How can an Alzheimer's person go thorugh physical therapy?

3 answers | Last updated: Oct 01, 2016
Southernhope asked...

My 83-year-old mother-in-law, suffering from dementia, has now broken her hip and surgery is scheduled for Friday. I've read all of the posts about recovering from hip surgery but what i haven't seen (and can't figure out) is how in the heck does a person who can't remember or understand much, then go through physical therapy? There were days (before this accident) where she literally could not remember how to walk.

it's all sad...and knowing that this surgery seems to be unavoidable, I'm really at a loss as to how to help.

Expert Answers

Joanne Koenig Coste is a nationally recognized expert on Alzheimer's care and an outspoken advocate for patient and family care. She is the author of Learning to Speak Alzheimer's. Also, she currently is in private practice as an Alzheimer's family therapist. Ms. Koenig Coste also serves as President of Alzheimer Consulting Associates, implementing state-of-the-art Alzheimer care throughout the United States.

Your concern about your mom-in-law's impending surgery is both admirable and warranted. The most difficult problem, related to surgery in elderly dementia patients, is the after-effect of anesthesia. To that caveat, I must add that often the person, who is cognitively impaired, becomes extremely agitated when they find themselves in strange surroundings with people caring for them who are not familiar, the sounds are foreign, the odors are unrecognizable, the environment itself is scary, and the list goes on. Be prepared that this possible behavior is not truly offensive but is, in fact, defensive - she will be defending herself against a world she simply does not understand. Lots of extra love and support works wonders! Now, with that said, let me assure you that physical therapy (PT) can be a very positive service for the post-operative dementia patient. Not so very long ago, Pt was not offered to the recovering AD person because they did not meet the criteria of being 'able to follow instructions' or to recall directions for exercises suggested by the PT. Fortunately, times have changed and Physical Therapy has become an important facet in the best recovery whether or not the person can follow or retain instructions. It is the appropriate movements performed by the therapist that are beneficial to future use of the injured joint. Frequently, the PT will demonstrate gentle range-of-motion exercises to members of the family or others who will be with the patient following surgery.
People with a dementing illness who are in the final stage of Alzheimer's or a related disease, and are now in need of total care, still benefit from physical therapy to control pain and maintain whatever movement remains. I suggest you read the related topic "Physical Therapy for a Broken Hip" for further information on the reasons to include post-operative PT. This was a great question and I know many readers are wondering the same thing. Thanks!

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Community Answers

Frena answered...

if possible, a family member or friend of the family needs to be with Mama in the hospital, to keep her informed of what's happened and why she's there and prevent her struggling out of bed or into peril.

See if that's possible, because otherwise she will run into the issues of a) of course. not remembering her own condition but also b) hospital medical staff who are not oriented to the needs of patients with dementia -- and i'm putting that in a very kind constrained way there.

A fellow caregiver answered...

My 75 year old mother who is in the 6th of the 7 stages of dementia just had a partial hip replacement 2 days ago. She has been so zonked out, I had to step in and continue to remind everyone that came in the room her condition and that she needed to wake up. She is not eating or drinking anything-she can't-she's out of it. So, now they listen to me as I continue to say NO more drugs!!! As I sit here with her hour after hour, she sometimes mumbles and is always incoherent, but I can talk to her and she seems to know I'm here. I am either her daughter, mother, sister or someone she knows, but she never really knows me or my name (I'm her daughter). You have to be their advocate. When she starts grimacing I know that's when we need to give her something for pain. So far, the pain she feels is when they move her. Even in her zonked stage she has cried out in pain when the PT's tried to get her in a chair or to use a walker. Give them love, understanding, patience, your time and ALWAYS be available to the doctors, nurses, technicians so that you can explain what they do and don't like, how to handle them, how to talk to them, etc. They can't so you have to! You have to ask the doctors the questions for your loved one and let them know what is indeed in their best interest. For example, my mother lives in a very small personal care home with 4 other women with dementia. The doctors and nurses kept telling me she would have to go some nursing home/rehab facility and not only did I tell them we would not allow that, but I wrote a letter to the doctors and staff and had the nurse put it in her file. We know what's best for her given her state of mind, her history and what works best for her. The owner of the PCH has visited mom and stated she will take care of her. Good luck to everyone who has a parent with this awful disease. Love and lots of prayers are needed for them and for all of those that love them.