By Becca Freeden

Introduction

At Lydia Plus Osteoporosis Project, we have been working on a training video to help with the practical considerations of “thinking about osteoporosis” when moving and handling. The videos we have produced look at the perspective of everyone involved in moving and handling. This helps everyone to be person-centred in considering these manoeuvres.

Link to video

The video can be viewed here, with condensed videos available on social media, including Twitter and LinkedIn.

Osteoporosis and bone health

Our bones are being remodelled throughout our lives so that we have a new skeleton approximately every ten years (1). Osteoporosis is a condition where bone density is reduced due to the bone reabsorption rate being greater than the rebuilding rate. Osteoporosis is diagnosed when bone density is below the population average, specifically measured by dual-energy x-ray absorptiometry (DEXA) scan, is more than 2.5 standard deviations below the population average(2). For more information, follow this link.

Osteoporosis can affect anyone

Osteoporosis can affect anyone, but it is more common in older people and in females and it is increasing in prevalence. The greatest risk factor for osteoporosis is menopause, 1 in 3 post-menopausal women are living with the condition(3). There is also an under-detecting of osteoporosis, and often the first sign of the condition is a low trauma fracture – a broken bone as a result of a fall from standing or lower (4). Any individual over 40 can estimate their risk of fracture using the FRAX or Qfracture tools.

Signs and symptoms

Often there is a misconception that osteoporosis is painful, while it actually has no symptoms. The pain people experience is usually following a fracture. There is a genetic link, and having a parent who has osteoporosis is a risk factor. A person may also have undetected spinal fractures, which lead to loss of height; noticing this can lead to the investigation of bone density.

Lydia Osteoporosis Project aims

People living with osteoporosis have a greater risk of fracturing a bone with a low trauma, such as falling onto a hand or hip. Half of all people over 75 will experience a fracture in the remainder of their life (3). The consequences include a reduction in quality of life, but outcomes can also be more serious. A person who fractures a hip has a 20-24% chance of dying within the year after the hip fracture.

Fractures in healthcare settings are usually as a result of a fall. The aim of LOP is to increase awareness of safe, person-centred moving and handling, to reduce the fracture rate. See our research at Smith and O’May (5)

Improve bone health awareness as a prevention strategy

By working to improve bone health awareness, we aim to reduce the incidence of osteoporosis, improving bone health overall. We produced a TikTok video showing the lifestyle factors involved in prevention. These include taking resistance and impact exercise, and considering good dietary sources of calcium, vitamin D, and other bone healthy minerals. Getting out in the sun every day is recommended, as is taking a vitamin D supplement from October to March. Reducing smoking and alcohol intake will also help.

Improve person-centredness in moving and handling

Person-centredness in healthcare involves engaging with individuals based on their own abilities and values, working holistically, and including the person in shared decision-making. A person may have a particular way of moving and we encourage exploring this as part of the manoeuvre. There also needs to be a consideration of the person working with them and how they feel when supporting the moving and handling task.

From McCormack, et al (6)

Of course, being trained in safe moving and handling is required to negotiate a move which is safe for all concerned. Examples of this are shown in the videos. We also demonstrate a ‘hip hinge’ manoeuvre which is a recommended way for all people involved to use for a lift or in bending to support a person in moving and handling.

Considering all people involved

Our goal here is not to create fear. Instead, we hope that by encouraging good knowledge and skills in moving and handling, as well as the skill to negotiate and collaborate on a task, we contribute to healthcare workers being informed, confident and empowered to work to promote their own health and that of others.

‘Think osteoporosis’

Due to osteoporosis being a ‘silent disease’ (5) without symptoms until a fracture occurs, and being under-diagnosed, we encourage you to ‘think osteoporosis’ and treat a moving and handling scenario as though the condition is present. We want to create safe, person-centred moving and handling practices that consider the risk for all concerned. To work with a person’s agency and individual wishes, managed risks may be a part of achieving independence.

Always being ‘hands-on’ in moving and handling is not always the safest strategy. Over-handling and poor handling could lead to a fracture. If a person has a fear of falling, being handled may increase their dependence on others for moving, and reduce the amount they move, leading to reduced balance and independence. The risk assessment of a person’s ability and needs is always dynamic. Take your time, and make it work for both (or all) of you.

The healthcare professional

Start with yourself – how are you feeling today? Did you sleep well, or poorly? Do you have a niggle somewhere? Ask a colleague for help if needed, even if the person you are working with usually only requires the assistance of one. You might have reduced bone mineral density yourself, so consider reducing risks when you move as well. Use a ‘hip hinge’ if you are bending or lifting and consider the load you will support – maybe you perform the move every day, but today you have a twinge in a muscle and need some help, or you need to break the task into smaller chunks.

Consider your training and your own unique ways of moving. Please note, using a ‘hip hinge’ does not mean you should not move your spine. Your spine will benefit from regular movement and a regular movement practice with resistance training and weight-bearing exercise with impact will help keep all your bones healthy.

The person being moved

The person you are working with may be communicating that they are not feeling good today or are less willing to participate in the task. Or perhaps their cognition is not as good as usual, and they are less able to follow instructions. Ask yourself, is it necessary right now? Maybe they need to go to the toilet and it is necessary. Alternatively, can it wait until they are rested or have had some pain relief? There can be so many reasons for a person to change from day to day. Again, seek a colleague’s help if your dynamic risk assessment tells you there is a change, and more help may be required.

Assess the person’s vulnerability and frailty. Be aware of fears, such as fears of falling, and reduce fears as able – help a person see what they can do for themself – to build their trust and confidence in their own abilities.

Communication

Through these techniques, we see each person as having their own unique experiences. Each person is an active participant in the care – collaborating and considering each party’s welfare and human dignity. We aim to consider each individual’s ways of doing, ways of moving, and what matters the most to them.

Each person has a right to take risks. Can we reduce handling, and therefore promote independence? Ask where help is needed. It is very tempting to step in, but be aware of the person’s wishes, and try to find a way of doing things today that works for everyone.

A reminder that you can find our training video here.

Brief overview of video content

The video gives an example of several examples of how a moving and handling scenario can go. However, it does not tell you how to carry out every moving and handling manoeuvre. Instead, we hope it gives you food for thought to approach every scenario considering the people involved and to consider what could influence the situation at the time.

The first example, ‘from lying to standing’ shows a person lying in bed and needing to go to the toilet. She tries initially to move to sitting using her own technique but finds it doesn’t work on the first attempt. The health care worker helps, using the bed controls and giving some advice, and then the person is able to stand up herself with the bed at the correct height for this.

The second example, teaching hip hinge’, is a demonstration of the “how to, not don’t do” approach for bending and lifting. The healthcare worker demonstrates the hip hinge, a slight bend of the knees, sticking the bottom back and bending from the hips, rather than the back.

In the final example, a person is stuck in her chair and needs help to get up. She struggles to manage this herself and the healthcare workers negotiate to work out the best way to help her to stand, with the assistance of two in this instance and checking that she has her balance before walking off.

Conclusion

We hope you find these videos helpful, and they give you some pointers for reflection on your everyday moving and handling activities. If you want to know more about the Lydia Project or if we can be of further help, please email us here.

Bibliography

1. Office of the Surgeon General. The basics of bone in health and disease. Bone Health and Osteoporosis: A Report of the Surgeon General: Office of the Surgeon General (US); 2004.
2. Glaser DL, Kaplan FS. Osteoporosis: definition and clinical presentation. Spine. 1997;22(24):12S-6S.
3. Willers C, Norton N, Harvey NC, Jacobson T, Johansson H, Lorentzon M, et al. Osteoporosis in Europe: a compendium of country-specific reports. Archives of osteoporosis. 2022;17(1):23.
4. Finkelstein JS, Brockwell SE, Mehta V, Greendale GA, Sowers MR, Ettinger B, et al. Bone mineral density changes during the menopause transition in a multiethnic cohort of women. J Clin Endocrinol Metab. 2008;93(3):861-8.
5. Smith MC, O’May F, Tropea S, Berg J. Framing moving and handling as a complex healthcare intervention within the acute care of older people with osteoporosis: a qualitative study. Journal of Clinical Nursing. 2016;25(19-20):2906-20.
6. McCormack B, McCance T, Bulley C, Brown D, McMillan A, Martin S. Fundamentals of person-centred healthcare practice: John Wiley & Sons; 2021.