What do you do when they are too scared of falling to try to function?

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What do you do when they are too scared of falling to try to function?

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My 93 yo mom has decided she can’t walk again. She had a minor fall on Thanksgiving day. I helped her up. She said she wasn’t hurt and everything was normal for a couple of days.

Then I had a relative assist her with a shower while I ran to the store. When I got back in an hour, they had my mom in bed at 8:00 and feeding her soup.

She stayed in bed until the next evening and since then hasn’t been able to walk by herself.

She had missed a meal and got nauseous. Then for days she wouldn’t eat enough to settle her stomach and had bouts of vomiting. She’s eating well again now, but that weakened her even more.

After that long in bed I’m sure she was stiff and now that she hasn’t been moving around she really is weak.

A couple of random days, she’s gotten to the toilet by herself, just to wake up the next day totally disabled. Now she’s having me push her while seated on her rollater to the living room and back. Going to the toilet just twice a day.

This time I’m trying to be patient with her completely instead of trying to convince her to get up and try to move around. When she’s attempting to standI stay near her but all it takes is my hand on her back and she’s doing all the work. I’m not even supporting her, just reassuring her but she thinks she can’t do it. Then she apologizes for being too heavy. She breaks my heart.

I know she needs to be getting up or at least exercising but she won’t do it and it makes it worse if I lose my temper. She won’t let me try to lift her because she’s afraid she’ll hurt me, and she’s afraid of falling,

She has doctor appt. next week and I fear what he and my sister may conclude. Hopefully we’ll get in-home therapy again. I did take a urine sample down to rule out a uti.

This is not the first time but I fear it could lead to her decline. I don’t know what to do if I can’t make her try.

charlotte

Falls Mobility

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She is 93, how long exactly do you think she is going to live? What is a reasonable expectation?

Might be time to place her in a home with trained care takers who know how to lift and move elderly people.

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That’s the thing, I have no way of knowing how long she’ll live. I know she’ll transition some how some day but I can’t decide that. Like a lot of people I’m waiting for an event. This could be it but I won’t welcome it and meantime I have to do whatever it takes to get through the day.

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My mom did something similar. She is 90 with Parkinson's and had a fall about once a month, even with me with her 24/7. She worried about falling so much she finally refused to walk anymore this past summer. I had in home therapists train me on how to safely transfer her, and mom is happier and seems healthier. It's a transition, but in home therapy will give you and your mom help and ideas

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Thank you. I hope that’s what he says next Wednesday.

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Yes, ask her Dr. about home therapy. I think Medicare will pay.

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We’ve had in-home therapy a couple of times and yes, medicare pays for it. She shames me by doing well with them but I don’t care about that. Its exactly what I hope the doctor decides for her, and that my sister doesn’t have a hidden agenda to present.

The therapists will show me how to help her better. I need training on how to help her in a wheel chair. Mostly she sits on rollator when she’s “too weak to walk” but has to stand and pivot around to sit in her armchair or bed. That’s when she really gets scared.

How do they just decide one day they can’t walk? Then they perpetuate the notion by laying around and make it true.

Sorry for rambling but I’m very nervous and worried about her.

charlotte

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Very frustrating. Of course, she should be staying as active as possible. It helps with so many health issues. But if she won't do it, at 93, how much pushing and prodding is a caregiver supposed to do? When do you just throw your hands up and say OK fine, do it your way? Tough call, no doubt.

My mom's only 76 so I try to push her but she is VERY resistant to do anything extra to help herself. It's very sad to me cuz I know she could be so much more mobile and in less pain, etc. BUT she just won't so I have kind of given up, though with a bit of a chip on my shoulder over it. Sorry, much different than your mom.

Good luck!

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Oh, but I’ve been there and done that and back then she was laying in a soaking wet bed telling me to go away, until I FINALLY got the family to hear me and come help.

My daughter literally lifted her up out of bed!

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It's a spiral. The longer she doesn't walk the weaker and stiffer she'll become and then she'll even be less likely to walk. Time is not on her side.

Yes, you can get home PT. Which in my experience is useless. The last time we had home PT for grandma after a fall to help her walk, the PT was there for at most 5 mins each session. She would pump her leg a few times and tell grandma to get up. When grandma didn't she would leave saying there was nothing she could do. Which is pretty much how the other time we got home PT went too.

If you can get outpatient therapy instead, that may be much better. Medicare will pay for either, you choose. Actually getting her out of the house and into an environment for walking may inspire her to at least try. The equipment they have at a outpatient facility would be much better than cobbling something together at home. They may even have a specialized treadmill where they can put her into a sling while she walks to help her regain confidence and teach her how not to fall.

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We’ve never had outpatient therapy. Now I’ve got a car she can’t get out to it in the driveway. It might be fun for her though.

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My mother wound up wheelchair bound after her last stay in the hospital. She did go to rehab for 3 weeks, but at 93 (in 3 weeks) and with bad neuropathy in her legs, it was TIME for a wheelchair. In reality, it's BEEN time for a wheelchair for the past 2 years but she's fought it tooth and nail. She's also fallen 36x before she went into the wheelchair, and 4x since. I feel relieved, frankly, that she's no longer SUCH a huge fall risk, and overall much safer in the wheelchair than she was toddling around with a walker.

She does get physical & occupational therapy (24 sessions) that Medicare pays for, and it DOES help her. They work with her for about an hour per session and then leave her with large rubber band type things that she uses while sitting in her recliner. It helps strengthen her leg muscles. I don't want to see her get BED bound now, so the PT/OT does help her keep up her muscle strength.

At this point in your mother's life, I'd let her be. If she doesn't want to walk too much, get her a wheelchair AND push for PT/OT, that's my suggestion. Of course, you can't force her to actually DO PT and OT if she doesn't want to.........so that ball is in her court, you know?

Wishing you the best of luck.

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Thanks for the input. Yes, I’ve tried the wheel chair and hope to get training on how to transfer her to bed and toilet and all. Right now it’s counter productive.

She responds well to any outside help. She just won’t do anything with me or by herself. I don’t push. I want good vibes between us so I try to keep it light.

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You might consider asking the doctor to send her to a SNF that will do intensive rehab. Might get her back on her feet.

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I’m letting the doctor tell me what we should do. Up til now he’s offered in-home therapist. I don’t know how often we can count on them.
At this point, we should have them on our Christmas lists we know them so well.

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This is my mom too. She doesn't move much anymore because she is so afraid of falling but she is also afraid of losing ability to walk. It is a cycle we cannot seem to break. I finally told her that I am not going to worry about her not walking anymore until she actually falls. Every time she worries about not walking I ask her if she has fallen yet. When she says no, I say ok, we are not going to worry now nor are we making any decisions about it until then. She is very slow but still moving around.

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My dad is very barely hanging onto walking. He’s attached to his rollator for every slow, shuffling step and is a constant state of being terrified of falling. He remains alone in his home. And, no, no one thinks this is wise, but he’s of sound mind and determined to keep it this way for as long as possible. So we wait for a bad event to change things. I’ve lost track of how many times we’ve done physical therapy and certainly know that each hospitalization causes a further setback. We all have to accept what we can’t fix or change, doesn’t make it easy. I certainly see where fear of falling makes people too scared to do much. We’re all headed down this road ourselves, maybe it’s one of those things we’ll experience and then understand?

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Yes that’s the difficult part. Knowing you can’t fix everything. That and the sound mind in a decaying body. Can’t hear, can’t see, now can’t walk. Lordy, Lordy! Yet I don’t make myself take walks either. Stupid of me.

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Some people are afraid of falling because their vision is poor or because they have lost sensation in their feet which allows them to feel safe.

Staying in bed for whatever reason can be deadly. Maybe she needs some incentive to get up and walk. Stop the "room service" and serve meals in the kitchen or dining room at least once a day. Sit and eat with her. Encourage her to walk with you to the bathroom to wash up etc. At least have her get up when visitors come. Reward any effort to keep moving.

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Yes she walks to the living room and back to the bedroom each day, unless she feels particularly weak. Then I seat her on the rollater and give her a ride.

Her favorite breakfast is cold cereal and I won’t serve that to her. She has to go to dining room table and make it herself (I take her all she needs to do so) and she has done that several times.

I don’t like it she isn’t toileting except twice a day. That’s a UTI in the making. We now have a water bottle that will remind her when she hasn’t had a drink on her cell phone. How funny is that? Haven’t used it yet but we’ll see how that goes.

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"How do they just decide one day they can’t walk? Then they perpetuate the notion by laying around and make it true."

Who knows what causes that decision? And yes, they perpetuation does happen - nasty cycle!

When we moved mom to MC, she was still mobile, no cane or walker needed. After about a year, she insisted she needed "one of those", indicating someone else's rollator. I had taken the walker and rollator that had been dad's when we cleaned out the condo, so I brought it there on the next visit. She fluctuated between asking who it belonged to and insisting she pay for it! But, she didn't use it. It took many months before she did start using it (and we taped paper with her name onto the handlebar) and she did fine. That was okay for quite a long time, but recently (6mo or less), she had a couple of little tumbles, no injury and that started the "can't walk/stand" spiral. Doc visit resulted in order for PT, but she absolutely refused to work with them.

I think in her case a combination of sitting too much (she always sits and reads paper/magazine/sale catalogs, wouldn't walk much or participate in the light exercise staff provides), and weight gain (20# in the first year) led to weakness which eventually would make it hard for her to stand/walk. Unfortunately it is a spiraling situation - not walking leads to more weakness, falling and more fear of falling and further weakness.

So, for many months now mom either scoots along in her transport chair with the foot rests removed (uses her feet to pull herself forward), or uses a wheelchair they have provided (I have offered to purchase, but the nurse is okay with using theirs for now.) If/when she needs to stand/walk, either to move to a chair or use the bathroom, she gets into a tizzy thinking she's going to fall. Not much can be done about that, esp when she refused PT. At one point she actually said to the nurse she needs to use it or lose it, something she harped on dad about, and something I tried to mention a few times (I got the nasty treatment, so I dropped it!) Nurse has also told me that for the most part they are not really supporting her, just being there, with a hand on her and she is really doing most of the work, but in her head, not so much....

Since you are caring for her at home, at the least PT might be able to help you with transitions, etc, even if mom can't or won't work with them. If need be, such as for bathing, can you bring in assistance to help you help her? You did say she responds better to others (very common!) The last thing you need is to injure yourself, then you can't help her! If she can't afford this, explore options for getting financial assistance, and/or consider a move to a facility if it gets too bad.

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Yes, yes, yes! Exactly! Transitions is what I need to learn and I would love the help in bathing her.

She doesn’t want me to lift her already and a naked slippery body is that much harder to support.

Fortunately, we did have her bathroom remodeled so it is somewhat handicap equipped.

She has an open roll-in shower but the safety bars are at the far end away from the seat. I had a support floor to ceiling bar installed nearby that she uses.

The only handicap width door we have is to her bathroom. Go figure. Guess they decided I can address all her needs there.

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Sounds like she is scared. A walker would probably make her feel more secure and balanced - even if she is doing all the work. Having a person next to her when she shifts from lying or sitting to standing up is also reassuring. You are correct in your knowledge that "lack of use" leads to muscle weakness and joint stiffness. Encourage her to use her walker rather than a wheelchair. Encourage her to be "up and doing" rather than staying in bed.

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She’s had a walker for years now and I feel bad how dependent on it she is. I should have encouraged her to take steps away from it, but she’d just had hip surgery and I was scared of her falling too.

I wanted her to use the wheel chair some so she could still have some independent mobility but it didn’t work that way.

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Get the doctor to order home physical therapy. They will get her up and moving. In the mean time, have her do leg lifts and other types of exercising to keep her legs strong. Arm raises. Anything you can think of to keep her limbered up a bit. If you don't have any, go to Walmart and buy some of those exercise stretch bands and maybe some very light ankle weights to give a tad of resistance.

She is scared to fall again. The bath assistance by your relative probably scared her more. My mom and I have step by step routines for everything and I know she gets really nervous when others try to assist simply because they do not do it the same way. My brain is constantly evaluating what COULD happen, if I do this, this could happen - it seems to work that way for every single thing I do in my life. And, let's be honest, not all folks have the ability to anticipate the simplest of tasks and the best way to do a task (they don't think about lining out what is needed before it is needed, don't see that it is harder for her to put on pants while sitting on the bed which is higher than the portable pot, don't realize when standing to get dried off - it has to be done really quick, I can go on and on).

Maybe have a chat about what can happen to her living arrangement if she can no longer walk at all. She's probably thinking about it, but talking may help. Assist her with the hand contact that she trusts and then ease your hand away for longer and longer periods and let her know she did it on her own. - Good luck with getting her back to her old routines.

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I think what happened was she became nauseous and it alarmed them. Then they showed her too much sympathy and it convinced her she was really sick, so she invalided herself.

She never acknowledges that not eating makes her stay sick. Actually causes her to be sick.

I know food is the last thing you want when you feel like you’re going to throw up, so I keep ginger ale, crackers and ensure on hand to give her slowly. If she insists on going back to bed all the time, she never gets her stomach settled.

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Lack of energy as well as muscle weakness will contribute to unwillingness to walk. Be mindful of hydration and nutrition and encourage exercises she can do in bed, like leg lifts and arm raises in various positions when she refuses to get up. If you bring in PT, they might give you some more comprehensive exercises you can do at home between their visits.

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I pulled the sheets of exercises for her to follow. She’s been saying for awhile she exercises in bed, I just know she doesn’t strain herself very much. But something is better than nothing.

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My father is the same way. After 2 falls outside tripping over uneven sidewalks, he stopped walking outdoors. Then he started falling indoors and stopped walking there, too. The fear of falling is greater than the fear of being immobile. What he refuses to recognize is that each time he fell outdoors, it was because he wasn’t looking where he was going. He acknowledges this, but still won’t look at his path. Each time he has fallen indoors, it was because he was in a hurry and going much faster than was safe.

We got him a home aide that is young and pretty. For her, he started using his exercise bike (just the pedals you put in front of a chair) and he has gotten stronger. He also has started to walk around more.

My dad like to show off for young, pretty girls. I’m not sure how this can help your mom. Proper motivation can change things.

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Yes, none of her therapists are cute but she’s eager to please them. I should say she enjoys showing off what she can do for them.

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My late mother got like this in the sense that any pain was terrible. Then when went to the ER, nothing was found. I know that this analogy differs from your's, but at least she has a doctor appointment soon. Good luck.

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Oh but it is similar to our situation. She keeps thinking we will address aches and pains that she’s had for years that the doctor has no solutions for. I just hope she doesn’t deviate from the issues at hand, even though I don’t like his answers any more than she does.

Such as a constant ache in her side which he says is her rib bones mashing against her hip bones. Even if that diagnosis is correct, he has no suggestions for relief.

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The fear of falling is so common. My mom is terrified of falling.

I no longer care for her. When she was in my house it was the same story. She would say, “Don’t try to pick me up because you may get hurt.” It’s terribly frustrating.

Home health does help. Make sure that she does both occupational and physical therapy at the same time. That’s what my mom’s doctor would order because it works best doing both. Actually rehab at a nursing home is even better. Ask her primary doctor to order it. Medicare will pay for it.

Sometimes I think they almost make themselves fall because they fear it so much that they can’t concentrate. Of course with my mom she has a neurological disease, Parkinson’s. That effects her mobility horribly. That combined with fear is a terrible state to.

My mom uses a walker. She would not have any balance without it. The walker gives some security. But she falls even with a walker.

Best wishes to you and your mom.

Hugs!

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Yes, her doctor and I discussed her “fear of falling” and he agrees it can be a real issue. In my moms case she concentrates so hard she gets frozen in place with her muscles quivering and she can’t move from there.

She calls for me to help but I stand by idly while she does all the work. That’s a confidence problem, I think.

She does well while the therapists are here but goes back to doing nothing quickly after they leave. You can lead a horse to water but you can’t make them drink...

She admits she’s lazy but she’s also just plain tired. I’m just as bad. This lifestyle is not agreeing with me. I’m getting a hump in my back and every day I list to the left more noticeably. Do I go out for walks or exercise? Nope and my little dog loves it!

Thank you for taking an interest in us. I value your opinion tremendously!

charlotte

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Thank you all for all of your advice and just for being here. I’ve also learned I was on the right track on many things.

I feel so much better, frustration relieved and not scared at all. No matter what happens, maybe big changes, I can cope and go forward continuing to support my mom through it.

Thank you all so much, I will keep you posted!

charlotte

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Good news! Doctor ordered in home physical therapy but not as many sessions as she’s had in the past.

I left it at “We’ll let the therapists assess her and see how many visits she needs.”

She needs a refresher course on how to navigate when she can barely walk and I need to find out what I should expect from her at this stage. Also, what I can do to help her. I’ve been letting her go at her own pace but we take two steps forward then go three steps back.

Attitude is everything and she’s sure come around in the last two days.

Thank you all again.

charlotte

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The therapists will assess his progress. Insurance won’t pay unless there is an improvement. They do usually improve. They do expect the patient to do exercises on their own in addition to OT and PT.

So glad the doctor has ordered another round of home health.

Best wishes to you and your family.

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What do you do when they are too scared of falling to try to function?

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