My 99 year old mother fell about a month ago and fractured her hip. She was living in Assisted Living. She has had multiple falls and injuries in the past. She had always participated willingly and fully in physical therapy she even seemed to enjoy the attention at times. With this new injury everthing has changed. She does not want to do the therapy, she does not want to get out of bed. She seems to have given up and feels there is no reason to make any effort. The therapists force her to try and stand, the goal is to allow her to at least stand and transfer so the hoyer lift (which frightens her) will no longer be necessary.

The last month since the fall has been one of non-stop physical, mental and emotional torture. All for her own good.

Her Dr. put her on anti depressants but so far they have made no difference.

So my question, is there a time we respect the wishes of the person, even if dementia and depression affect her thinking? Should we continue forcing her to do therapy in the hope that she will be more mobile eventually? There has been some improvement as she can now stand for a minute or so with support from the therapist.

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Good grief? At 99 she probably hoped it would be the end!

WHY do we work so hard to prolong the 'life' of someone who has already lived so very long? Why the antidepressants? Why the therapy? Why not just palliative care and letting mom do whatever the heck she wants?

Just love her and let her have the last few months/weeks/ days of her life without expecting ANYTHING from her.
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Reply to Midkid58
NYDaughterInLaw May 14, 2019
I agree 100%.
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Please, PLEASE ! do not force her to do anything !!! Show her LOVE and 99 she has earned it. Encourage her to eat, let her sleep and let the end stage of her life be pleasant for her and those she Loves....think about it !!
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Reply to Lynne7

Breaking a hip is very serious for someone your Moms age. Some don't survive it. Going under and already having Demenia may have made the Dementia worse.

Such a hard decision. I really don't think a 99 yr old should be forced to do anything and especially if she is anxious and scared. She will just be in a wheelchair for the rest of her life which with numerous falls, she should have been in anyway. Why a hoyer? Is Mom a big lady?

You realize, at this point, she will not be able to go back to an AL. Her care will be too much.
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Reply to JoAnn29

At 99 and with dementia I wouldn't make her do anything she didn't want to do. I would just try to make the time she has left as enjoyable and pain free as possible for her.
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Reply to faeriefiles
janlsk May 15, 2019
But there appears to be no choice that accomplishes this. If we continue with PT the hope is she will be more mobile, able to use a wheelchair at least, able to get outside perhaps transfer to a car? The more options for movement the better the chances are that she will be in less pain. Lying in bed 24/7 is not going to be enjoyable or painfree unless she is put on opiate pain meds.
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I hope your mother's team has given proper consideration to what caused this latest, disastrous fall. It may be that a change in your mother's overall physical state made her fall, rather than the fall made the change, if you see what I mean; and that her body is making itself heard.

When you say "force"... There is a very fine line to be drawn, here, and it can be difficult to keep to the right side of it. Encourage, support, assist, cheerlead, bribe if necessary - these are all fine. Force, actually force her, under protest? No. Not for any amount of her own good.

You're the best judge, you know her, and it sounds as though you try to be present during these therapy sessions? But, I don't know if this makes any difference - what would you think if you read about a 99 year old lady being "forced" to undergo strenuous PT and being given happy pills to make her want to get better? If you think your mother will get through this and regain some quality of life, you know best. If you don't - be your mother's advocate, and prioritise what makes her happiest.
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Reply to Countrymouse

Wow she is 99 years old, she shouldn't have to do anything! My father was the same way..once he got home from Rehab, that was the last of it. He didn't want to do anything. He died one month later...Leave her Be. . He was only 79, she is a blessing at 99 years old...she has done enough.
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Reply to Chemoangel1967

I see your dilemma, I too often think about the time when it's hard to feel confident in the fact that we are benefiting Mom, it's that quality over quantity thing that's not always so clear cut as more and more interventions are available to prolong a beating heart. It does sound like your mom is letting go, giving up the energetic fight if you will and part of the dilemma is determining if that's a temporary reaction to this new fall and rehab, depression maybe or simply her saying it's my time to let go. The fact that she is afraid of the Hoyer and doesn't want to use it caught my attention. If you say to her while the lift is being used and when she is fighting PT, it's up to you mom, the only way to avoid using the lift permanently is to be able to stand and pivot to the chair and the only way to accomplish that is PT. You can fight PT and not put in the effort if your willing to use the lift for the rest of your life and spend most of it in bed, that's your choice but it does mean (whatever it will mean to set up leaving rehab). It's also your choice to only put the effort in to PT to improve enough to stand and pivot to the chair, if you want to the professionals feel you could improve enough to use your walker to move around again but that will take continuing with PT. If she is able cognitively let her actively make the ultimate decision rather than passively the way it sounds like she is. That way yo can both feel more solid and at peace with whatever her choice is. My DH grandmother was 101 (I think it was) and not as active but able to get herself around the first floor with a walker when she started "visiting" all of her relatives, children to great grand children, traveling cross country on a train and stopping at each family. She would tell my FIL each morning all about her visit with the family of the day and then one morning she was gone, we realized it was after she had visited everyone in her dreams and this "trip" was her saying good by to everyone one last time. She was perfectly oriented during the day knew she was home at FIL's and participated in each day, talking with family even so it wasn't all fantasy or hallucination it was just her choice of time to go.

I'm sorry I don't have a better or clearer answer for you but I get the sense from your dialogue here that you love, care and know her enough to be on firm ground following your instinct here. Tough as it is I don't get the sense you will make selfish decisions I believe you will act in her best interest over yours if that's what's needed. My thoughts are with you.
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Reply to Lymie61
janlsk May 15, 2019
There really is no issue of quality or quantity here. There is nothing being done to prolong her life. Only to manage the mobility and pain issues. Is it better to let her lie in bed and then deal with whatever complications this may bring or persist in trying to improve her mobility? I would be fine with the idea that if left alone she would just fade away peacefully but she has no health issues and could very well live for years yet. She was in bed only for 9 days after the fall and by day 7 she was trying to get up because she was uncomfortable lying down full time.

I have also tried to explain her choices, remain in bed or submit to the lift/PT routine. She says she understands but 5 minutes later she has forgotten. Part of her dementia, she has little short term memory.
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Is there a time we respect the wishes of the person, even if dementia and depression affect her thinking?.... Yes there is. She's 99 years old. If she doesn't feel the need to keep going, it's time to accept her wishes and let go. Easier said than done but still, she's 99! If she lives to see 100 then great! If not, that's ok too. Let her decide what she wants as it's her life. Hugs.
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Reply to mmcmahon12000
didiblue52 May 16, 2019
Absolutely agree. Let your loved one have dignity in their living.
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I second the idea to have mom re-evaluated for a back fracture. That’s what happened to my mom. A fall. X-ray. Told no fracture. Home and in a great deal of pain. A second trip to a different ER a day later showed she had fractures. She fully recovered after hospitalization, rehab and care at home but it took several months. I think she was about 94 when this happened.

I learned on this site that fractures don’t always show up right after the injury.

The location of any fracture can help show where to place the ice, lidocaine patch etc to give her relief. If it’s not a fracture then you will know. After a fall sometimes there is a fear of falling again. So there’s that to consider but I think your mom is in pain.

I am a huge fan of therapy. I’ve seen my loved ones greatly benefit from therapy and have great quality of life for many years after having a need for therapy that brought them back to enjoy life. But it’s a fine line on forcing someone. Since you can see she has improved then you are encouraged. I would be too. But I would want to know that every effort would be taken to make sure she isn't in pain.

When my mom ( without dementia) was in bed she would say nothing hurt. But when she had to get up. Severe pain. My mom was tough. She forced herself.
She knew she had to move.
She was afraid to take pain pills but got great benefit from lidocaine patches and ice and heat packs. (She did take pain meds in the very beginning).

When my aunt (92 with dementia) fell and twisted her knee, she would say it didn’t hurt.
However when PT examined her they would find the pain. Even mild pain relief measures like ice packs and extra strength Tylenol helped my aunt to do her therapy. Ice doesn’t work on everyone. Some find more comfort in heat or alternating heat and ice.

There is a great deal to know about the human body and spirit. Each person is different.

I understand you are trying to return her to a better quality of life and to get there the PT must be endured. I get that. But please make sure she gets another looksee.

My mom had follow up X-rays lying in bed at her rehab. There are traveling X-ray services. My mom didn’t have to leave the rehab for the X-rays.

Hugs to you and your mom. I hope she’s better soon. Please come back and let us know how she’s doing.
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Reply to 97yroldmom
Zdarov May 16, 2019
OP, this sounds like your best next step. I recall now that my 92-yo father had a crack in one of his vertebra that didn’t show up till they checked again. He spent several weeks ‘just’ not feeling right before that.
Also - it’s going to sound so simplistic, but - water. I imagine they’re making sure she’s hydrated but it’s worth checking.
She's tired at 99 years. Antidepressants? Futile! Get her family around her and give her all the attention. Have a party, theme party. Tea party with real china tea cups, saucers. Have retro party with music of her era, etc. Have her favorite foods. And do what she likes to do. Don't try to force her. Enjoy her!
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Reply to LuvingSon

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