Dawners Asked October 2015

My Father (80) has decided he is quitting PT. Any advice?

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He needs PT to stay strong enough to stay home. Dad is 80 years old w/spinal stenosis, diabetes, chronic pain and severe mobility problems. 3 months ago he had neuro surgery and is recovering (earlier this year, he lost complete use of his hands and became incontinent). He had serious surgery, did 3 weeks in-hospital intense PT and has had 5-6 weeks of PT since he got home in late August. He has made so much progress! But now, he decided to focus on one aspect of the PT he hates - won't talk to the therapists about his concerns - and decided that "its not doing any good." I could honor his decision - except Mom (70 w/no health issues) is taking care of him and, quite frankly, it's killing her (not being dramatic - literally). His response to my concerns about how his decision affects his family is "Oh well, that's okay. I won't go downhill, not me." We have already done 5 months of the hospital, nursing home cycle earlier this year. I can't help but to feel that I am left to wait until he gets so weak that Mom can no longer take care of him at home (she is refusing home health services) and/or he ends up in hospital. He says that PT isn't that important and I am blowing it out of proportion. Am I?

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Sunnygirl1 Oct 2015
Since you can't force him to participate, I might discuss plans with him and mom for when he is not able to stay at home. Look at the options so you have a backup plan.
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Eyerishlass Oct 2015
What's your dad doing in place of PT? Sitting in a recliner watching TV? If he's not up and moving regularly and doing his exercises he will grow weaker. You're not blowing this out of proportion, you have a legitimate reason to be concerned. In time the burden of his care will fall to your mom. It's the old adage of "use it or lose it". When elderly people just sit all day they atrophy and get sick.

When your dad says, "It's not doing any good" remind him that he's not in a nursing home, he's at home and he's at home because of the progress he's made in physical and occupational therapy.

If it makes you feel any better your dad's attitude is not uncommon. I'm in healthcare and I've worked in rehab and I've seen many, many elderly people give up on PT and OT. They tend to decline without it. I also saw an elderly lady in her 90's religiously do her PT and OT exercises everyday. It took her the entire morning to do them but she did them and the last I saw her she was still living alone and doing well. I think the fact that she had a daily task to do everyday was almost as important as the exercises themselves.
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freqflyer Oct 2015
Sunnygirl1, I had a frozen shoulder, too and you are so right, it was painful big time. One time with physical therapy I thought 3x a week was way too much so I cut it back to 2x a week... then I realized my shoulder/arm was hurting me more, so I went back to 3x a week and it was easier to deal with. Now I am on a break, due to the continuing saga of my aging parents.

Dawners, so your Dad just might need a break for awhile. But don't have him take too much time off. My Dad was lazy about doing exercises unless the physical therapist was a cute gal, then he was enthused :) But between visits my Mom couldn't get him to practice. Yet my Mom was doing exercises she was shown by a PT 20 years prior and was still doing them faithfully every day. Each of us is different.
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lealonnie1 Oct 2015
My Dad refused to accept the fact that he wasn't able to walk, and refused to use a walker or get PT, etc. He lived with my Mom & they were a single unit as well; married for 68 years. I had to let it go, and made the decision to wait for the phone to ring with bad news. That's exactly what happened. My Dad fell on 7/24/14 and broke his hip; Mom called from the ER with the news. Long story short, Rehab refused to release him back into independent living, and I had to get both of them into an Assisted Living Facility (ALF). The decision was made FOR me, and for them, once he fell. I believe that the PT Dad had in the ALF is what kept him alive for 11 months following his fall. The PT gave him hope that he would walk independently again, and get back into his former apartment (believe it or not). He passed on 6/23/15 at the ALF but had physical therapy until 3 weeks before his death.

I have no words of wisdom for you Dawners, except to say that there is only SO much you can do here. Sometimes a disaster has to happen before the old folks can see the light. Sending you a big hug today, and a prayer that your Dad will see the burden he's placing upon your Mom & yourself.
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Thinking it over, perhaps he's just "had enough" right now and needs a break. Maybe a few days of R & R at home might help him view continuing PT more differently.
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Dawners Nov 2015
Greetings! Update on my dad...
Today mom and dad had an appointment with the doctor who is the director of the PT program he was in at Ohio State University.
1. According to mom, he said (quietly) in the waiting room that he was only going to tell the doctor about how he didn't like the treadmill part of PT. Mom suspected he wasn't planning to tell the doctor that he doesn't intend to continue--and she was right.
2. So the appointment was mostly about him becoming able to cath himself (he still has urinary incontinence that gets worse and then better - urologist thinks it will get better as the cervical spine heals and recovers). Dad doesn't think he will ever be able to cath himself even though the OTs and doctor assure him he can and tell him that he will be more independent.
3. Because dad didn't cop to his decision to quit therapy and diverted her question about why he hasn't been in 2 weeks by saying they are in the middle of a bathroom remodel and it was too much for mom to drive him to PT 3x a week. THERE WAS NO DISCUSSION OF HIS DISCONTINUING PT! The doctor doesn't know he is quitting. Mom didn't say anything (she never does - this is her survival technique).
3. On the way home, dad said he was going to get PT at the VA. Along with that he wants to go to the VA to have someone look at his hip, get MRI's, x-rays, etc.
This is significant because when he fell apart last January, I spent a great deal of time, blood, sweat and tears untangling his health care (he was going to VA for some things and going to private doctors for others and not telling the doctors full information about what was going on. He literally had 2 doctors lists with 2 different med lists and instructions about what to tell which doctor and what not to tell another doctor. So, when he fell apart - of course, the health care team had to be narrowed and they had to know what was going on - and no one really knew! Anyhoo, long story short - I sidelined the VA in order to advocate and get care for him in the private hospital system he was in. There is no VA hospital in our area - only outpatient center.
CONCLUSIONS: Both of them are in denial. She is in denial because she has to be to live with what is going on everyday. I told her that he will spend the rest of his days seeking this doctor and that doctor and he is using VA because we (meaning me) won't really know what he doing and not doing. I told her that's fine and dandy until it all hits the fan again and we are left to figure out what he was doing.
Regarding the PT - It is like when I say "I will start my diet on Monday" and Monday never comes. I told her that he is probably just saying that to "benefit" her, me and my sister. As of now...he hasn't even called to get an appointment for a PCP or geriatric assessment (this assessment has a waiting list of up to 3 months) in order to get going.
BOTTOM LINE: I know and have known I can do nothing in this situation, except be there for mom when she melts down. I must work through my disappointment in my dad's behaviors and realize he is a "do as I say - not as I do" kinda guy. I promised my mom that I will be kind and loving the next time I see him and I will move heaven and earth to support her - but I will refuse to discuss anything medical or health related with him. Also, I told her that when he declines (because he will sit in a chair all winter), becomes ill or falls - I am not going to stand on my head to advocate for him. She is okay with this.
Sorry for the eternal post....I have no one else to talk to about this. Sister is an "ostrich" and rarely talks with me about dad, hubby is kind and listens the best he can.
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Dawners Oct 2015
GardenArtist - I had the same revelation today!!!! He needs to get his pain under control (he has been on a fentanyl patch for over 2 years) which he let the prescription run out 2 weeks ago. He used to take vicodin, but can't get it anymore on an ongoing basis without being in a pain management program. It wasn't helping much anymore. To Sunnygirl's point, I know it's very difficult for him...I have not endured what he has and I give him all credit (and mom too for being by his side). I will keep the cognitive decline issue in mind as well. It kind of makes sense when I think about how he didn't call his PCP for a refill on the pain medication that he needs. Mom was doing all of this kind of thing for him, but has been letting him have responsibility for the things he can do (he can hold a phone and dial now - couldn't over the summer). She still handles most of his meds, but he has to participate in his own care in whatever way he can - but maybe he is challenged still with even this.
I CAN'T TELL ALL OF YOU HOW GLAD I AM TO HAVE PEOPLE TO TALK TO ABOUT THIS...my husband is so tired of hearing me :)
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New2this Oct 2015
I had to do my PT at a hospital, I had a main therapist but often got others depending on scheduling. The main one told me, and always emphasized at the start of a session, slightly uncomfortable is ok, anything you'd consider pain is not, say so immediately and we will stop. I only had that happen one time with a new exercise that was added in, it seemed to hurt a tendon in a different area. I spoke up, and it was stopped and removed from my routine. I mentioned it the following session to make sure, it was noted and they had no issue. I was shocked how much good it did me in my case, I've worked out most of my life and played many sports, didn't think I had anything left to learn. I didn't realize I'd been using other muscles wrong due to the injured back, leg, nerve. I didn't realize how much building and stretching other core muscles would help me be able to move in the new and safe ways my "new" body needed too, either. Two years later I still do the PT homework when I think I need it, and I always see an immediate increase in range of motion.
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Sunnygirl1 Oct 2015
I might also offer that as my parents have gotten older and pushing 80, I think that they don't really appreciate some things. Maybe it's mild cognitive decline.....I don't know, but I wonder if they really have the capacity to fully appreciate certain things.

I'll also add that it took all I had to push myself to PT when I had two frozen shoulders and I was in my 40's! It was painful! lol I can't imagine enduring long term PT in my 80's! He's done pretty well.

I hope they offer some helpful suggestions when you meet.
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blannie Oct 2015
I'll come at it from a slightly different perspective, since you've gotten very good answers so far about "should he/shouldn't he" continue PT. Whatever the decision is, if your mom and dad are like my mom and dad were, they're a unit and it's virtually impossible to split them apart to get one (mom) to act reasonably (bring in outside home health) if dad isn't cooperating either. You can set up scenarios and try to get them both to be reasonable, but at the end of the day, you can only do so much. So set reasonable expectations about how much you can do in this situation to make things better. It's tougher when our folks have some cognitive decline and may not be able to fully reason, but it is what it is. And yes, please keep us updated!
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