Silver Age Health丨Things to note during rehabilitation training for the elderly

▏Pre-training assessment and preparation

1. Physical condition assessment

Before the elderly undergo rehabilitation training, it is crucial to comprehensively and carefully assess their physical condition, which is the cornerstone of formulating a scientific and effective rehabilitation plan. The assessment covers several key aspects, including physical function, underlying diseases, and psychological state. Physical function assessment is an important part of understanding the basic physical condition of the elderly. By measuring indicators such as height, weight, blood pressure, heart rate, and cardiopulmonary function, we can fully understand the basic physical conditions of the elderly. For example, elderly people with poor cardiopulmonary function should avoid high-intensity aerobic exercise, such as long-distance running and fast swimming, during rehabilitation training, and are more suitable to choose some low-intensity, slow-paced exercises, such as walking and Tai Chi, to ensure that the heart and lungs can withstand the load brought by exercise. Understanding the basic diseases of the elderly is also indispensable. Ask in detail whether the elderly suffer from chronic diseases such as cardiovascular disease, diabetes, respiratory diseases, and nervous system diseases, as well as the control of these diseases, treatment plans, and drug use. For elderly people with hypertension, before rehabilitation training, it is necessary to ensure that blood pressure is controlled within a relatively stable range to avoid large fluctuations in blood pressure due to training, which may cause cardiovascular and cerebrovascular accidents. The psychological status assessment should not be ignored either, as it has an important impact on whether the elderly can actively participate in rehabilitation training and the achievement of rehabilitation results. When facing illness or accidental injury, the elderly often have negative emotions such as anxiety, fear, and depression, which may affect their willingness and enthusiasm for rehabilitation.

2. Training Environment Preparation

Creating a safe and comfortable training environment for the elderly is an important guarantee for the smooth progress of rehabilitation training, which is directly related to the experience and safety of the elderly during the training process. Safety hazards in the training environment may cause accidents such as falls and collisions in the elderly, which will not only affect the rehabilitation process, but also cause further damage to the body. First of all, a comprehensive safety inspection of the training venue should be carried out to remove all kinds of obstacles. Whether it is an indoor rehabilitation training room or an outdoor activity venue, the ground should be flat, dry, and free of debris. The spatial layout of the training venue also needs to be reasonably planned. Ensure that there is enough space in the training area to facilitate the elderly to perform various rehabilitation training movements and avoid collisions due to narrow space. The placement of rehabilitation training equipment should be neat and orderly, with moderate spacing, so that the elderly can use and operate it. Around the training venue, necessary protective facilities, such as handrails and railings, should be set up to provide stable support for the elderly when walking, standing and training.

▏Key points during training

1. Principle of gradual progress

The principle of gradual progress is an important principle that must be followed in rehabilitation training for the elderly. It emphasizes that rehabilitation training should start with simple and basic content, gradually increase the difficulty and intensity, avoid overtraining due to haste, and bring unnecessary harm to the elderly's body. When conducting balance training, the elderly can be allowed to sit on a stable chair in the early stage and perform simple movements such as turning the head and tilting the body left and right to exercise their static balance ability. As the elderly's balance ability gradually improves, they can be allowed to stand in place and perform slow movements such as lifting their feet and turning around to increase the difficulty of training. When the elderly can complete these movements more stably, further balance training during walking can be carried out, such as walking on a flat ground, gradually increasing the speed and distance of walking, or setting some simple obstacles during walking for the elderly to avoid, so as to improve their dynamic balance ability. Training at each stage needs to fully consider the physical adaptation of the elderly and give enough time for the body to adjust and recover. In terms of strength training, at the beginning, you can use lighter dumbbells or elastic bands for simple muscle contraction training, with fewer repetitions per set of movements. As muscle strength increases, gradually increase the weight of the dumbbells or the resistance of the elastic band, and increase the number of repetitions and sets of each movement. This gradual increase in the intensity and difficulty of training can enable the elderly's body to continuously improve muscle strength during the adaptation process, avoiding muscle strain or excessive fatigue caused by a sudden increase in load. Through a step-by-step training method, the elderly's body can steadily improve its function during the gradual adaptation process, reduce the risk of injury, and achieve better rehabilitation results.

2. Reasonable training time and intensity

Reasonable arrangement of the time and intensity of rehabilitation training is the key to ensure that the elderly can effectively carry out rehabilitation training while avoiding excessive fatigue and injury. The training time and intensity should be adjusted according to the physical condition, disease type and rehabilitation stage of the elderly. For the elderly who are weak and suffer from multiple chronic diseases, the frequency of rehabilitation training can be relatively low, generally 3-4 times a week, and each training time is controlled at 30-45 minutes. In terms of training intensity, low-intensity sports should be selected, such as slow walking, gentle Tai Chi, etc. For the elderly with cardiovascular diseases, the walking speed should not be too fast, about 60-80 steps per minute, 20-30 minutes each time, and appropriate rest in between. Such training frequency and intensity can not only exercise the elderly's body to a certain extent, but also will not bring too much burden to the heart. For the elderly who are in good physical condition and have a smoother rehabilitation progress, the training frequency can be appropriately increased to 5-6 times a week, and the training time can be extended to 45-60 minutes each time. In terms of training intensity, some moderate-intensity sports can be gradually added, such as jogging, swimming, etc.

3. Monitoring of physical reactions during training

During the rehabilitation training of the elderly, close monitoring of physical reactions is an important means to promptly discover problems and adjust training programs, and is crucial to ensuring the safety and effectiveness of training. Physical reactions that need to be focused on include breathing, heart rate, pain, and other aspects. Breathing is one of the important indicators that reflect the load of physical exercise. Under normal circumstances, the breathing of the elderly will be moderately accelerated during rehabilitation training, but it should be kept stable and regular. If symptoms such as shortness of breath, wheezing, and difficulty breathing occur during training, it may mean that the training intensity is too high and the body cannot bear it. For example, during aerobic exercise, such as brisk walking or aerobics, if the elderly have shortness of breath and even need to breathe heavily to maintain breathing, this indicates that the intensity of exercise needs to be reduced, the body needs to rest for a while, and training can be continued after breathing returns to normal. Heart rate is also a key indicator for monitoring physical reactions. Generally speaking, the heart rate of the elderly during exercise should be controlled within a certain range, and the appropriate heart rate range can be calculated according to the formula "(220 - age) × (60% - 80%)". During training, heart rate monitoring equipment, such as smart bracelets and heart rate belts, can be used to monitor heart rate in real time. If the heart rate exceeds the appropriate range and does not decrease for a period of time, it means that the training intensity is too high. The training should be stopped immediately and the elderly should rest to restore the heart rate to normal. For example, the appropriate exercise heart rate range for a 70-year-old is about 90-120 beats/minute. If the heart rate reaches more than 130 beats/minute during training and does not decrease for several minutes, the training intensity needs to be adjusted in time. Pain is an important signal from the body and must be taken seriously in rehabilitation training. It is normal to have mild muscle soreness during training, because exercise causes lactic acid accumulation in the muscles. Generally, this soreness will gradually ease within a few hours to a day after training. However, if there is severe pain, joint pain or pain that lasts for a long time, it may be that the body has been injured, such as muscle strain, joint sprain, etc. At this time, the training should be stopped immediately and the painful area should be checked. If the pain is more severe, you should seek medical attention in time to clarify the cause and take appropriate treatment measures.

▏Integrate training with daily life

1. Daily living activities training

Integrating rehabilitation training into daily life activities such as dressing, eating, and going to the toilet is an important way to improve the self-care ability of the elderly. Taking dressing training as an example, for the elderly with limited limb function, when choosing clothes, they should choose loose and easy-to-wear styles, such as open-front tops and pants with elastic waistbands. When starting training, you can start with simple movements, such as letting the elderly practice putting their arms into their sleeves, starting from the affected side and gradually transitioning to both sides at the same time. Family members or rehabilitation therapists give patient guidance and assistance to help the elderly complete the dressing movements. As the elderly's ability improves, the assistance is gradually reduced, allowing the elderly to complete the dressing process independently. Through such training, not only can the elderly's limb coordination and muscle strength be exercised, but also their ability to take care of themselves in life can be improved and their self-confidence can be enhanced. In terms of eating training, choose appropriate tableware according to the physical condition and needs of the elderly. For the elderly with weak hand grip, tableware with non-slip handles can be used to facilitate their grasping. During the training process, let the elderly practice using tableware to grab food, such as using a spoon to scoop up food and put it into their mouths, starting with simple foods such as rice and noodles, and gradually transitioning to foods that are more difficult to grab, such as beans and small particles. At the same time, pay attention to correcting the elderly's eating posture, keep the body sitting upright, and tilt the head slightly forward to avoid choking food into the trachea. Through repeated practice, improve the elderly's eating ability and ensure that they can eat independently and safely. Toilet training is also critical for the elderly, especially for those with lower limb dysfunction or cognitive impairment. Before training, ensure that the bathroom environment is safe, the floor is non-slip, and handrails are installed to facilitate the elderly to get up and stand. During training, first help the elderly familiarize themselves with the facilities and layout of the bathroom, and teach them how to use the toilet and flush buttons correctly. Start by assisting the elderly to sit up and stand, and gradually transition to the elderly being able to complete these actions independently. For elderly people with limited mobility, a toilet chair can be used to assist in going to the toilet. The height of the toilet chair should be moderate to facilitate the elderly to get up and down. During the training process, the elderly should be given enough time and patience to be encouraged to complete the toilet process independently and improve their ability to take care of themselves.

Continuity of rehabilitation training

The continuity of rehabilitation training is one of the key factors affecting the rehabilitation effect of the elderly. Only by adhering to rehabilitation training for a long time can physical functions be continuously improved and enhanced, and comprehensive rehabilitation be promoted. In the early stage of rehabilitation training, many elderly people are often able to actively participate in training due to the improvement of their physical condition and their expectations for rehabilitation. As time goes by, factors such as fatigue, pain, and lack of obvious progress during training may cause them to gradually lose confidence and motivation, and interrupt training. In order to encourage the elderly to take rehabilitation training as a part of their lives and persist in it for a long time, a variety of effective measures can be taken. The key is to formulate a personalized rehabilitation training plan. According to the elderly's physical condition, interests and hobbies, and rehabilitation goals, the training content and time should be reasonably arranged. If the elderly like outdoor activities, walking, Tai Chi and other sports can be included in the training plan, so that they can do rehabilitation training while enjoying nature, which will increase the fun and attractiveness of the training. At the same time, set clear and achievable short-term and long-term goals so that the elderly can see their progress and achievements, and enhance their self-confidence and sense of accomplishment. For example, a short-term goal can be to be able to dress independently within a week, and a long-term goal can be to improve walking speed and stability within a month.

▏ Post-training care and adjustment

1. Physical relaxation and recovery

After training, helping the elderly to relax physically is of great significance for promoting physical recovery, reducing fatigue and preventing sports injuries. Massage is an effective way to relax. Professional masseurs or family members gently massage the elderly's muscles to promote blood circulation and relieve muscle tension and soreness. When massaging, you can start from the limbs, such as the quadriceps and calf triceps of the legs, and the biceps and triceps of the upper limbs, using kneading, massage, patting and other techniques, and massage each part for 5-10 minutes. The massage intensity should be moderate to avoid excessive force causing pain. Warm water bath is also a simple and easy way to relax, which can dilate blood vessels, promote metabolism and relieve muscle fatigue. Let the elderly soak in warm water at a suitable temperature (generally 37-40℃) for 15-20 minutes to effectively relax their body and mind. During the warm water bath, pay attention to safety to prevent the elderly from slipping. Handrails can be installed around the bathtub or tub, and non-slip mats can be laid on the floor. At the same time, ensure that the water temperature is stable to avoid discomfort to the elderly caused by too high or too low water temperature.

2. Adjust your plan based on training results

Rehabilitation training is a dynamic process, which needs to be adjusted in time according to the training effect and physical reaction of the elderly to ensure the scientificity and effectiveness of the training plan and better promote the rehabilitation of the elderly. During the training process, the physical function of the elderly should be evaluated regularly, including muscle strength, joint mobility, balance ability, cardiopulmonary function and other aspects. For example, the hand muscle strength of the elderly can be tested by a handgrip, the joint mobility can be measured by a joint angle measuring instrument, and the balance ability can be evaluated by a balance test scale. According to the evaluation results, the progress of the elderly in rehabilitation training can be understood and whether the current training plan has achieved the expected effect can be judged. If it is found that the training effect of the elderly in some aspects is not ideal, such as slow growth of muscle strength and no obvious improvement in joint mobility, the reasons should be analyzed and the training plan should be adjusted in time. It may be that the training intensity is not enough. At this time, the training load can be appropriately increased, such as gradually increasing the weight of dumbbells or the resistance of elastic bands in strength training; it may also be that the training method is not suitable and needs to be replaced with a more effective training method, such as using more targeted joint loosening or stretching techniques when improving joint mobility. If the elderly experience physical discomfort or increased pain during training, the current training should be stopped immediately, and a comprehensive physical examination of the elderly should be conducted to find out the cause and take appropriate treatment measures. After the elderly recover, the training plan should be readjusted according to their physical condition, and the training intensity or training method should be changed to avoid discomfort again. By paying close attention to the training effects and physical reactions of the elderly, and adjusting the rehabilitation training plan in a timely and scientific manner, the training can be made more in line with the physical needs of the elderly, the effect of rehabilitation training can be improved, and the full recovery of the elderly's physical functions can be promoted. (Picture from the Internet)

Author | Han Mei is a practicing pharmacist who has worked in a well-known national tertiary hospital for more than 30 years and has rich medical care experience. She has represented the hospital on many occasions to go out for exchanges and study. She is an expert in food hygiene and nutrition, has a national nutritionist qualification, and is a science enthusiast.

Preliminary review | Chen Jiaqi, Li Shuhao

Review | Wei Xinghua

Final Review | Han Yonglin