How much should we force a senior to do for their own good?

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.

Is she reacting positively to any part of her daily regime?
Is there anything she WILL leave her room for?
Are there any aspects of her therapy that she’ll express interest in?
Has she had any past friendships in her residence that she still maintain?
Does her therapist encourage you to think that she can improve enough to reach any reasonable goal?
Does her MD attempt to find some medication that may elevate her spirits?
A very tough call. In a somewhat similar situation with my mother, she usually participated reasonably in physical therapy until she was required to try a full flight of stairs. She started to cry and shut down. The therapist agreed that the demands of her therapy schedule were in excess of potential gain.
She was 90 at the time, and shortly after began using a wheelchair full time.
Is your mother staying in bed to avoid attempts to engage her in therapy?

Try a different therapist, if possible. Some of my therapists were ridiculous in terms of demanding activities from me that I just couldn't fulfill. I shut down too. The really good therapists adjust to fit their patient's needs and abilities. Therapy was extremely important to my recovery so having a therapist who could work with my issues was critical.

Please, PLEASE ! do not force her to do anything !!! Show her LOVE and affection....at 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 !!

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.

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.

A broken hip in the elderly is often not caused by the fall but by osteoporosis which allowed the hip to break thus causing the fall.

Every situation is different but it is important to remember that "getting better" takes a great deal longer the older one gets.

Maintaining as much movement/ independence as possible is of primary importance but making the choice not to co operate with the therapists is also totally Mom's choice dementia or not.

By all means get Mom out of bed but make sure the chair she has to sit in is comfortable. Let her go back to bed for a couple of naps.

Any change of position is good because it helps prevent bedsores. but forcing anything else is a bad idea. It is very tiring being elderly and sick

I will try and answer some of the questions posed and explain our situation. Before this fall my mother was ambulatory with a walker. Able to get up and move around on her own. She is continent. Her dementia is reflected in very poor word recall, sometimes confusing times, dates and people. At times delusional (?). Saying the door to the bathroom goes onto the attic, there is a cat in her bed, etc. But overall she is present and knows where she is, who I am etc. Her dementia does not seem worse since the last fall.

Before the last fall all Drs., therapists, aides involved in her care recommended she remain as capable of walking and as strong as possible. Dr. encouraged her to get up and walk several times a day. Being confined to a chair would have brought with it a host of new problems.

Although my mother is 99 she is in remarkably good health. She has a pacemaker but no other major illnesses. Not diabetic, no pneumonia, kidney problems, UTI's since the fall. There is no indication whatsoever that she will pass away withing a few days, or months. So palliative care for the time she has left could be for years.

JoAnne asked "Why the hoyer?" Because Mom cannot get out of bed safely and transfer to a chair with only support from the aides. The goal of the PT at this time is to get her strong enough to stand and pivot so she can use a chair. Without that she is bedridden 24/7. And although she may think this is fine, of course she will be uncomfortable very quickly from lying in one position. Along with bed sores, increased chance of pneumonia, aspiration and on and on.

When she is in bed she says she is bored and just "lies here" but when up she wants to go back to bed. As for the therapy, yes, she is forced. She asks the therapists to please not make her stand, but they pull her up anyway. This has been going on since the fall. Of course she was in great pain in the hospital but it was necessary to roll her and move her for bed changes, wound care and position changes. She would cry and beg them to lie her back down flat but these movements were needed. I would have happily withdrawn care and allowed her to pass but there was no care that was sustaining her life. She is not terminal in any way.

So the choices are, allow her to lie in bed with all it's attendant complications and side affects or continue the forced rehab in hopes she will at least be able to stand and transfer. That would allow her to avoid the Hoyer and give more options for when/where she spends her day. But at the cost of further mental and emotional stress.

This:

"She asks the therapists to please not make her stand, but they pull her up anyway."

- if it happens exactly as you describe, is not acceptable.

What do you think caused your mother's most recent fall?

What change do you think has made the difference between her being cheerfully ambulatory before, and her not wanting to get up and participate now?

There are other ways to do PT than to drag an unwilling patient from her bed. They also must spend more time and thought on discovering what, exactly, she is objecting to.

If the Hoyer is hurting her and the exercises continue to hurt her, I hope somebody has examined that healed hip REALLY carefully.

What was the pacemaker implanted for?

oh Lord.

When my mom, post stroke, was in AL, (and had aphasia, so couldn't really talk) she was resistant to PT. We thought she was "just" being stubborn.

The PT noticed that she wasn't bearing weight on one side. He ordered a mobile Xray.

Her hip was broken.

Please advocate for your mom to have a VERY careful evaluation of her pain. Very careful and very thorough.

We had a nice young man on here a couple of years ago. He was told that his mother was stubborn and resistant to getting out of bed.

Her back was broken in several places. Didn't show up on the first xray.

PLEASE have her checked out. Don't let them dismiss her pain.

Can you get an adjustable bed? Just being able to sit up in bed may help her feel like she has some more control.

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.

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.

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.

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.

Personally I believe we should make them do only what is necessary to achieve their aims. So if they want to be able to walk round the supermarket they are going to have to do their physio, if they want to live out their days in their room in ALF / NH then we should not force them to do anymore than is necessary. As long as they voice what they want and understand the requirements for achieving any specific aim then that is what we should go with. In the case of someone with dementia then it is going to depend on stage and abilities, what gives them pleasure and we have to make a decision on fitting with those. If very advanced and it makes no difference to them and purely extends life then it may come down to what makes our lives easier without being negative for them.

Is it possible that there was something wrong with the hip replacement? In addition to checking for fractures as suggested, urge her doctor to order imaging —multiple views —of her hip. It’s possible that she appears uncooperative but her hip isn’t working as expected.

I recently heard a story that sounds identical to this — it turns out the hip replacement was installed incorrectly.

I know you wouldn’t want to put her through the pain of another surgery, recovery, etc. It may be worth investigating.

In the other situation, a second, corrective surgery fixed everything. The patient was fully cooperative with PT when the hip replacement was installed correctly.

I had a friend in a similar situation, though she was only 71. She just wanted to lie in bed and slip away, but the PTs would come storming in twice a day, yelling at her to get up and move, and when she couldn't, forcing her body through painful exercises while telling her she would never get better unless she took responsibility for her own movement. The nursing home said that if the PTs couldn't document demonstrable progress, the insurance wouldn't pay for her to stay there. Since her husband couldn't handle her at home, she was subjected to forced movement and scolding until the day she died.

It sounds like she still has some cognition and you do NOT force anybody to do anything against their will, and even violates a patient's bill of rights to refuse treatment. Now someone 99 years old? Get real!

Pretty similar to my mother’s situation, janlsk, although when my mom moved into my house briefly, before she entered residential care permanently, she DID find, when motivated by her innate nosiness, the initiative to walk from one room to another to find out if we were talking about her.
Besides the pain, it would seem as though your mom has no incentive to do what is expected of her. If the therapists can’t think of any way to offer her a cause/result for her therapy, perhaps it would be worth a “break” to see if her demeanor improves and/or if her physical status declines.
If she is observably happier without therapy, I think she’s then earned the right to decline it.

This is what my dad went through. When he gave up on p/t etc, he became more bedridden and developed pneumonia and it was a revolving door to get him well, only for him to have another recurrence of pneumonia. He was just too weak to really participate in building up strength. He had a DNR, and when it got to the point of him needing to be intubated, he refused, and he died later that night. He was 95 yrs old when he died. He just didn’t have the fight in him anymore.

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.

janlysk writes “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.”
My husband is in moderate cognitive decline, so I don’t yet know if this will keep workin long-term, but here’s something that has worked for me.
When he doesn’t want to comply with the recommendations of his medical team, I sit with him, make eye contact, and maybe hold hands. I say, “I know you don’t remember this because the part of your brain that would make that possible is broken. But when the doctor explained this to you, you agreed that you would give it a fair trial. Any time you decide you don’t want to do the therapy, you are the one who calls the shots.” Usually, he then does whatever I’ve been asked to facilitate for him with a sigh and “okay, if i said i would, i will.” A few times, we have even video’ed the doctor talking about it so we can take the expert home with us. Nothing works for all people or lasts for all time, but this has been more successful than forcing the issue.

My mom is 97 and can still walk with a rollator and go to the bathroom herself. She is currently in memory care. When at home she would go through phases of not wanting to get out of bed and I would have to talk her through it. Get up, get going, keep moving. You situation is different because of your mother’s age and injuries, but I can still see the benefit of her being gently encouraged to stand briefly for the lift.

An X-ray tech once told me "The older you are, the longer it takes to recover." I was in my 40s at the time. I asked her, "Am I old?" and she answered, "Yes!" I was less than half of your mother's age:) If she participated in rehab fully in the past, you should ask yourself what is different now. How does this break compare with the others? Do you see other symptoms that didn't present on those earlier occasions? Is her diet worse now? Is she on a new medication that may be causing side effects like drowsiness, depression, or lack of appetite? I wouldn't force anyone to do pt. However, after 99 years, your mom might have earned a gentler approach to pt. What Medicare expects a patient to do at advanced ages like your mom can feel barbaric. When you visit with her, encourage her to sit up straighter and move just by playing a board game for example. If her rehab facility is combined with a long-term care facility, see if she can join in with the residents in activities that will provide occupational therapy. When your mind is on the game (think corn-hole or even something as passive as attending a music program or BINGO) you aren't as aware of how you are engaging your muscles. She may feel discouraged and depressed and doing these activities can be more effective than a pill! Lastly, I don't advocate scare tactics, but when my grandmother had a terrible stroke, the patient in the bed next to her in the hospital was not willing to participate in her own recovery. Her stroke wasn't that bad but Philomena was in a funk.......until her family and doctor mentioned the two words, "Nursing Home." We witnessed a verified miracle......her recovery nearly spontaneous! I don't tell you this story to encourage you to threaten your loved one, but she may not realize the end result of her lack of participation. Phrase it in a way to encourage her as a goal. "I hope that you are able to be well enough to leave this place. Won't it be nice to go out for lunch (at her favorite restaurant)?" You might also try to find out if something is upsetting her. Maybe she is afraid or reticent to return home. The idea of falling again might be the real block. Last suggestion, get her into sunshine. If the facility has a porch, garden, or atrium, get her there!

What if she were to do some simple movements of her arms and legs right in her bed a couple of times a day? Just enough to keep her muscles from atrophying and allowing her to keep some mobility of her limbs. Then, maybe gradually she could be persuaded to stand. It may be that her muscles are cramped from prolonged bed stays and that is what causes her pain when she tries to stand.

My mom is 83 and a couple of weeks ago, caught herself when she was falling, resulting in costochondritis. Anyone who has had it knows it feels like a heart attack, very painful to move. She immediately wanted to take to her bed. She lives in memory care and they won't keep her if she can't get up to use the bathroom and walk to the dining room unassisted. We told her if she wanted to be moved to a nursing home with much less in the way of activities, it was okay not to get up but, if she wanted to stay in memory care, she had to keep moving even though it hurt. She made the decision to move just enough to stay at memory care. As was mentioned above, she IS nosy and couldn't go poking around the facility if she was in bed, so that was a motivator too. If your mom has nothing to motivate her, nothing she wants to be able to do, she will probably remain in bed.

This whole post has left me so grateful I have left detailed instructions as to my own care, should I become as your mom has.

99--my mind just freezes at the thought. I am 62, riddled with arthritis from the combo of 'bad genetics' and a life actively lived. I am currently rehabbing a broken foot that I broke 18 months ago!!!!!!!!!!!! Honestly, there are days when the thought of even standing on it for one minute makes me cry and I haven't even gotten out of bed. I WILL NOT live to 99 if it means pain, day after day. Life is to be LIVED not just to lay there and make Co2.

And it's just going to get worse.

My sweet kids would not let me suffer like this. And I do think your mom is suffering, and to what END? Another year, a few months with everyone in her life haranguing her to 'get up and get moving?"

Gosh, I hope at minimum you are allowing painmeds.

Not to be rude, but when my sweet border collie was dying of cancer, I let her lay wherever she was comfortable, gave her pain meds all day and let her pee on the floor (something she had NEVER done). I laid by her on the vet's floor and held her in my arms when I decided she'd just had enough.

Your mom's situation is breaking my heart.

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!

We can never force anyone to do anything against their will. But we need to find ways to encourage them especially if it affects their quality of living. I have very high regards to caregivers (the good ones). We give our all to our loved ones/patients/clients. Time, energy, patience, understanding, tears, love, and compassion. That is why it is very difficult to see them decline even though we know that is inevitable. It is all about stages and we (not the patient/client) need to adjust to them. Adjust the activities to something they can still do and enjoy. And if that time comes when they'll just be more comfortable in bed... we just need to make sure they'll still feel cared for, clean and dignified when family or friends visit. No skin issues like pressure sores, clean and pleasant room/home. Where they can see things that make them happy like family photographs, or a window with a view of the garden, or enjoy listening to their favorite song. That is what I did for my dad. When they reach that age or stage, they count not the steps they take but the time you hold their hands, stroke their hair and lovingly embrace them.

Life will find ways to end...make it a meaningful one for them.

What will the therapy accomplish? - will she enter the Olympics? ... NO because she is 99 with a broken hip - this may shorten her life from 101 to 100 but she is way, way older than 99% of the humans on our planet

This fall etc may have brought to the fore front her eventual decline - it may have hastened it but it was coming - her spirit is tired & that is what has removed her desire to go forth - think about giving her love, support & comfort because this could take a long time to heal if it ever can

I hope this doesn't sound mean but maybe it is time for you to be realistic about how her spirit has started to withdraw into itself - she is basically saying 'I've had enough' & she doesn't want to be bugged by high energy physios etc that are so peppy that even their presence makes her tired .... just another view but one you should know might be true