At our recent Activities Strong Virtual Winter Gathering, Liza Behrens, PhD, RN, an assistant professor at Penn State University, examined “surplus safety” in eldercare, in which the goal is to reduce risks at all costs. 

“This is a byproduct of regulations and institutional practice designed to eliminate all risks, including the risk of positive and meaningful experiences that make life worth living,” Behrens said. 

To protect residents’ rights to enjoy a person-directed quality of life, Behrens asserted the need for a “just” culture of safety — one that identifies and addresses behaviors that create the potential for adverse events, calls for appropriate accountability that supports disciplinary actions against individuals or organizations who engage in reckless behavior, and avoids punishing individuals for adverse events over which they have no control. 

“We need a just culture where we can do our best to honor residents and their right to make choices,” she noted, adding, “Each of us can help this change. We can’t eliminate all risk in the name of patient safety, but we can’t allow surplus safety to continue.” 

It is important to talk about the dignity of risk-taking. “No matter what we do, we impact residents’ dignity,” Behrens said. “Dignity of risk in eldercare refers to empowering an individual’s ability to make choices and remain autonomous in decision-making, which may give rise to risk taking that subsequently enhances personal growth and quality of life.”

“If we can help people engage in risk-taking, we can improve their quality of life and wellbeing,” Behrens continued.

“If we want to create meaningful moments for our residents, we need to work backwards and start with individual preferences,” said Betsy Kemeny, PhD, CTRS, FDRT, associate professor at Slippery Rock University and president of the National Academy of Recreational Therapy. 

“Part of this involves moving away from pre-designed programs and fitting the residents into it and evolving to a live calendar that incorporates individual preferences,” with an emphasis on smaller groups with common needs such as affiliate groups or clubs that provide continuity and purpose.

Kemeny added: “We want to get away from preplanned calendars and really think out of the box. To do that, we need to go beyond Section F of the MDS [Preferences for Customary Routine and Activities].” 

In other words, we need to know our residents holistically and beyond just their medical and daily care needs.

A truly person-centered model of care that improves wellbeing must be built on a deep understanding of who the person is and what their current needs and preferences are. This is key to enabling dignity of risk and empowering residents with the ability to make choices and remain as autonomous as possible. 

When we truly get to know residents in a holistic way, we can gain an understanding of how they view risk and what risks they are willing to take to enjoy the quality of life they have defined for themselves. 

As Kemeny said, “We need to be aware of risks but not limit residents from living their own lives and do things like using typical tools like bread knives or scissors.” She added, “Don’t limit access to outcomes because of your own biases related to a resident’s age and ability to engage and risk taking.”

When we have residents’ life stories and get to know them holistically, it is easier to set expectations around the dignity of risk taking. We can all start today by being champions advocating for a stand operating procedure for decision-making related to health and safety risks for residents, especially for those who are living with dementia. 

Learn more about surplus safety, dignity of risk, and getting to know residents by watching the webinar here.

Charles de Vilmorin is the CEO and co-founder of Linked Senior, creators of the Life Story product.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

Regular leisure-time activity appears to be linked to younger, healthier brains in older adults, a preliminary study has found.

Investigators used magnetic resonance imaging to measure the brains of older people who reported a range of leisure-time activity – from inactive to very active. The most active participants had a brain volume equivalent to someone four years younger. In contrast, the least active individuals had smaller brain volume – a measure that’s tied to cognitive decline, reported Yian Gu, M.D., Ph.D., of Columbia University, New York.

Some brain shrinkage is normal in aging, but significant volume loss is tied to dementia and other disease. The results support growing evidence that greater activity throughout life protects against brain volume loss, said Gu. 

“These results are exciting, as they suggest that people may potentially prevent brain shrinking and the effects of aging on the brain simply by becoming more active,” Gu said.

The study involved 1,557 people with an average age of 75. The most active reported a weekly total of either seven hours of low-intensity physical activity, four hours of moderate physical activity or two hours of high-intensity physical activity. 

Results remained similar after investigators excluded data from 296 participants with mild cognitive impairment. 

The study will be presented at the American Academy of Neurology’s 72nd Annual Meeting in Toronto, Canada, this spring.

The scientists recruited more than one million women, following their weight, caloric intake and activity levels for nearly two decades. Women who were obese at the study’s start were 21% more likely to develop dementia when compared to women with a clinically favorable body mass index. This result remained constant after controlling for multiple factors, including age, education and smoking status.

In contrast, while early results tied dementia to poor diet and inactivity, that link weakened over time. By year 15, neither of these factors was associated with dementia, the authors reported.

Rather than being risk factors, “[t]he short-term links between dementia, inactivity and low calorie intake are likely to be the earliest signs of the disease, before symptoms start to show,” theorized study author Sarah Floud, Ph.D., of the University of Oxford.

Participants had an average age of 56 and did not have dementia at the study’s start. Fifteen years from the start of the study, more than 18,600 women were diagnosed with dementia. Data was culled from the UK Biobank.

The study was published this week in the online issue of Neurology.

The findings come from Tufts University researchers who set out to gauge the impact of physical activity on seniors over 70 who had low physical function and engaged in less than 20 minutes of physical activity each week.

The study assigned half of the seniors to a program of walking and walking-based strength and balance training, while the other half received health education workshops.

The researchers originally aimed to have participants engage in 150 minutes of activity per week, but they noticed improvements in gait speed, mobility and physical performance after just 48 minutes of activity per week.

Those results are “encouraging” and show that “small increases can have big impacts,” lead researcher Roger Fielding, Ph.D., said in an announcement published Monday.

“We wanted the physical activity sessions to include exercise that participants could do outside of the study, and we hope that learning of these results might motivate others to try to make safe, incremental changes to their activity levels,” Fielding said. “Reducing muscle loss, functional decline and loss of independence are important to anyone, at any age, and at any physical ability.”

The study appears in PLOS ONE.

Lively uses passive sensors applied to everyday household objects to measure daily activity levels and automatically notify family members or caregivers when anything is wrong. Under the terms of the partnership, activity data derived from Lively sensors will be combined with the clinical and social activity captured within Caremerge’s platform to correlate any physical health decline or frailty risks for caregiver intervention, improving care delivery and lowering hospital admissions.

This will allow senior living providers to see changes in a routine, the company noted.

“The addition of the Lively’s sensor technology to the existing Caremerge care coordination and communication platform continues to allow us to provide a higher quality of life for seniors at home or in a senior living community, better decision making for care providers, and peace of mind for the families,” Caremerge CEO Asif Khan said.   

One of the studies showed that walking might be better for you than running. Researchers compared self-reported health outcomes of 33,060 runners and 15,045 walkers over a six-year period. Participants were mostly in their 40s and 50s, but were as old as 80.

Running reduced the risk of a first-time hypertension diagnosis 4.2%, while briskly walking the same distances reduced the risk 7.2%, the researchers found. And walking beat running as way to reduce coronary heart disease risk, as well. Running reduced the risk 4.5%, and walking reduced it 9.3%.

Granted, runners may cover more ground than walkers when they hit the trails, boosting the effectiveness of their exercise sessions. But if you walk as far as you would run, you’ll be even better off, this research suggests. This is good news for seniors who need to do a lower impact workout, and for people like me. You say “jogging,” I hear “torture.”

The other study is even more pertinent to long-term care. It showed that seniors’ cognitive abilities improve from doing activities regularly, no matter how strenuous those activities are.

For this study, researchers divided seniors into different groups and had them perform various exercises and mentally stimulating activities. Some seniors did more strenuous or challenging things, such as playing mentally challenging video games, while others did easier activities, such as watching an educational DVD. After three months of doing these activities for three days a week, all the participants showed similar improvements in their thinking and memory.

With the weather warming up and a new quarter starting for many businesses, people are no doubt making springtime resolutions to get in shape and tackle ambitious projects. If you’re one of these people, good luck.

But you might want to walk rather than run, literally and metaphorically. The payoff might be just as great, and the journey much more pleasant.

British researchers examined data from 15 studies with 718 people in which groups of dementia patients took part in structured group activities. Activities included playing show-and-tell with various objects, baking, drawing and other types of games. Activity sessions lasted from 30 to 90 minutes and were held up to five times per week.At the end of the studies, participants completed tests that evaluated their mental functioning.

Participants in the cognitive activity groups performed one or two points better than participants who did not.

“This is showing the people who work in memory care communities and nursing homes and assisted living facilities that they can improve cognitive function, and they need to be providing these kinds of interventions,” neuroscientist Robert Winningham, Ph.D., told Reuters.

The study was published in the Cochrane Database of Systematic Reviews. Click here to read the full study.