tell us what you do at home
  • Bring in glasses, hearing aids and walking aids
  • Bring in comfortable day clothes and well fitting shoes
  • Encourage you to sit up in the chair and for meals
  • Take you for a walk
  • Bring in photos, books, puzzles, crosswords

Amy 3 nursewalking patient

THE BENEFITS

  • Speeds recovery
  • Reduces time in hospital
  • Encourages patient and carer involvement in healthcare and recovery
  • Helps to retain patients’ individuality and self-esteem
  • Helps patients to quickly return home, mobile and functional

 

If you or your family are worried that it is not safe for you to get up or you might do the wrong thing – ASK US!  We will tell you what is safe and OK for you!

#endpjparalysis

#goinghome

Amy 2 home

Amy Conley is a Consultant in Geriatric Medicine at Dumfries and Galloway Royal Infirmary

6 thoughts on “Get up, Get dressed, Get moving by Amy Conley

  1. Fantastic Amy, an important powerful message
    The challenge being how we get this message to everyone in our communities – would be great to see this on the front paper of the papers, on the website, online media, at the front door of health and care buildings etc…..

    • Hi Helen, We are launching an awareness campaign on Monday 23rd July at DGRI. We will have a stand in the atrium and hopefully local press to take some photos and give us some publicity. Please come and visit us! (I will be the one in the pyjamas!)

  2. #endpjparalysis is a positive campaign that OT has been increasingly involved in leading across the UK. It would be great if this DGRI initiative mentioned Occupational Therapists & explained our role to support people to get up, get dressed & move about as part of a meaningful daily routine whether at home or in hospital. Our June2018 OTNews publication featured articles on this campaign & on promoting the importance of the OT role within the MDT. One aspect reported as having a great impact for staff is being motivated by the sharing of good practice in teams & seeing how small changes can have wide reaching improvements for patients. Getting up, washed & dressed before 12pm has improved outcomes in relation to patients maintaining dignity & the principles of participating in a daily routine on the wards has been recognised as important in the recovery journey.

  3. Anything that stops people feeling alone and helpless in their beds is an excellent idea, supporting their physical and mental health and wellbeing. Especially as single rooms also risk isolation. A fantastic initiative.

    I think you’re right Helen – I understand that we have a media guy Rod who could do that perhaps?….

  4. Absolutely sums up the issue of pyjama paralysis Amy, the example you offer of granma is what we see every day in practice. Older people in single rooms often express feelings of boredom loneliness, isolation, despair, fear and at times imprisonment! We need to create an environment which promotes independence, individuality normal social interaction. The campaign is a great idea, and reflection on whats happening not just locally but internationally. You’re absolutely right Helen, we need to get the message out there.

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