How to care for bedridden elderly patients at home

Any person can get bedridden due to various health issues. However, it is elderly generation which is more vulnerable to getting bedridden as they experience various health issues as age advances. Old age is a beautiful stage of a life cycle but it comes with many challenges, one of them being staying physically active and mobile. If you have a loved one at your home who is ageing and you see age-related issues deteriorating their health. The primary mode of action is to find a way out to stop them from getting bedridden. This can be done by taking care of their Physical as well as mental health. Family, friends and medical professionals, such as Geriatric Physicians, Geriatric Physiotherapists, Psychologists, counsellors etc., play an important role in preventing a patient from getting bedridden. At this stage, it is important to maintain proper health checkups, Physical examinations, dietary intake and proper mobility of the elderly persons. Encouraging them regularly for maintaining their physical activities helps improve their physical as well as mental functions. Regular exercise can also reverse some of the effects of chronic diseases. A sedentary lifestyle often seen to be predominant in older people is one of the main reasons for the premature onset of old age health issues. Normal physical activity and a proper exercise regime set by your physiotherapist are very important to maintain a good metabolism and thereby contribute to healthy cardiovascular, musculoskeletal, neurological and psychological well-being.

Some of the commonly seen health issues in the elderly which need proper attention at the right time to prevent further complications are:

• Osteoporosis

• Arthritis

• Cardiovascular diseases

• Respiratory Diseases

• Alzheimer’s disease/dementia

• Parkinsonism’s

• Motor Neuron diseases

• Multiple sclerosis

• Stroke

• Depression

Another most commonly seen problem in the elderly is loss of balance, which leads to fear of falling or even falling leading to fractures. These all medical conditions can be prevented to deteriorate one’s health condition to the extent of getting bedridden by proper physical activities, exercise and a healthy diet. Proper medical intervention with your team of Geriatric physicians, physiotherapists, dietitians and a counsellor is needed at this stage. However, in some cases, the deterioration may have already affected the person’s health and led them to bedbound. At this stage, we need to prevent further complications and try to comfort the patient as much as we can.

Prolonged time spent in bed can cause many complications. Even though the period for remaining bedridden may vary from person to person depending upon the severity of their condition. It is highly recommended to consult a physiotherapist at this stage. If your therapist finds it ideal for the patient to perform exercises (actively, active assisted or passively depending on the condition of the patient) they will prescribe an exercise programme for the patient, which will help the patient to perform activities of daily living, such as going to the toilet, washing face, brushing, eating independently and also maintaining a good strength of muscles. However, if the deterioration is severe and the patient cannot move at all then we also need to be watchful about many other complications which come with prolonged bed rest. Some of the complications for elderly patients being in bed for long due to various health issues are:-

• Malnourishment: Low metabolism due to lack of movement lead to malnourishment. This is a serious problem as it can lead to a weak immune system. A prior diet plan for such patients is recommended by a dietitian.

• Deep vein thrombosis: Blood clot formation is commonly seen when blood flow slows down in bedridden patients due to lack of movement. To prevent these Your Physiotherapist will prescribe passive exercises. These are performed by physiotherapists passively on a patient. This means the physiotherapist moves each part of the patient’s body by him/herself. This not only improves blood circulation but also maintains the joint range of motion and prevents muscle contracture or prevents muscles from getting tight and stopping the movement further.

• Contractures /Weak muscles/Decreases Range of motion in joints: These are prevented by passive exercises as well as the proper position of the body with the help of pillows. Turning the patient every 2 hours in the bed from side to side is advisable

• Respiratory Complications such as pneumonia: Pneumonia can be prevented by chest physiotherapy. Breathing exercises in case of patients who can perform exercises actively can prevent respiratory complications. In case of patients who are not able to perform active exercises, postural drainage and other manual techniques to clear the airways can prevent further respiratory complications

• Urinary tract infection: This might require catheterization, monitoring the symptoms, and watching the output and colour of the urine. Keeping the area clean can prevent further aggravation of the infection

• Constipation: After consulting your doctor and dietitian. It is advisable to give laxatives or food rich in high fibre. Encourage the patient to increase water intake. In the case of critical patients, more medications to clean the gut may be required and needs medical supervision.

• Pressure sores or commonly known as bed sores: Repositioning and turning the patient every 2 hours can help relieve pressure points. Also, the use water/air mattress or water glove at critical pressure points is helpful. The common bed soreness points in the human body are the buttocks, shoulder blades, back of elbow, back of the heel, back of the skull, hip, inner knees etc.

• Depression: Being bedbound is a very stressful stage for patients as well as caregivers. It is very important to show love, care and support to such patients. Apart from exercises, encourage them to read a book (if they can) or a family member can read a book for them. Ask them to watch television, especially something they have always liked. If visitors are allowed to meet such patients, invite their friends to meet and talk to them. Keeping their room well ventilated, and well-lit and making sure their bed is closer to the window may also help. Nature is a natural healer and sitting closer to a window will not only help them breathe fresh air but also watch nature. Soothing massage to help relax muscles and mind may calm down the anxiety.