The author is a geriatrician, epidemiologist and researcher at the University of Montreal Hospital Center. He is also a co-founder and medical expert at Eugeria, whose mission is to improve the daily lives of people with Alzheimer’s.
Since the start of the pandemic, I have received many patients who have experienced deterioration in daily functioning. After a medical examination, I regularly find no new diseases that could explain this deterioration. However, the patient and his relatives swear by iron that he has changed. If a few months ago dad walked around the neighborhood and easily carried on conversations, then lately he seems to have lost his physical abilities and cognitive orientation.
We’ve talked a lot about deconditioning with the expansion of the response to the pandemic, especially in residential areas for the elderly, such as DHSSR and private homes. Let’s take a closer look at what it is.
The difference between deconditioning and “common” diseases
While there is no single definition of deconditioning, the site quebec.ca describes it well: “Deconditioning is the sum of the physical, mental, and social consequences associated with inactivity, a period of sedentary lifestyle, or intellectual and social insufficiency. »
The absence of a current illness can also signal that a person is facing a case of deconditioning. When a person consults, it is most often because the symptoms are bothering them and they are looking for a diagnosis that can explain them. Thus, shortness of breath can be a sign of pneumonia, heart failure, or even anemia. These diseases usually have a specific cause and treatment.
When it comes to deconditioning, a symptom or health problem is not related to a specific disease. So if, after a few weeks of confinement, dad can no longer walk around the neighborhood as before, without finding a physical problem that would interfere with him, we will talk about deconditioning. However, if we find that his osteoarthritis has worsened, we may not necessarily make that diagnosis. Unless, due to pain, a person became less active and his general condition suffered.
Six Facets of Deconditioning
We can easily imagine the impact of a sedentary lifestyle and lack of stimulation on our muscles. However, deconditioning can affect all areas of functioning. By considering each of the following geriatric areas, it is easier to diagnose, prevent, and treat.
Geriatricians believe that one day spent in a hospital bed requires three days of rehabilitation recovery. The cardiorespiratory and muscular systems are highly adaptable: when you use them, they get stronger, but when you slow down, they slow down in turn. Walking speed, balance, endurance, physical strength (to get out of bed or chair) decline rapidly during periods of inactivity.
The brain may not be a muscle, but when not stimulated enough, it reacts in exactly the same way. We don’t realize it, but all of our daily interactions with our loved ones and environment keep our neurons active. Due to isolation and distancing, many patients reported loss of cognitive functions, while tests showed little objective change. As if the neurons were rusty, but ready for action when stimulated.
Maintaining one’s autonomy requires performing daily activities (eating, hygiene, etc.) and household chores (cooking, shopping, etc.). They are often performed with such regularity that they become automatic. However, once the routine is interrupted, and especially if the break continues, resuming some of these important activities can be difficult, especially if you have cognitive impairments.
Eating is a social activity for most of us. This is all the more so for people with a loss of autonomy who rely on the presence of relatives or guardians for food preparation or cabaret and to compensate for eating difficulties. For the most vulnerable, a period of inactivity can easily impair their residual ability to eat and maintain adequate nutrient intake.
Social and emotional spheres
Human contact is extremely important at any age. Interactions give us a sense of belonging, give meaning and structure to our daily lives, and support us. The social network is often the foundation upon which our mental health rests. The affective sphere, i.e. mood, anxiety and other psychological symptoms, changes rapidly in the absence of stimulation.
These areas are interconnected. For some people living in a residence for the elderly, eating in the dining room kills four birds with one stone: increases mobility, excites neurons, satisfies appetite and, to put it in good French, “social”! Seemingly innocuous actions are necessary to remain ‘conditioned’.
Physiological reserve and disability threshold
The pandemic and health measures are deforming us all, young and old, to some extent. But why talk especially about the elderly, especially the most vulnerable? Because with them, what doctors call functional reserve and threshold comes into play. With age, and especially with the accumulation of chronic diseases, the body loses part of its physiological reserve: a 10 km race for a typical eighty-year-old will be harder than for a thirty-year-old. It’s a bit like older, more vulnerable people who work at full speed all the time. A decrease in this reserve facilitates the loss of functional abilities (for example, walking around the block, climbing floors). They are closer to the threshold of incapacity for work: a small deterioration will have big consequences. The same period of immobility will be more detrimental to the autonomy of a walker than a marathon runner. For many patients, one can say that a week in bed is worse than returning to Earth after several weeks of weightlessness for an astronaut.
Deconditioning, a health issue
For the World Health Organization, health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. To achieve this state, it is necessary to avoid deconditioning in all areas of health. Aristotle said that we are what we constantly do. A wise truth when it comes to deconditioning.
Tips to avoid deconditioning
There is no magic solution to unconditioning: you have to…recondition yourself. After a stay in the hospital or surgery, it regularly happens that older people go to rehabilitation. On the menu are actions aimed, as necessary, at restoring the previous state of operation for each aspect of the deconditioning. Without resorting to rehab, here are some simple tips to help you avoid deconditioning and improve your functioning:
- Move out of your usual living quarters. If you do not leave your room, apartment or entrance often, it’s time. By expanding our living space, we encourage our muscles, as well as our neurons, to do more.
- Say yes and overcome the initial inertia. While taking health precautions, find the activities we used to do and the people we used to see. Take advantage of the slowly approaching spring to engage in outdoor activities.
Check out the quebec.ca website for more tips and resources from Fondation AGES, Institut universitaire de gériatrie de Montréal and CIUSSS de l’Estrie-CHUS.