Best Chairs for Frailty Units and Care of the Elderly Wards

Older people can lose physical function quickly when they spend prolonged periods in bed. Illness itself can contribute to this decline, but so can inactivity, reduced mobility and doing less for than you would normally do at home.

This is why preventing deconditioning should be part of the care pathway in hospital frailty units and care of the elderly wards.

A suitable chair makes it easier and safer for patients to sit out, transfer, stand, engage in therapy and return quicker to their normal level of activity.

In this guide, we look at what to consider when choosing seating for frailty units and Care of the Elderly wards

Jump straight to…

• • What is Deconditioning?
  • The Importance of Seating in Frailty Units
  • Features to Look for in Chairs for Frailty Care
  • Preventing Deconditioning with Seating
  • What about Pressure Care?
  • How our Chairs Support Deconditioning Prevention
  • Conclusion
  • Frequently Asked Questions

What is Deconditioning?

Deconditioning is the decline in physical and functional ability that can occur when someone remains inactive in bed for an extended period of time.

Hospitalisation is a big factor in this, and hospital-acquired deconditioning is a now recognised clinical term using in the Model Discharge Pathway and the focus of campaigns such as #EndPJParalysis and Last1000Days.

Someone who normally gets up, walks to the bathroom, dresses themselves and spends time in the living room may spend most of the day in bed as an inpatient following surgery or treatment.

For someone who is already frail, that change in routine can have a significant effect.

Deconditioning isn’t just about loss of muscle mass or strength, although it does include this. Reduced activity can affect mobility, balance, confidence and the ability to carry out everyday activities independently, which can result in a vicious cycle:

Illness → inactivity → loss of strength and confidence → reduced mobility → greater dependence → more inactivity.

That’s why preventing deconditioning and breaking that cycle early is such an important part of the recovery process in Frailty Units and Care for the Elderly.

The Importance of Seating in Frailty Units

A ward chair in hospital can either do one of two things; facilitate activity and mobilisation, or become another reason why a patient remains inactive.

If a chair is uncomfortable, difficult to transfer into or out of, or the wrong size, it will deter the patient from sitting out and staff may be more likely to keep the patient in bed.

On the other hand, the right chair can be an integral part of the patient’s mobilisation process, enabling their rehabilitation.

Rather than simply just get the patient out of bed and into a chair, the aim is to create opportunities for the patient to do more for themselves.

This could mean:

• Getting up from the bed with appropriate assistance
• Sitting out for meals
• Practising sit-to-stand
• Transferring between the chair and another surface
• Moving around the ward
• Participating in physiotherapy or occupational therapy
• Getting to the bathroom rather than remaining in bed
• Spending time socialising with other patients or visitors
• Building confidence in everyday movement

In this context, the chair becomes an enabler of the rehabilitation programme, rather than just a place to sit.

Features to Look for in Chairs for Frailty Care

Frailty units care for people with very different levels of mobility and physical ability, so having inbuilt flexibility in the chair to adjust it to different requirements is important.

When choosing chairs for Care of the Elderly Wards, it’s helpful to measure them against the following criteria:

Making sit-to-stand easier

The transition from sitting to standing is one of the most important functional movements in everyday life.

A chair that is too low, too deep or poorly positioned can make standing unnecessarily difficult. For a frail patient, that may mean requiring more assistance than they would otherwise need.

• Height adjustment helps staff position the seat to the right height for each individual.
• Having padded armrests at the right height are important to enable frail patients to stand.
• For patients who require additional assistance, a rise function can provide further support during transfers.

Supporting active transfers

A suitable chair should facilitate the different transfer techniques, whether this is lateral sideways transfers, using a standaid or a mobile hoist.

Features like flip-away armrests, adjustable seat height and the chair base can affect the ability for patients and staff to transfer safely.

This is particularly relevant in frailty care, where a patient may be capable of standing or partially assisting with a transfer even if they cannot yet walk independently.

Encourage sitting out of bed

‘Sitting out’ is the first but significant step in regaining lost mobility, as it creates a position that opens up so much more opportunities for meals, conversations, therapy sessions and personal care.

The chair needs to be comfortable enough for the patient to want to sit out in, but still supporting an active approach to care.

Adjustable to the individual

Patients in frailty wards will have different heights, weights, body shapes, mobility levels and postural requirements.

Adjustability can allow the seat height, depth, width and other aspects of the chair to be adapted to the individual.

Work with rehabilitation and therapy

A multidisciplinary team of physiotherapists, occupational therapists, nurses, healthcare assistants and other members of the team will all be working towards the same objective, to help the patient regain or maintain function.

Height adjustment, accessible controls, transfer-friendly design and good positioning all contribute to more useful seating during rehabilitation.

Rather than thinking of the chair as a separate item of furniture, it can be an enabling part of the environment in which functional activity takes place.

Preventing Deconditioning with Seating

Preventing deconditioning is part of a wider approach that considers mobility, nutrition, hydration, continence, cognition, sleep, pain and the patient’s normal level of function.

The role of seating in this context is to remove barriers to mobilisation and independence, and be an enabler in the whole rehabilitation process.

This is particularly important, because there can be a tendency in hospital environments to prioritise safety by reducing movement, but can lead into a spiral of reduced mobility and potential deconditioning.

From ‘Sitting Out’ to Functional Activity

One useful way to think about seating in frailty care is to consider what happens after the patient gets into the chair.

For example:

Getting into the chair – can the patient contribute to the transfer?

Sitting for breakfast – can they feed themselves comfortably?

Getting to the bathroom – can they stand and transfer with appropriate assistance?

Therapy – can the chair support exercises, sit-to-stand practice or other functional activity?

Social activity – can the patient spend time outside their bedspace?

Returning to bed – can they participate in the transfer again?

Each individual activity may seem small, but this is an important principle in a deconditioning-aware approach, to look for opportunities to maintain function rather than designing care around inactivity.

What about Pressure Care?

Pressure care remains an important factor for patients who need to sit out for longer.

However, a good pressure management strategy should sit alongside an active mobility strategy.

In other words, a patient shouldn’t be kept in bed just because they are considered at risk of pressure damage, nor should a pressure-relieving chair cushion be used as a reason to leave someone sitting out for longer periods without mobilisation.

The right approach is dependent on the patient’s mobility assessment and care plan.

Good seating should support appropriate positioning, comfort and pressure redistribution while still allowing the patient to participate in movement wherever it is safe to do so.

How our Chairs Support Deconditioning Prevention

At Vivid Care we design hospital seating around the practical challenges faced by patients and clinical teams.

HiBack Bedside Chair

The HiBack Bedside Chair is a clinically-proven bedside chair developed with the NHS, that helps patients sit up out of bed and get on the pathway to recovery faster.

• Easy height adjustment – the winding action effortlessly adjusts the seat height between 16-22”
• Easy for patient transfers – the flip back armrests are ideal for side or standing transfers, and with the specially designed seat base the HiBack is fully compatible with standaids.
• Easy cleaning and infection control
• Levitex seat cushion provides enhanced comfort but with the firmness to enable easy standing, due to its unique qualities that progressively increase firmness under load. The higher rate of return gives frail patients better sensory feedback and improved proprioception.

Lento Mobile Riser Recliner

The Lento Mobile combines mobile ward seating with rise-and-recline functionality, for patients requiring a higher level of postural support.

• Adjustable positioning – the fully adjustable seat dimensions and interchangeable backrests allow staff to cater to the size and positioning requirements of any patient
• Pressure-relieving materials – stretch dartex fabric and high risk gel seat wrap provides for patients at higher risk
• Compatibility with transfer equipment – specially designed castors and removeable armrests make this perfect for standaids or even lateral transfers.
• Mobility around the ward – with a slim profile, push handle and braked castors this is ideal for mobility around the ward, or moving to rehabilitation/exercise areas.

Conclusion

For frailty units and Care of the Elderly wards, a well-designed chair can make transfers easier, support posture and pressure care, and provide sitting comfort.

When preventing deconditioning is part of the goal, hospital seating should be considered not simply as furniture, but as part of the patient’s pathway to recovery.

For more information, explore our Deconditioning in Hospital: A Clinical Guide, which covers the wider clinical picture and practical approaches to preventing hospital-associated deconditioning.