It’s hard watching our parents get older and less able to navigate the physical and mental challenges of a world where the necessities of life such as healthcare, travel and activities of daily living are becoming increasingly difficult to access. These changes affect not only our loved one but also place an increased burden on caregivers and family. The good news is that there are effective albeit underutilized steps you can take to improve or, at least, maintain their function.
Mobility, the ability to walk and function independently, is a critical marker for long term survival and quality of life and a great place to start. Reduced mobility can contribute to greater risk for falls, infection, loss of cardiovascular function, mood problems and declining mental acuity to name just a few. I have outlined strategies for optimizing mobility for elderly patients.
Mind over Matter
The first objective is to get your loved one motivated to improve his/her status. Set achievable goals in small steps. If the process seems too long and difficult it will result in discouragement at a time when sadness, depression or anxiety may already be factors. Celebrate every achievement even if that achievement is holding steady. Don’t allow the phrase “You’re just getting old” to be spoken anywhere in their presence. I’ve found it useful to spend time as their doctor with the patient outlining goals and expectations when family encouragement isn’t doing the trick.
This is very much a mind game and motivation is a key element to succeed.
Muscle strength is a requirement for mobility. It doesn’t take a lot of strength; just enough to get around.
Don’t be fooled into concentrating on just leg strength. A balanced approach using all muscle groups is important. Core muscles and upper extremities are necessary for maintaining balance, recovering from a trip or misstep and using support structures such as handrails. A balanced program can be developed by a physical therapist or physiatrist and carried out with that provider, at a club or at home with a minimum of equipment. Set up a regular routine with variety from day to day. Make the exercise pleasant with your parent’s favorite tunes, good lighting and understandable instructions. Measure progress in long enough intervals so that it will be obvious and avoid measuring if there has been a setback such as a cold.
Muscle strength requires absorption of nutrients especially protein. A doctor or registered dietitian (RD) can create a diet plan that is enjoyable and meets the requirements for muscle strength. If there are digestive issues such as gas, reflux or nausea, or the patient doesn’t seem to progress at a rate consistent with the level of effort being expended, this is a sign that nutrients may not be absorbing and should be addressed. This is a common problem that is resolved in a straightforward manner.
Balance is accomplished by a remarkable combination of body systems working together including the inner ear vestibular apparatus, vision, motor and sensory nerves, muscles and joints, all orchestrated by the brain. If any one of these is lacking or there are obstacles such as pain or reduced confidence, balance will suffer.
Balance can be tested. The results can sometimes provide information about what is causing the problem but not always. If there is not a clear culprit it may be worthwhile to assess each of the body systems associated with balance to see which one is underperforming. It is not adequate to just say balance is lacking without identifying, to the extent possible, why it is lacking so that you have the opportunity to fix it.
Pain from joint diseases such as arthritis, injuries or even unrelated organ systems such as dyspepsia (digestive discomfort) can limit mobility. Joint pain may be temporarily relieved by non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen but they are not a permanent solution. Natural medicine adjuncts such as glucosamine and chondroitin are controversial but there are many positive reports. They are worth a try but done best with a doctor familiar with their use since many treatment failures are a result of inadequate dosage and timing. They are generally safe but some have side effects. Glucosamine, for example, can increase the risk for bleeding in some patients. Give them at least 6 weeks to work. In some cases, it may take a few intravenous doses to speed things along but that can be done quickly and inexpensively.
There are many other naturopathic strategies for controlling pain that address the cause and are worth considering.
Elderly patients frequently do not get adequate eye care. A comprehensive eye exam and, perhaps, corrective lenses can have a dramatic effect. Visual acuity, cataracts, poor adaptation and other eye problems can affect mobility as well, especially when lighting is poor.
Eye exercises may also be helpful. They are controversial but I have seen them provide benefit.
Range of Motion/Flexibility
Flexibility and range of motion can be a game changer, especially when recovering from an unstable moment. Specific, gentle exercises are effective even when there is pain or injury in the affected body area. Range of motion exercises are easily incorporated into an overall exercise program.
There are reasons for fatigue including insomnia, hormones, metabolic issues and drug side-effects.
Poor sleep quality is the most common reason for fatigue in our practice, usually a result of pain, malabsorption, metabolism issues, use of stimulants (a vicious cycle to be avoided), digestive problems, respiratory complaints such as sleep apnea or anxiety. The resulting fatigue can be difficult to diagnose but the effect on mobility can be substantial when the patient is simply too exhausted to move effectively.
Sleep studies are helpful but I start with a comprehensive Review of Systems, a medical diagnostic tool where the patient is asked questions about the function of literally every body system. This information is combined with the principal complaint, history and other diagnostic information to create a plan that addresses all of the possible culprits. Everything is connected (anatomy 101) and the big picture from the Review of Systems is important.
Stimulants are not the answer. The initial jolt is paid for by the resulting slump when the stimulant wears off and further when the residual effects adversely affect future sleep.
Confidence and security
Self-confidence and personal security are increasing concerns with age and affect the patient’s willingness to try to improve mobility. Our society, sadly, presents endless negative images of aging and they have their effect. The antidote is success, positive reinforcement, achieving goals and receiving respect. This means removing negative influences where possible.
When you are older you may not be able to fight or run as well as when you were younger and this is a common concern for elders. Keeping the environment as safe and secure as possible helps a lot. For example, if your loved one ends up in a hospital room with a disruptive or aggressive roommate, get a new roommate immediately. It can take years to get over the trauma of a night with a screaming, delusional person in the next bed and no one answering the call button
Our relationships with our parents can be complex, confusing and burdensome as they age. This is the stuff that has underwritten many a new Mercedes in psychiatrists’ driveways. It is my hope that these suggestions will provide a roadmap for making objective decisions that are not affected by your own anxiety, guilt or the other emotions that frequently come with the territory.
Be as consistent and vigilant an advocate as possible without abandoning your own life and don’t let the healthcare system bully you. Medicare, insurances, providers and institutions may need a push or an appeal to provide what is needed. Don’t be afraid to challenge the system, respectfully and with purpose.
Finally, do not allow anyone to treat your parents as children; the inability to perform or understand some tasks does not take away from their entitlement to respect.
Managing mobility can yield great rewards for the patient and the family. This is an investment well worth making.