Self-Care: Live with Quality and Dignity

This chapter provides comprehensive self-care guidance for older adults. Through activities of daily living (ADL) training, transfer training, and proper use of assistive devices, we help seniors reduce life burdens, enhance quality of life, and live with dignity.

Section 1: Activities of Daily Living (ADL) Training

ADL refers to fundamental physical actions required for independent living, performed repeatedly each day. These include basic activities like 👕 dressing, 🍽️ eating, 🏠 managing living spaces, 🚶 mobility, and 🚿 personal hygiene. They also encompass advanced social activities like 🤝 social interactions, 🎪 community engagement, and 🛒 shopping. While these may seem simple, they can be challenging for older adults—especially those with a history of falls 1,6.

Why ADL Training Matters

Aging weakens the body and complicates movement. Fall-related injuries (e.g., strokes, fractures) severely impact quality of life. ADL training aims to:

Achieve independence tailored to individual capabilities.
Reduce bedridden time and enrich mental well-being.
Mitigate fall-related consequences 5,6.

Key Training Areas for Fall-Prone Seniors

🧼 Self-Care Activities
- 🍽️ Eating:
  - Use a firm chair with back support (avoid soft sofas).
  - Press knees firmly when standing.
  - Keep dishes within easy reach to avoid leaning.
- 🚿 Hygiene:
  - Sit while washing at a properly sized sink.
  - Store toiletries (toothbrush, towels) within arm’s reach.
- 👕 Dressing:
  - Sit on a bed/chair for upper-body clothing.
  - Pull pants to hips while seated, then hold support while standing.
  - Choose lightweight, flat-soled shoes with Velcro straps (avoid laces).
- 🚽 Toileting:
  - Ensure doors open/close easily (no spring-loaded hinges).
  - Remove thresholds or mark them brightly.
  - Install grab bars and automatic bidets.
- 🛁 Bathing:
  - Use non-slip mats and a shower chair.
  - Limit bathing to ≤15 minutes to prevent dizziness.
- 🚶 Walking:
  - Maintain posture: eyes forward, chin up, chest out, back straight.
  - Avoid hands-behind-back walking (increases fall risk).
🧺 Instrumental ADL
- 🛒 Shopping:
  - Choose well-lit, uncrowded stores.
  - Limit trips to ≤40 minutes.
  - Use carts; opt for delivery for heavy items.
- 🪜 Escalators:
  - Hold rails, stance wide, and step carefully.
  - Use elevators if unsteady.
🎭 Leisure Activities
- **✈️ Travel**:
  - Consult a doctor before trips; use a walking cane.
  - Avoid steep paths or solo hikes.
- 🎮 Games (chess/cards):
  - Take breaks hourly to prevent dizziness from prolonged sitting.

Section 2: Transfer Training

What Are Transfers?

Transfers involve changing body positions (e.g., bed-to-chair, standing-to-walking, stair use) 4,6.

Why Training Matters

🏠 Essential for independence.
⚠️ 70% of falls occur during transfers (e.g., toileting, bathing) 5.

Key Techniques

Stable Stance: Feet 10–15 cm apart, knees bent.
Minimize bending: Use leg/hip strength (not back) to rise.
Stay close to supports when assisted.

Training Exercises

🛏️ Rolling in Bed: Turn head → swing arms → bend knees → push feet.
🏋️ Bridge Exercise: Lying down, lift hips to strengthen core and legs.
🪑 Sit-to-Stand: Turn sideways before rising to protect spine and heart.

Section 3: Using Assistive Devices

🦯 Mobility Aids

Canes:
- Types: Single-tip or quad-base (for balance issues).
- Height: Adjust to wrist level when standing.
- Gait:
  - 🚶♀️ 3-point: Cane → weak leg → strong leg.
  - 🚶♂️ 2-point: Cane + weak leg → strong leg (faster).
- Stairs:
  - ⬆️ Up: Strong hand on rail → strong leg → cane → weak leg.
  - ⬇️ Down: Cane → weak leg → strong leg.
🦽 Walkers:
- Standard (no wheels): For maximum stability.
- Wheeled (2–4 wheels): For limited strength; use brakes on slopes.
- Walker-cane hybrids: With seats for fatigue.
Wheelchairs:
- Fit: Seat width = hips + 5 cm; back height = armpit – 10 cm.
- Pressure Relief: Shift weight every 30 minutes.
- Stairs:
  - ⬆️ Up: Tilt backward → lift wheels.
  - ⬇️ Down: Descend backward slowly.

🏠 Daily Living Aids

Grab Bars: Near toilets/showers.
🚿 Shower Chairs + Non-Slip Mats.
**⚠️ Smart Alerts**: Wearables with fall detection, GPS, and auto-alerts to caregivers .