Chair and bed rise performance in ADL-impaired congregate housing residents.

OBJECTIVES: To examine the ability of activity of daily living (ADL)-impair ed older adults to successfully rise, and, when successful, the time taken to rise, from a bed and chair under varying rise task demands. SETTING: Seven congregate housing facilities SUBJECTS: Congregate housing residents (n = 116, mean age 82) who admitted to requiring assistance (such as from a person, equipment, or device) in pe rforming at least one of the following mobility-related ADLs: transferring, walking, bathing, and toileting. METHODS: Subjects performed a series of bed and chair rise tasks where the rise task demand varied according to the head of bed (HOB) height, chair se at height, and use of hands. Bed rise tasks included supine to sit-to-edge, sit up in bed with hand use, and sit up in bed without hands, all performe d from a bed where the HOB was adjusted to 0, 30, and 45 degrees elevations ; roll to side-lying then rise (HOB 0 degrees); and supine to stand (HOB 0 degrees). Chair seat heights were adjusted according to the percent of the distance between the floor and the knee (% FK), and included rises (1) with hands and then without hands at 140, 120, 100, and 80% FK; (2) from a recl ining (105 degrees at chair back) and tilting (seat tilted 10 degrees poste riorly) chair (100% FK); and (3) from a 80% FK seat height with a 4-inch cu shion added, with and then without hands. Logistic regression for repeated measures was used to test for differences between tasks in the ability to r ise. After log transformation of rise time, a linear effects model was used to compare rise time between tasks. RESULTS: The median total number of tasks successfully completed was 18 (ra nge, 3-21). Nearly all subjects were able to rise from positions where the starting surface was elevated as long as hand use was unlimited. With the H OB at 30 or 45 degrees essentially all subjects could complete supine to si t-to-edge and sit up with hands. Essentially all subjects could rise from a seat height at 140, 120, and 100% FK as long as hand use was allowed. A sm all group (8-10%) of subjects was dependent upon hand use to perform the le ast challenging tasks, such as 140% FK without hands chair rise and 45 degr ees sit up without hands. This dependency upon hand use increased significa ntly as the demand of the task increased, that is, as the HOB or seat heigh t was lowered. Approximately three-quarters of the sample could not rise fr om a flat(0 degrees HOB elevation) bed or low (80% FI() chair when hand use was not allowed. Similar trends were seen in rise performance time, that i s, performance times tended to increase as the HOB or chair seat elevation declined and as hand use was limited. Total self-reported ADL disability, c ompared to the single ADL transferring item, was a stronger predictor of ri se ability and timed rise performance, particularly for chair rise tasks. CONCLUSIONS: Lowering HOB height and seat height increased bed and chair ri se task difficulty, particularly when hand use was restricted. Restricting hand use in low HOB height or lowered seat height conditions may help to id entify older adults with declining rise ability. Yet, many of those who cou ld not rise under "without hands" conditions could rise under "with hands" conditions, suggesting that dependency on hand use may be a marker of progr essive rise impairment but may not predict day-to-day natural milieu rise p erformance. Intertask differences in performance time may be statistically significant but are clinically small. Given the relationship between self-r eported ADL disability and rise performance, impaired rise performance may be considered a marker for ADL disability. These bed and chair rise tasks c an serve as outcomes for an intervention to improve bed and chair rise abil ity and might also be used in future studies to quantify improvements or de clines in function over time, to refine physical therapy protocols, and to examine the effect of bed and chair design modifications on bed and chair r ise ability.