Who makes the decision that someone should use a wheelchair full time instead of walking when that person is not necessarily able to make the best decision on her own?
Mom (92) fell and broke her hip at the end of February and then fell and broke her leg in June. (She used a walker while walking.)
She is currently in a nursing home for short term rehab. She is able to stand up with assistance and can walk at least 100 feet. They are working with her to see if she can use her hands to move a wheelchair herself.
I think rehab will recommend walking for short distances and use of the wheelchair for longer distances.
However, I think that two of my three siblings think she should now use a wheelchair only (no walking) to prevent another devastating fall. I think I am beginning to agree.
Mom’s primary care doctor retired. I consulted with another primary care doctor in the same practice, but she has never met my Mom and told me she cannot make that determination now.
Her orthopedic surgeon said that continuing to walk - at least for shorter distances - would help prevent the atrophy that could occur if she were in a wheelchair full time.
I am just so confused. I just don’t know what to do or who to consult. If all siblings decide a wheelchair is best, do we just try to get a prescription for a wheelchair from a doctor?
Any help is appreciated!
So many seniors fall because they have a spontaneous break and the fall is not the cause but the result of the bone breaking.
That is what I would want to know before I decided to keep her in a wheelchair fulltime. If her bones are swiss cheese then she will be safer in a wheelchair, because she will probably have more spontaneous breaks, but if her bone density is good I would keep her as mobile as possible to avoid the many problems that come with being wheelchair bound.
Best of luck finding the correct path forward.
A bone scan, if not already done, would be very helpful in determining the course of action. After my mother's one leg broke, she asked the osteologist if the other one was likely to do so, and he told her "they have the same 'history'--osteoporosis" and sure enough, a year later the other one broke. Fortunately, she was still able to walk unaided for a few years afterward, but I always felt concerned that a hip might also break. As she got older, she eventually used a walker, then a wheelchair and then finally bedridden.
I guess if one has severe osteoporosis, the choices are "fall and break it now" or have it break spontaneously later on--neither being a pleasant experience (to put it mildly).
Get her videos of seated exercise programs to practice daily. Make sure she is taking all medications and supplements that have been prescribed. Also, look at her living environment and remove all fall risks.
Getting in and out of bed can be dangerous for a short person if their feet don't hit the floor when seated on the edge of the bed. Make sure she knows how to do this safely, or that she knows to call for help and NOT get up hserself.
PT can teach her how to move safely, but you have to make sure she can do what she was taught or she can't be independently mobile. That is different from being wheelchair bound.
I would say if someone is with her, if she is wearing a Gait Belt and she is using a walker that is great. She will use muscles that will atrophy if she is in a wheelchair all the time. With someone with her that can aid her and guide her down if she begins to fall that may prevent injuries. But I would not let her walk on her own.
(not to be cynical here but...an orthopedics income is based on mending bones that have fractured so I am sure that is one of the reasons he says to keep her walking..what do the people doing the rehab / PT say? what would they do if this was their mom?) And you have to keep up with the PT at home doing the exercises that will help her are you and your siblings willing to do that daily? Will your mom participate?
I agree with Grandma1954 that a combination of the two is better - some walking is very beneficial to help retain the strength to assist in transfers, bathing and toileting because once the ability to even stand momentarily is lost it is a whole different level of care. In a facility setting that could mean carefully guided walking as part of routine PT, at home it means someone would need to supervise and guide every step.
Its very difficult to prevent falls. Are the falls caused by her osterporosis?
I would listen to the surgeon to keep her mobile as long as possible but be prepared knowing the wheelchair is in her future.
These are very difficult decisions for sure. Smiles to you as my dear 89-year-old Mother would have rather have been pushed around in a wheelchair as opposed to using a walker, so I had the opposite problem. I wanted her to walk because I didn’t want her to lose what little muscle that she had.
My Mom walked with a walker and a gait belt, which proved invaluable, and supervision within the house. I would put my Mom in a wheelchair only if we were going out of the house. We also did daily chair-type exercises with her.
We don’t like change, and we certainly don’t like seeing our parents decline. Why don’t you take cues from your mother on what she should do?
If you decide to put her in a wheelchair, just make sure she does daily chair exercises to keep up the muscle, well I would do that regardless of walker or wheelchair.
I think the key here is assistance / supervision when she moves from point A to point B no matter what means she is using.
You and your sisters will make the right decision. Best of luck to you. And your dear mother!
Mother is one fall away from a wheelchair, FT. And what she doesn't 'get' is that will mean she is Hoyer lifted into it in the am and put back to bed in the evening and will not be able to move about her small apartment. The doors are simply too small and cannot be widened.
After her many surgeries--both ankles, knees and one hip..she was good with PT until the PT stopped coming in home. She never did a single exercise again.
You really want to put off the wheelchair dependence as long as possible. It changes the dynamic of everything. In mother's case, it will require daily aides and she does NOT want that. Or placement in a facility. She REALLY doesn't want that.
If your mother is able to walk one hundred feet, she can walk. What she should be encouraged to work on is balance (her physical therapists will address this); and she will need continuous monitoring to ensure she does not mobilise unattended. Is she able to recognise the need to press a call button and wait, or can she not be relied on for that?
Do you know what caused the falls?
She's never had pressure sores or significant muscle loss, and can still get up and down to use the bathroom by herself. She still falls, but not as often as she did before getting into the w/c full time. She lives in a Memory Care ALF and has gotten physical therapy a few times, but she really has no desire to exercise or move her body much, which is her prerogative. You can always get your mother PT as necessary to keep her moving about a bit if she does become wheelchair bound.
I agree that a w/c is a last resort for a few reasons, but also this: if it's necessary, do it. Forget about exercise and all the what if's............safety comes first, so if everyone (including the PCP) is on the same page about mother going into a w/c, then move forward with that decision.
As a rule, Medicare will pay for ONE appliance (either a walker or a wheelchair) once every 5 years; you will need a doctor's written prescription for either, and they can submit it directly to Medicare and you can have an appliance delivered. If she does go into a w/c, I recommend a high grade gel cushion for her to sit on for added comfort; Mountainside Medical is a good website for ordering such cushions: https://www.mountainside-medical.com/search?type=product&q=gel*+wheelchair*+cushion*
Best of luck!
My relative uses a wheelchair part-time (for longer outings) but has continued to walk around at home. There have still been falls but I honestly think these would still happen regardless.
To improve safety, regular PT sessions, falls alarm, getting more supervision have all been added.
I was like your siblings. After sooo many falls I was thinking my relative should start using wheelchair full-time. But after more info from the PT, I saw it's more complicated. Doctor had ordered a bone scan too to help weigh the risks. Both Doc & PT said to walk until she really couldn't.
I would explain to the sibs there are pros & cons to walking or wheelchair & encourge them to trust the PT/Doctor's advice.