When is it time to recognize that walking is no long safe for Mom?

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CoopHeath Asked February 2022

When is it time to recognize that walking is no long safe for Mom?

I've posted a few questions related to my mom's lack of mobility after a fall in Nov/procedure/uti/memory issues- We had one consult with the neurologist- his notes state Alzheimer's and encephalopathy. During a 12 mo period, my mom had 5 falls- 3 of which were in the street on her head, only 1 resulted in an ambulance ride & CT scan. The doctor mentioned to us both that Mom should be utilizing the wheelchair.

Currently my mom is resident in the NH/Rehab and after a visit to hospital for low RBC and GI issues. They found bleeding ulcers. She has another shot at getting back into rehab to become mobile. Not sure if it's tied together, but my mom has no control of her bowels... this is the main cause of her distress.

When is it time to stop focusing on regaining walking ability and focus on being wheelchair-abled? I mean, if mom could move herself from bed to WC, then she could also do same from WC to commode. Anyone else have similiar concerns?

Difficulty Walking Mobility Rehabilitation Center

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score 3 · Answer 1

CoopHealth: Perhaps it would be best for her health especially with a history of routine falls if she is the occupant of a wheelchair.

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score 2 · Answer 2

Ask doctor to get evaluation and treatment from physical therapy> They will evaluate her muscle strength, her balance and her ability to use several types of walking aids. I would trust their recommendations.

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score 5 · Answer 3

This is definitely a question and answer as unique and personalized to your loved one as her fingerprint, and hence can ONLY be addressed by the doctor and the POA and your Mom. My brother's ex, his friend during his life is now limited to the wheelchair. This was a long time coming and they attempted to avoid it due to the fact he is thin, his skin is fragile and they are terrified for bedsores. They are doing all they can, but his balance puts the certainty of his falling at the forefront.
I sure wish you good luck. Ask for a PT consult and make it clear to the doc that this is an important question for you and for Mom.

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Thank you!

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score 2 · Answer 4

What's the encephalopathy about? That might be making a substantial difference to all kinds of important issues, and it sounds as if your mother's neurologist still has a fair old bit of investigating and explaining to do.

Meanwhile: all mobility is good mobility, the focus must be on *safe* mobilising whether that's standing, walking, transferring or whatever. There are aids and techniques for virtually everything a person could want to do, it's a question of helping her understand what she can and can't do when and where and with whom.

How old is she?
What's her morale like at the moment?
How is her cognition, and decision-making, and ability to process information, and all that stuff?
Does she have access to the full battery of rehab therapies? - PT, OT, the lot?

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I am HOPING to get an answer from Neuro this week regarding the notes in her chart- We are getting EEG Wed but I don't know if that's just going to lead to another test or based on what he finds he's going to give us conclusion.

Currently PT is in eval for her. She was booted from it back in mid Jan due to ins and no progress. Low RBC sent her to hospital and at return they have brought her back in to see what can they do. TODAY she told me she cannot make her feet touch the ground. I always have to double check with PT as her cognative state has improved a bit but around the PT its suspect.
Mom is 75 with a decade of falls that resulted in injury and no one ever forced her to use walker or cane even if we suggested it. History of stroke at 35 and TIA event in 2012- while at work- she was a nurse-...
She is in good spirits and what she said today, I turned it around for her. Like -let's focus on what you can start doing. So if you can get your strength up and start working on transfer from bed to wheelchair. We talked about how much more she could do if she just accomplished that. Short term stuff is really the big issue for cognition and after 4pm doing something like playing rummy 500 card game- shows way more challenges.
Since taking some anti inflamatories for her replacement knee (probably osteorthritis) she seems more clear headed!!!
I do not believe that if PT can get my mom walking that it would be any sort of safe for her. I'm still leaning towards WC and wondering if she has a real brain issue causing the rest.

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score 2 · Answer 5

It seems that after falls they (physical therapists') etc goal is to encourage our elderly parents to walk. My mother is a severe fall risk at 92 and it's much safer for her to use a WC. She can transfer from WC to bed, to chair, to commode but has to be real careful. She is in assistant living and I don't really see that she needs to walk. I know if she could walk safely, it would be better for her but that's just not going to happen no matter how much physical therapy she gets.

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Thank you

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score 1 · Answer 6

After my mom had 40 falls in AL WITH using her walker, it was time for her to go into a wheelchair full time. She had horrible balance issues and neuropathy in her legs & feet which contributed to vertigo all the time. Which is what led to her chronic falls. So after a bout of pneumonia, a 7 day hospitalization, the doctor said there comes a time when a wheelchair is required; that time was NOW for mom. She went into rehab for 3 weeks and I let the PT/OTs know that she'd be wheelchair bound from then on. So they worked with her to regain her upper body strength so she could maneuver herself around in the w/c a better better. She stayed in her w/c for the next nearly 3 years until she passed away recently. She still kept falling, however, because she insisted on transferring herself from w/c to easy chair/toilet/bed, etc. And that's when she'd fall, plus she'd fall out of bed and off the toilet, too. But she never got hurt, believe it or not. I think her body was composed of super-ball material, to be honest! LOL

Wishing you the best of luck and hoping your mom isn't as stubborn as mine was!

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Lea I’m so sorry to hear that your mother has passed on. I understand the difficult situations you have faced during your life. My prayers for you now is that you can let your mind, body and soul just rest. I know you need it. May you have plenty of warm sunshiny days ahead. Again, I’m sorry.

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score 2 · Answer 7

I would think that with rehab and continuing PT, she has a decent shot at becoming mobile again. Is she interested in walking or really doesn't care?

Is she still living at home? With no bowel control, I don't see how she could be. If it were me, I would try to use this as an opportunity to get her a permanent placement.

If she will use the walker, that would be my first choice. If she can't/won't then I guess there will be no choice but to be in a WC. Sad, but sometimes there really is not choice as a person ages and declines.

Good luck.

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No no my mom is currently resident in the Rehab/Skilled Nursing.
She appears interested- but lots of physical challenges to get approved to get back into rehab.
We are still in medicaid pending status- once I know its completed then I was going to look into places nearer to me.
Guess we will see what happens- trying to hold no expectations.
Thank you!

(2)

score 3 · Answer 8

When mom is walking now does she use a walker?
If she is using a walker then I would agree with the doctor that it is time to use a wheelchair.
If she currently is not using a walker or uses it sporadically she should use it constantly. If she still falls using the walker then it is time for a wheelchair.
Do know though that even with the "constant" use of a walker there will be times when she will not use it. "I just got up to get the remote I left on the coffee table" or "I just had to go 5 steps to the sink".... And falls can and will happen even using a walker.
And even using a wheelchair there will be times she will get up to get something or forget that she has to use it and will try to stand up.
No way around it falls WILL happen.
Rehab san teach her how to safely transfer.
But you mention mom has dementia. Because of this she WILL forget she has to use the wheelchair, she WILL forget how to transfer, she WILL fall.
The sad task that you face is to determine what you want done when she does fall, chances are she will be seriously injured at some point. What will you authorize medical staff to do?
(sorry to be a "Debbie Downer")

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You are totally not a Debbie Downer- I'm asking for outside input. My mom was not using a walker prior to the last fall (which got us here). She had terrible gait and balance- I had her working with trainer and in pilates but she would hide falls or trips. Her left ankle- we have learned- has degenerative bone issue as well as her left shoulder. The left knee- a total replacement-is "now" the issue as to why she cannot stand for PT. Its been since Mid Nov that my mom has not been able-whether physcially or mentally- to get on her feet to try walking. She's max assist & drag. Though she is finally moving around in bed much more- able to reach for her water, feeding herself, grab her phone- but she cannot sit upright without assistance. Thank you for asking me more questions. :-)!

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When is it time to recognize that walking is no long safe for Mom?

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