Managing Quarantine Debility

[ photo by Jessica Arraes ]

COVID related debility.

I recently had a patient, Carol (not her real name), in acute inpatient rehabilitation with debility due to a few different factors. Her biggest contributing factor to her debility, however, was the fact that she had basically been quarantined in her house for the past 10 months.

Prior to March 2020, Carol was very active with her family, her church and community. She lives alone and did nearly everything for herself. She was still driving herself to the grocery and getting her own groceries. Once everything shut down, however, things changed. She no longer went on her weekly grocery run or went to her biweekly church services. No more gatherings with her small group of friends, and her weekly slumber parties with her great-grandchildren also came to a stop.

The activities she was doing prior to COVID were what kept her in great shape. She had been able to walk community distances without a walker. She did not need any help doing any of her household tasks or her activities of daily living. Throughout the past 10 months, she did her best to stay as strong as she could, but not being able to go out really caused her to lose the strength and independence that she had been so proud of (I have written about these negative effects previously, Isolating Elderly During The Pandemic).

Debility is a qualifying rehab diagnosis.

Carol saw her primary care physician (PCP) a couple of weeks before she was admitted to my hospital. She was there for her usual annual check-up. It was during this visit that it was noted her blood pressure was quite elevated. Carol said she had been taking her blood pressure with her home BP cuff and saw that it was running high but just thought the cuff was not operating correctly. He PCP made some adjustments to her medications in an effort to get the blood pressure back down. Carol already had a fairly recent history of a stroke in one of her eyes, causing vision loss, so her primary doctor knew it was of utmost importance to get the BP down. It was during this visit that Carol confessed she was noticing she was getting quite weak and was having some trouble even going up and down her stairs. She had even had a few falls at home which was something that had never happened before. 

When I was talking with Carol, I started thinking that Carol’s story is most likely the majority of our elderly population’s story over the past year. Personally speaking, my own grandma was quarantined in her assisted living facility, not even able to make her three times a day walk to her facility’s dining room. She certainly was not leaving her building doing the usual outings with the family that she had once enjoyed.

My dad and aunts and uncles have consistently commented that Grandma is moving much more slowly now. She has even had a few scary falls in her apartment. This is a conversation I believe I will be having several times in these next few months as the elderly population is able to be out more now that the majority of them are able to be vaccinated. There are options for helping to make up for that lost strength. I thought it would be worthwhile to give some advice on how to go about doing so.

Treatment options to reverse debility.

My first suggestion is to get your loved one (or yourself) to your PCP. With the levels of COVID-19 infections in the community, there is a good chance your loved one has not been for an annual exam since the onset of COVID, assuming he or she has otherwise not had any health issues. Just like what happened to Carol, there could be something happening from a medical standpoint that your loved one might not even know is a problem. The PCP might catch it before it really becomes a problem.

Once you are at the PCP’s office, this is the time to discuss the decline in strength, concern for falls, need for extra help, etc. The PCP can write an order for home health that should include both PT and OT evaluation and treatment, and, if necessary, a home health aide and/or nurse. Having a course of 4-6 weeks of in-home therapy can jump start improvement of your loved one’s strength, endurance and safety.

If your loved one feels so inclined, this can also be done in outpatient therapy. This is nice because it is added time outside, forcing your loved one to move around even more to get to and from the appointment. Many are under the impression that one must have a major illness or injury to be able to get therapies, but this is not the case. Physical and occupational therapy can be ordered as maintenance therapy, which helps to prevent a catastrophic event that might occur if a loved one falls. 

Once the therapy is in place, encourage your loved one not only just to participate with the therapist in the regular sessions but also to continue with the prescribed home exercise program on the days the therapist is not there. As things open up more for your loved one, the final thing I recommend is to encourage them to remain active by helping them participate in the activities they enjoyed prior to the lock down. This might be as simple as inviting them to your house for dinner or asking them to go for a walk. As with any exercise program, it’s always easier to do it with someone else. 

Thankfully, our aging loved ones are going to be able to be out and about more with the administration of the COVID-19 vaccine. Now is the time to start getting the things in place to reverse debility, by improving their strength and endurance, in preparation to get out and enjoy life again.

Has debility had a profound impact on you or your aging parent? Share your experience in the Comments section or contact me directly.

© 2021 Jessica Kluetz, DO