The Biological Basis for Assisted Movement
As we age, our bodies undergo biological changes that can affect mobility. A key factor is sarcopenia, the progressive loss of muscle mass, which leads to reduced strength and balance. This makes simple movements, such as turning in bed, more difficult. Understanding these physical limitations is the first step toward effective and safe assistance. An older adult who retains even a small amount of muscle control can be a significant partner in their own care, reducing the physical strain on the caregiver and maintaining a sense of autonomy.
The Pre-Turn Checklist: Communication and Preparation
Preparation and clear communication are fundamental to a safe and comfortable turn. Before you begin, always explain the process to the older adult. This reduces anxiety and ensures they know what to expect and how to help. A simple conversation can improve cooperation and coordination. The following steps should be completed before initiating the turn:
- Explain the process: Clearly and calmly explain the steps involved in the turn.
- Establish a signal: Agree on a verbal or physical cue, such as a countdown, to initiate the movement together.
- Ensure the bed is safe: If using a hospital bed, lower the head and flatten the bed to a comfortable working height. Always lock the wheels to prevent unexpected movement.
- Position supportive pillows: Have pillows ready to place under the head, between the legs, and behind the back for comfort after the turn is complete.
Specific Actions for an Older Adult to Assist
For an older adult with some mobility, their participation is invaluable. By leveraging their existing strength and using the proper techniques, they can greatly facilitate the turning process.
Using Leg and Foot Leverage
By bending their knees and placing their feet flat on the mattress, the older adult can use their leg muscles to initiate or assist with the turn. This creates a powerful pivot point that shifts the body's weight, making the roll easier. If they cannot bend their knees, crossing the ankle further from the caregiver over the closer ankle can help the hips rotate in the correct direction.
Engaging Upper Body Strength
Utilizing arm strength is another key way to assist. The older adult can:
- Hold a bed rail: If a rail is present, they can hold onto it to provide their own leverage and stability.
- Reach across the body: As they roll, they can reach the arm furthest from the caregiver across their chest toward the direction of the turn, which helps pull the upper body over.
- Push off the mattress: Some older adults may have enough strength to push off the bed with their elbow or hand to help lift and move their trunk.
Moving in Unison
Timing and coordination are critical. The older adult should move with the caregiver on the agreed-upon signal. This synchronized movement prevents jerking motions, which can cause discomfort or injury.
Comparison of Assistance Techniques
| Feature | Active Participation | Passive (Non-Assisting) | Benefit for Patient | Benefit for Caregiver |
|---|---|---|---|---|
| Turning Effort | Significantly reduced | High | More comfortable, feels more involved | Less strain on back and joints |
| Control | Patient feels more in control | Patient is fully dependent | Maintains dignity and autonomy | Predictable movement, lower risk |
| Techniques | Uses leg and arm leverage, follows cues | Requires draw sheet or multiple caregivers | Promotes residual mobility | Safer lifting ergonomics |
| Best for | Individuals with some strength/mobility | Individuals with limited or no mobility | Better circulation, less skin shearing | Safer for heavier patients |
Utilizing Supportive Aids and Safe Handling
Even with active participation, supportive aids can enhance the safety and ease of the turn. A draw sheet, a small sheet placed under the individual's torso, is a fundamental tool. For the older adult, they can still bend their knees and cross their arms while the caregiver uses the sheet to minimize friction and prevent skin shearing. For those with more upper body strength, a trapeze bar mounted over the bed can provide a stable overhead handle to pull on.
Post-Turn Support and Skin Care
Once the older adult is turned, the work isn't over. Proper positioning is crucial for comfort and preventing pressure injuries. Using supportive pillows or foam wedges to maintain the new position is key. Place a pillow behind the back, another between the knees, and a third to support the top arm. This ensures the spine is aligned and bony prominences are cushioned. It is also an ideal time to inspect the skin for any signs of redness or irritation, a key part of pressure injury prevention. For more advanced techniques and resources, consider information from the American Physical Therapy Association.
Conclusion
While turning an older adult in bed can seem like a demanding task, fostering their participation transforms it into a cooperative effort. By clearly communicating and empowering them to use their remaining strength to bend their knees and use their arms for leverage, the process becomes safer, more dignified, and more comfortable for everyone involved. This proactive approach supports not only physical health, but also the older adult's continued sense of independence and self-worth.
