Who makes the decision that someone should use a wheelchair full time instead of walking when that person is not necessarily able to make the best decision on her own?

Mom (92) fell and broke her hip at the end of February and then fell and broke her leg in June. (She used a walker while walking.)

She is currently in a nursing home for short term rehab. She is able to stand up with assistance and can walk at least 100 feet. They are working with her to see if she can use her hands to move a wheelchair herself.

I think rehab will recommend walking for short distances and use of the wheelchair for longer distances.

However, I think that two of my three siblings think she should now use a wheelchair only (no walking) to prevent another devastating fall. I think I am beginning to agree.

Mom’s primary care doctor retired. I consulted with another primary care doctor in the same practice, but she has never met my Mom and told me she cannot make that determination now.

Her orthopedic surgeon said that continuing to walk - at least for shorter distances - would help prevent the atrophy that could occur if she were in a wheelchair full time.

I am just so confused. I just don’t know what to do or who to consult. If all siblings decide a wheelchair is best, do we just try to get a prescription for a wheelchair from a doctor?

Any help is appreciated!

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My question is; "How are her bones?"

So many seniors fall because they have a spontaneous break and the fall is not the cause but the result of the bone breaking.

That is what I would want to know before I decided to keep her in a wheelchair fulltime. If her bones are swiss cheese then she will be safer in a wheelchair, because she will probably have more spontaneous breaks, but if her bone density is good I would keep her as mobile as possible to avoid the many problems that come with being wheelchair bound.

Best of luck finding the correct path forward.
Helpful Answer (10)
jacobsonbob Aug 2020
Yes, my mother had two spontaneous breaks about a year apart--the femur in each leg. Fortunately, she didn't fall, it took surgery and an extended period of rehab/physical therapy after each one to be able to walk again. She was in her mid-80s at the time, and still with normal mental abilities. If this had happened five or more years later, the situation would have been very different.

A bone scan, if not already done, would be very helpful in determining the course of action. After my mother's one leg broke, she asked the osteologist if the other one was likely to do so, and he told her "they have the same 'history'--osteoporosis" and sure enough, a year later the other one broke. Fortunately, she was still able to walk unaided for a few years afterward, but I always felt concerned that a hip might also break. As she got older, she eventually used a walker, then a wheelchair and then finally bedridden.

I guess if one has severe osteoporosis, the choices are "fall and break it now" or have it break spontaneously later on--neither being a pleasant experience (to put it mildly).
Wheelchair only is a great idea - as long as you don't mind her getting pressure sores, losing muscle tone and possibly bone density too, and above all missing out on exercise.

If your mother is able to walk one hundred feet, she can walk. What she should be encouraged to work on is balance (her physical therapists will address this); and she will need continuous monitoring to ensure she does not mobilise unattended. Is she able to recognise the need to press a call button and wait, or can she not be relied on for that?

Do you know what caused the falls?
Helpful Answer (8)

My mother can walk 150'; I help her up/down so she can use a walker inside our house and a wheelchair anytime we go somewhere. Being able to stand and walk even a few steps is very important in maintaining a senior's health and well being in a home or AL situation. The walking senior can assist with transfers, doesn't develop bed sores, has less joint pain from arthritis, and less risk of blood clots. After falling late 2018, my mother was mostly bed bound for a couple of months and her pulse and blood pressure went up during the period of inactivity. As soon as she started using the walker in PT, both pulse rate and blood pressure came right back to normal and have stayed there. Being somewhat mobile also allows Mom to feel more independent and improves her mood. I have to watch her carefully when she's seated somewhere because she forgets she needs help and will try to get up and take off (sometimes without her walker) but I believe the improved quality of life is worth the effort.
Helpful Answer (8)

My mother has severe spinal stenosis with extreme leg weakness bilaterally. We walk her most days with two assists and w/c behind her short distance in the house only. One usually navigates the w/c. We walk her most days for exercise. She uses a w/c whenever she goes out. She has a custom w/c. Medicare will pay for the chair if she is eligible. Doctor has to fill out forms and submit to Medicare. We also do range of motion exercises in her chair/bed to prevent atrophy every day. The w/c is Solara brand. It costs about $5,000 if self pay, but with your mothers mobility problems and history of falls she might be eligible. Good luck!
Helpful Answer (7)

Good morning.

These are very difficult decisions for sure. Smiles to you as my dear 89-year-old Mother would have rather have been pushed around in a wheelchair as opposed to using a walker, so I had the opposite problem. I wanted her to walk because I didn’t want her to lose what little muscle that she had.

My Mom walked with a walker and a gait belt, which proved invaluable, and supervision within the house. I would put my Mom in a wheelchair only if we were going out of the house. We also did daily chair-type exercises with her.

We don’t like change, and we certainly don’t like seeing our parents decline. Why don’t you take cues from your mother on what she should do?

If you decide to put her in a wheelchair, just make sure she does daily chair exercises to keep up the muscle, well I would do that regardless of walker or wheelchair.

I think the key here is assistance / supervision when she moves from point A to point B no matter what means she is using.

You and your sisters will make the right decision. Best of luck to you. And your dear mother!
Helpful Answer (6)
earlybird Aug 2020
Great advice, Shay!
If your mom still has the use of her legs, let her walk. If you can walk with her, that might give you some peace of mind. Get a prescription for a wheel chair (I prefer the transport chair because it is so much lighter to deal with), but only use it for Dr's appointments where she may have to walk long distances. My husband has LBD and I have him use a walker around the home, but use transport chair for long distances. By allowing your mom to continue to use her legs, will help you out greatly.
Helpful Answer (6)

Listen to her orthopedic surgeon. Unless your sibs are doctors or PTs how can they know what is best? Not-moving is the surest way to decline. Make sure Mom does NOT walk without a walker, and has supervision when she is walking. Then, keep her moving.

Get her videos of seated exercise programs to practice daily. Make sure she is taking all medications and supplements that have been prescribed. Also, look at her living environment and remove all fall risks.

Getting in and out of bed can be dangerous for a short person if their feet don't hit the floor when seated on the edge of the bed. Make sure she knows how to do this safely, or that she knows to call for help and NOT get up hserself.

PT can teach her how to move safely, but you have to make sure she can do what she was taught or she can't be independently mobile. That is different from being wheelchair bound.
Helpful Answer (4)

First comment I have is..Your mom has dementia she will not remember that she can not walk and will try to stand up from the chair she will succeed and she will fall again. So using a wheelchair will not prevent another fall.
I would say if someone is with her, if she is wearing a Gait Belt and she is using a walker that is great. She will use muscles that will atrophy if she is in a wheelchair all the time. With someone with her that can aid her and guide her down if she begins to fall that may prevent injuries. But I would not let her walk on her own.
(not to be cynical here orthopedics income is based on mending bones that have fractured so I am sure that is one of the reasons he says to keep her walking..what do the people doing the rehab / PT say? what would they do if this was their mom?) And you have to keep up with the PT at home doing the exercises that will help her are you and your siblings willing to do that daily? Will your mom participate?
Helpful Answer (4)

If she had been living somewhat independently then that is obviously no longer going to be an option - you say she is in a nursing home for rehab, where is she going after that?
I agree with Grandma1954 that a combination of the two is better - some walking is very beneficial to help retain the strength to assist in transfers, bathing and toileting because once the ability to even stand momentarily is lost it is a whole different level of care. In a facility setting that could mean carefully guided walking as part of routine PT, at home it means someone would need to supervise and guide every step.
Helpful Answer (4)

I cannot agree more with the idea of continuing some kind of range of motion/muscle strengthening exercises to minimally keep the movement ability the best as it can be.

Mother is one fall away from a wheelchair, FT. And what she doesn't 'get' is that will mean she is Hoyer lifted into it in the am and put back to bed in the evening and will not be able to move about her small apartment. The doors are simply too small and cannot be widened.

After her many surgeries--both ankles, knees and one hip..she was good with PT until the PT stopped coming in home. She never did a single exercise again.

You really want to put off the wheelchair dependence as long as possible. It changes the dynamic of everything. In mother's case, it will require daily aides and she does NOT want that. Or placement in a facility. She REALLY doesn't want that.
Helpful Answer (4)
Grandma1954 Aug 2020
There are Swing Clear Hinges you can put on a regular door and it will allow the door to open fully giving you another 2 inches or so of clearance. So it is possible that with a regular WC or Transport chair you could get through a regular door.
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