Fun and Functional Therapy for Older Adults in Isolation

By Lindsay Milgrim, MOT, OTR/L, LSVT Certified Clinician
Occupational Therapist

Isolation precautions are not new to the medical field, but they have never been so prevalent until 2020. COVID-19 placed many older adults in increased isolation to reduce their risk of contracting the virus. As an occupational therapist, seeing multiple patients who remain in their room twenty-four hours a day presents new challenges. But for as difficult as this may seem for the clinician, it is even more so for the patient.

A National Institute of Aging study shows social isolation increases our chronic stress levels and suppresses our immune systems, which affects both our physical and mental health. Per a CDC study, approximately 41% of adults delayed urgent or routine medical care due to fears of contracting COVID-19. Now, one year into the pandemic, practitioners have found improved ways to safely allow the population to receive medically necessary services with a reduced risk of infection.

These changes have challenged clinicians to continue providing clinically excellent services while completing most sessions in the patient’s room or with less equipment, greatly reducing the risk of cross-contamination. However, these restrictions can cause our treatments to feel routine or even boring for both the clinician and patient. How can you continue to assist patients in achieving their functional goals while keeping the treatments patient-centered, engaging, and fun?

For patients in isolation, here is a robust list of meaningful and creative activities that require minimal equipment and space. These activities can be downgraded or upgraded by completing them while sitting, unsupported sitting on the bed, or standing.

Daily Living Activities for Isolated Patients

Self-care may seem like the easiest activity to complete while in isolation, but it can be a challenge for many. These tasks are meaningful and provide patients with a strong sense of accomplishment. It’s easy to stay in pajamas or sweatpants all day when there isn’t anywhere to go, but the simple act of maintaining a normal routine and good hygiene can boost one’s mood while enduring such an abnormal time.

• Dressing, bathing, toileting, grooming, self-feeding
• Bed mobility
• Transfer training
• Nail painting
• Organizing clothing and labeling drawers to improve clothing selection for dressing
• Folding the laundry and put items away in the closet or drawers
• Making the bed to challenge a patient’s problem solving, standing tolerance, and balance
• Cleaning room by wiping down surfaces
• Preparing a favorite recipe or baking a sweet treat like cookies
• Educating on disease management, edema, home safety, pain management, oxygen management, orthotic training, plan of care
• Making environmental modifications to create a safer or more functional living space

Therapeutic Exercise Patients Can Do in Their Rooms

Adequate exercise has been a significant challenge for many with the restrictions in place. In many facilities, patients cannot use the gym and must remain in their rooms. Many patients in their homes are no longer able to go to their community gym or are afraid or unable to go for a walk outside. Clinicians must get creative with providing adequate equipment and a routine that is easy for patients to use and complete in their homes.

• Using one piece of equipment for multiple activities, reducing cleanup. My favorite example is using a single ball for bilateral upper extremity exercises, trunk exercises, and a ball catch
• Completing weight-bearing exercises while standing, such as wall push-ups, marching, Yoga, and Tai Chi
• Challenging balance by completing range of motion exercises in sitting or in standing
• Providing a patient with a TheraBand, leaving it in their room for future sessions to reduce the risk of contamination between patients

Therapeutic Activities to Fight Isolation

It’s important to have some fun in the session, too. These activities can add variety and help build rapport in the session while challenging various goals.

• Scavenger Hunt. The patient must walk around the room and search for hidden items. This is a great activity to improve dual tasking, functional mobility, visual scanning, and activity tolerance
• Video Chat With a Loved One. Help reduce their feelings of isolation with a familiar face. Have the patient stand while conversing for added exercise
• Obstacle Course. Place obstacles such as a chair, clothing, a towel, a TheraBand, or a trash can on the floor and have the patient ambulate from start to finish safely. This is great for safety awareness, balance, and problem-solving skills
• Simon Says. A fun, no-equipment game that can improve strength, body awareness, balance, and motor planning
• Post-It Note Game. Number post-it notes on the wall and in various order, instruct the patient to reach to facilitate visual scanning and weight shifting while reaching
• Family Photo Walk. We all love to reminiscence and talk about our loved ones, and this a great way to work on standing tolerance and balance
• At-Home Concert. Play their favorite music and dance! Apple Music and YouTube have great song compilations by decades or genre

Fine Motor Skills You Can Coordinate During a Pandemic

No extensive collection of games or equipment are needed to engage fine motor skills in isolation. Scan the patient’s room and use what is available or provide materials that can be used in multiple sessions. Meaningful tasks or those that can reduce the sense of isolation may be the most motivating during this time.

• Buttoning, tying, and zippering clothing
• Opening and closing containers they have in their room such as shampoo bottles, make-up, or anything you can find.
• Writing a card to a loved one
• Reading a magazine and flipping the pages
• Sorting or counting coins they have in their wallet or purse
• Coloring or painting

Despite the many challenges this year has placed on everyone, it has also emphasized our innate need for connection and purpose. Sustained isolation may wear on our patients’ motivation, but our skills and knowledge regarding the impact of meaningful occupations can help facilitate better functional outcomes. Remembering that you may be the only person your patient sees that day or regularly is important to maintaining a therapeutic sense of self throughout the plan of care. We can continue to motivate, educate, inspire, facilitate, and treat our patients with the same care, empathy, and fun—no matter the location.