Specialist Seating – The Q&A Series Part 4: Conditions 2/3
Providing answers to some of the most commonly asked questions about Specialist Seating.
What can happen as we get older?
The term “older person” can be used to describe an individual aged 65 and over1; the term “elderly person” is also used. It is inevitable that with age comes an increased risk of illness and disability; an estimated 4 million older people in the UK live with a limiting longstanding condition, which equates to over 40% of all people aged 65 and over2. Frailty becomes more prevalent with age, affecting around 10% of those over 653, increasing to around 65% of those aged 90 and above4.
The older person can experience general weakness and fatigue, with or without an associated illness or disability. Frailty, which is characterised by a progressive decline in physical, mental and social functions5, can significantly exacerbate these problems resulting in pelvic instability and poor postural control as gravity takes hold. Gravity can pull them in to a slumped kyphotic posture, often with leaning to one side or sliding down the chair.
As a result of potential pelvic instability, an increased thoracic kyphosis, windsweeping or obesity, an older person can experience discomfort, decreased physiological function, a decline in their health, and even isolation. They may suffer recurrent respiratory infections, digestive problems or complain of pain resulting in becoming confined to their bed.
What is the best chair for the older person?
The main seating considerations for the older person, also known as an elderly person, are:
- Comfort– Feelings of safety and security should be the main objective; if an individual isn’t comfortable then they may not use the chair regardless of the clinical benefits.
- Function– The chair must be compatible with the older persons functional movement, mobility levels and mode of transferring.
- Postural support– Appropriate stability at all body segments is vital for body protection, social interaction and physiological function, including respiratory function, swallow ability and digestion.
- Pressure care– Equal weight distribution over the maximum surface area possible is crucial for reducing the risk of pressure injuries; integrated pressure relieving systems and tilt-in-space can help redistribute pressure.
CareFlex chairs meet these key objectives through a range of functions and accessories. Where safe and appropriate, tilt-in-space can encourage good energy management, and back angle recline can promote comfort. A range of back supports can allow the older person to sit upright and as symmetrically as possible, and an articulating headrest can support an increased thoracic kyphosis. Adjustability and flexibility are also key features of our seating range, ensuring the chair can be set-up for the individual and can continue to meet any changing needs. This will promote pelvic stability and security within the chair, reducing the risk of falls. Chairs also come with the WaterCell Technology as standard to reduce the of pressure injuries.
How can dementia affect posture?
Dementia is not a disease, but an umbrella term for a collection of symptoms that result from damage to the brain caused by different diseases6. Different types of dementia can affect individuals differently, and they will experience symptoms in their own way7. In the later stages of Alzheimer’s disease, the most common cause of dementia, and especially seen in vascular dementia and dementia with Lewy bodies, an individual’s cognitive and physical decline can result in the lack of ability to move effectively, safely and independently. Problems can include reduced muscle mass due to reduction in physical activity and complex motor sequences becoming less coordinated resulting in difficulty mobilising and an increased risk of falls. Eventually an individual is at risk of becoming confined to one position.
In terms of postural need, dementia’s effect on movement can result in:
- General weakness
- Poor sitting balance
- Posterior pelvic tilt
- Increased thoracic kyphosis
- Change in postural awareness
How can specialist seating help an individual with dementia?
- Adjustable seat depth and width can ensure the correct individualised set-up for a person with dementia, promoting improved pelvic stability and spinal posture.
- Appropriate seat height can improve standing ability, in turn reducing carer effort and promoting safety.
- Tilt-in-space can promote energy management for people with low muscle tone and reduced muscle strength by reducing the effects of gravity for a period of time, and further stabilise the pelvis.
- Integrated pressure care with WaterCell Technologyencourages maximum support and equal weight distribution with the aim of reducing pressure injury risk.
- A reconfigured waterfall back can comfortably accommodate kyphotic postures, reducing the pressure at the apex of the thoracic spine.
- An articulating head rest can encourage a supportive head position for maximum comfort.
- A negative angle leg rest can allow for a more stable foot placement on the floor to further assist with standing.
- A flip-up angle adjustable foot plate fully supports the feet so pressure is reduced at the heels.
The HydroTilt chair can support an individual with dementia to maintain their optimum sitting posture whilst also encouraging normal movement and safety. In multi-user environments the MultiAdjust, with back angle recline and tool-free flexibility, could be the ideal solution.
How can cerebral palsy affect posture?
Cerebral palsy is the name for a group of lifelong conditions that affect movement and co-ordination, caused by a problem with the brain that occurs before, during or soon after birth8. The symptoms of cerebral palsy aren’t usually obvious just after a baby is born; they normally become noticeable during the first two or three years of a child’s life. The severity of symptoms can vary significantly; some individuals only have minor problems with limited symptoms, while others may be severely disabled.
The postural challenges that could be present include:
- Abnormal muscle tone
- Involuntary movements
- Muscle weakness
- Poor sitting balance
- Pelvic instability
- Pelvic obliquity
- Pelvic rotation
- Increased thoracic kyphosis
What functions and accessories are needed for an individual with cerebral palsy?
The optimum chair for an individual with cerebral palsy will not only meet their holistic needs but also the clinical and support network objectives. There is a clear need to ensure adequate postural support at all body segments, as part of a 24-hour postural management care plan.
The HydroTilt offers adjustable seat depth to ensure correct set-up and promote pelvic stability for individuals with moderate postural needs. Tilt-in-space can further encourage pelvic stability while promoting comfort, energy management and a regular change of position.
Individuals with more complex postural needs may require the HydroFlex that offers back angle recline, if safe and appropriate, to accommodate any hip contractures. The addition of a pommel may be indicated for windsweeping. Positioning aids, such as pelvic belts or chest harness following risk assessment, may also be indicated to maximise postural control.
For the most complex presentations the SmartSeatPro’s multi-segmental back can accommodate, or correct where possible, any scoliosis and/or rotation through the spine and pelvis. Flexible postural support throughout, with the ability to adjust both left and right sides of the chair, can uniquely accommodate asymmetries in combination with a contoured cushion.
- Age UK (2018) Later Life in the United KingdomAvailable from: www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/later_life_uk_factsheet.pdf
- Office for National Statistics (2013) General health (General Lifestyle Survey Overview – a report on the 2011 General Lifestyle Survey)Available from: www.ons.gov.uk/peoplepopulationandcommunity/personalandhouseholdfinances/incomeandwealth/compendium/generallifestylesurvey/2013-03-07/chapter7generalhealthgenerallifestylesurveyoverviewareportonthe2011generallifestylesurvey#long-standing-and-limiting-long-standing-illness-or-disability
- Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people The Lancet381(9868):752-62
- Gale CR, Cooper C, Sayer AA (2015) Prevalence of frailty and disability: findings from the English Longitudinal Study of Ageing Age and Ageing44(1):162-5
- Van Campen C (2011) Frail older persons in the Netherlands The Hague, Netherlands: The Netherlands Institute for Social Research
- NHS Choices (2017) Dementia guideAvailable from: www.nhs.uk/conditions/dementia/
- NICE (2018) Dementia: assessment, management and support for people living with dementia and their carers[NG97] Available from: www.nice.org.uk/guidance/ng97
- NHS (2017) Cerebral palsy Available from: nhs.uk/conditions/cerebral-palsy/