Preventing the Need for Long-Term Care Requires More Than Just Strength Training | How a Physical Therapist Views Protecting 'Functional Living'
When people hear the term "preventing the need for long-term care," many think of strength training, gymnastics, or walking.
Of course, exercise is important.
Maintaining leg and lower back strength and preventing falls are also essential for preventing the need for long-term care.
However, as a physical therapist working with the elderly, I feel that what is truly important for preventing the need for long-term care is not just increasing muscle strength itself.
What is important is not reducing what you can do in your daily life.
Standing up.
Walking.
Going shopping.
Taking a bath.
Going outside.
Meeting people.
Continuing hobbies and community activities.
I believe that protecting these "things you can do in daily life" is an important goal of preventing the need for long-term care.
This time, I will consider preventing the need for long-term care from the perspective of functional living.
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"Preventing the need for long-term care requires more than just strength training | The perspective of functional living"
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Preventing the need for long-term care is not just about "doing strength training"
When it comes to preventing the need for long-term care, it is easy to focus solely on exercise.
Let's strengthen our legs and lower back.
Let's keep doing gymnastics.
Let's increase the amount we walk.
All of these are important.
However, if you think of preventing the need for long-term care only as "doing exercise," you may miss an important perspective.
For example, even if muscle strength increases slightly, if the opportunity to go shopping does not return, life will not expand.
Even if you practice walking, if the places in your house where you are likely to fall remain the same, anxiety will remain.
Even if you continue doing gymnastics, if your outings and connections with people decrease, your overall life will shrink.
What is important for preventing the need for long-term care is not just "what exercise to do," but "how that person's life changes."
I believe it is important to look not only at muscle strength and walking ability, but also at what can be done in daily life and what is becoming difficult.
Signs that you need to prevent the need for long-term care appear in "things you have stopped doing"
A decline in functional capacity does not happen suddenly one day.
In many cases, small changes appear in daily life little by little.
For example,
You have stopped going out recently
You have started leaving shopping to your family
You have stopped doing the cleaning
You have started avoiding stairs
You find taking a bath to be a hassle
Your opportunities to meet friends have decreased
You have stopped going to hobby group meetings
These changes cannot always be dismissed as just 'getting older'.
Of course, physical strength changes with age. However, the change of 'having stopped doing things you used to do before you knew it' can hide signs that your functional capacity is beginning to decline.
But, the change of 'having stopped doing things you used to do before you knew it' can hide signs that your functional capacity is beginning to decline.
What is important for preventing the need for long-term care is not just starting some new exercise.
First, noticing the things you have recently stopped doing is important.
'Come to think of it, I haven't been going out lately'
'I used to go shopping by myself'
'I used to talk to my neighbors often'
I believe that noticing these small changes is the first step in preventing the need for long-term care.
What we want to protect through long-term care prevention is 'functional capacity'.
Simply put, functional capacity is what you can actually do in your daily life.
For example,
standing up
Walking
Going to the bathroom
Taking a bath
Getting dressed
Cooking
Cleaning
Going shopping
Going out
Meeting people
Continuing hobbies
All of these things are related to functional capacity.
In other words, functional capacity is not just about whether you can walk.
Can you move safely around the house? Do you have the confidence to go outside? Are you able to continue doing the things you want to do? Are you maintaining connections with others?
We need to consider all of these factors.
When people think of preventive care, they tend to focus on their legs, lower back, and muscle strength. However, it is actually important to look at everything, including diet, oral function, going out, social connections, and mental state.
When considering functional capacity, the perspective of fall prevention is also essential. If you want to organize your thoughts on why people become prone to falling, rather than just 'what to train to avoid falling,' please also read our article on fall prevention.
When functional capacity declines, activity levels, mood, and social participation also decline.
When functional capacity declines, your life gradually becomes smaller.
For example, you go out less. As a result, the amount you walk decreases. When the amount you walk decreases, your legs and lower back become weaker. When your legs and lower back become weaker, you become afraid of falling. When you become afraid of falling, you go out even less.
And when you stop going out, your opportunities to meet people also decrease.
As a result, your mood is more likely to drop.
It becomes harder to find motivation.
Your daily rhythm is also more likely to be disrupted.
In this way, a decline in functional living is not just a matter of muscle strength.
Physical function
Activity level
Home environment
Anxiety about falling
Connections with others
Mental state
All of these are interconnected.
Therefore, when it comes to preventing the need for long-term care, simply saying, "Your muscles are weak, so let's do strength training," is sometimes not enough.
It is important to look at what kind of life that person is leading, what they have stopped doing, and what they want to be able to do again.
Looking at that is essential.
Outpatient Service C is not a "place to exercise," but a "place to rebuild your life."
When considering the prevention of long-term care, the roles of Outpatient Service C and comprehensive community support projects are also important.
Although the name of Outpatient Service C may vary by municipality, it is often positioned as ashort-term intensive long-term care prevention serviceconducted within comprehensive support projects.
What is important here is not to think of Outpatient Service C only as a "place to exercise."
Of course, exercise is performed.
Muscle strength, balance, and walking ability are also assessed.
However, the primary goal is not just to complete an exercise menu.
What is important isto sort out daily life difficulties in a short period and get closer to living your own life again.
For example,
becoming unstable when standing up
I've started having trouble going shopping
I'm going out less often
There are times when I feel like I might fall at home
I've stopped doing housework
I'm anxious about how to spend my days when I don't have services
By reviewing these daily life situations, we can consider the necessary exercise, movement practice, environmental adjustments, and lifestyle improvements.
I believe that is the important role of Outpatient Service C.
In Osaka Prefecture's 'Osaka Ee-machi Project,' the initiatives in Neyagawa City are introduced as community building that uses both Outpatient Service C and the Life Support System Development Project as a two-pronged approach.
From this, it can be seen that Outpatient Service C is not just a place for exercise, but has arole in connecting people to community activities and social participation after their life functions have been adjustedas well.
In the context of Outpatient Service C and preventive care, it is also important to have an objective evaluation of 'how much a person can do.'
As an entry point for considering not just physical function but also the connection to daily life, reading the article explaining the SPPB will make the link between evaluation and life functions easier to see.
What is important in the Comprehensive Support Project is to think about 'life after graduation'
What is important in Outpatient Service C and the Comprehensive Support Project is not just staying healthy while using the service.
A person's life continues even after the service ends.
In fact, that is where it becomes important.
While attending Outpatient Service C, you can exercise.
You can have staff talk to you.
You have regular opportunities to go out.
However, if you end up staying cooped up at home again after that period ends, your life functions may decline once more.
The goal of Outpatient Service C is not to continue the service, but towork together to create a form in which the individual can continue living in the communityI believe.
Therefore, the Comprehensive Support Project requires a perspective that considers 'life after graduation.'
Connecting to places to visit
Participating in community activities
Continuing exercises that can be done at home
Resuming shopping and going out
Receiving support and monitoring from family and the community
Connect individuals to home-based support and community resources as needed
By creating this flow, preventive care is no longer something that exists only within services.
Preventive care is not something that can be completed solely through individual effort.
How to continue living within the community.
How to connect with people and places.
How to maintain roles and sources of enjoyment.
I believe that thinking about these aspects will become important in future preventive care.
Physical therapists look at 'living situations,' not just 'muscle strength'
You might have the image that physical therapists are professionals who focus on muscle strength, joint movement, and walking.
Of course, that is important. But for physical therapists involved in preventive care, I believe it is necessary to have more than just that,
a perspective that looks at daily living situations as well.
Which movements are causing difficulty?
In what situations is there a risk of falling?
Is the home environment making it difficult to move around?
Have outings or household chores decreased?
What does the individual truly want to resume doing?
It is necessary to examine these things.
For example, even with a problem like 'I can no longer go shopping,' there is not just one cause.
Is standing up unstable?
Is there anxiety about walking outdoors?
Do they feel unsteady when carrying bags?
Are they afraid of steps on the road?
Are they anxious about walking in crowded places?
The necessary support changes when you look at the actual situations of daily life.
Even with the same 'anxiety about walking,' what you need to consider differs depending on whether the anxiety is inside the home, outdoors, or while shopping.
What is important in preventive care is not simply increasing walking distance.
Where does the person want to go?
What do they want to do?
Who do they want to meet?
What kind of life do they want to continue living?
It is important to think about the walking and movements that lead to those goals.
That is why I believe physical therapists should not just be 'people who build muscle strength,' but also people who think together with the patient about movements to return to daily life.
When looking at daily life situations, it is also important how you view basic movements such as standing up and walking.
If you would like to learn more deeply about assessment and intervention, please also read the articles on standing up, walking, and the basic movement analysis series.
I believe your perspective on viewing daily functioning will become more concrete.
Summary | Preventive care begins with protecting daily functioning
Preventive care is not just about strength training or exercise.
What is important is not reducing the things one 'can do' in daily life.
To achieve this, it is important to notice things that have recently been stopped.
Stopped going outside
Started letting others do the shopping
Stopped doing housework
Opportunities to meet people have decreased
Stopped pursuing hobbies
Signs that daily functioning is beginning to decline can be hidden within these changes.
Outpatient C services and comprehensive community support projects can be considered as support for re-evaluating those daily functions and continuing to live in the community.
And as a physical therapist, I want to value not just looking at muscle strength or walking, but also what kind of life that person wants to regain.
I believe preventive care does not have to start with anything special.
First, think about things you have stopped doing recently.
Daily activities that have started to make you feel a bit uneasy.
Things you used to be able to do, but now avoid.
It all starts with noticing those things.
Protecting what you can still do in your daily life.
Continuing to live in a way that is true to yourself.
I believe that is what preventive care is for.
Recommended articles
References
Ministry of Health, Labour and Welfare: 'Preventive Care Manual, 4th Edition'
Ministry of Health, Labour and Welfare: 'Guidelines for the Appropriate and Effective Implementation of Comprehensive Projects for Preventive Care and Daily Life Support'
Osaka Eemachi Project: 'Regain Your Original Life! Functional Improvement and Promotion of Community Participation Through Short-Term Intensive Rehabilitation'