Will dad ever get his strength back, and is the physical therapy worth doing?

Dlb61 asked...

My 88 year old father has had several small strokes, has dementia, COPD, and some Parkinson's symptoms. We have a caregiver come to the house to care for my dad and mom 8 hours a day, 5 days per week. My dad can barely walk. He is blind on the right side of both of his eyes because of the strokes. He needs a walker most of the time, when he is very tired, needs to use a wheel chair.

My older brother has a new girlfriend who happens to be a doctor (not currently practicing) are complaining that the caregiver does too much for my father. My brother's girlfriend thinks that he should be re-learning how to walk and exercise and practice walking every day. He has started physical therapy again (at her urging) and hates it. He fights with the caregiver about going and complains during the whole session. By the following day he is exhausted and in pain, so the caregiver lets him rest. My brother and his girlfriend feel that she is wrong to do this. They believe that dad needs to keep working every day to get his strength back.

My question is, will he get his strength back - enough to walk and take care of himself (showering, dressing, etc.) and what kind of quality of life is he having if he hates what they are making him do? He is depressed as it is (he is aware of his memory loss and inability to walk and take care of himself.) When my brother and girlfriend are around on some weekends, he does engage and seems happy while they are there, so they believe that he is not as bad as we have thought.

Are they correct in doing this?


Expert Answer

Laura Cheney, a physical therapist who specializes in geriatrics, graduated with honors from the University of California at San Francisco in 2000. She loves her job working as the sole physical therapist at a premier life-care facility in San Francisco. She has written articles and lectured extensively on fall prevention and other issues relevant to the aging experience. As a registered yoga teacher, she teaches yoga, meditation, and other mindfulness techniques to seniors -- helping them expand their repertoire for coping with stress, pain, and illness in the later years.

Your question is "Will he get his strength back?" Yes, muscles do continue to respond to strength training throughout the lifetime. But functional outcomes such as walking, bathing, dressing require a lot more than pure strength. For example, balance, motor control, muscle flexibility and length, vision, safety awareness, mental capacity and motivation etc. Your situation is complicated by multiple 'cooks in the kitchen'--all certainly who have the best intentions. I know how difficult these physical therapy decisions can be and it is difficult for me to make a specific judgement from this vantage point but given your father's age and multiple diagnoses I would really consider whether walking independently and full self care is really a realistic goal. It may just be setting your father up for failure. And with the energy he has left in his life he should focus it on what he desires and finds important. I think the important key to your father's care is setting realistic expectations. These expectations and goals can be set together with you and the guidance of a physical therapist who has evaluated your father. It might help to have the whole family present so everyone is on the same page. Your father's motivation is a key component. There is also a lot of middle ground between sitting in a chair all day and having the caregiver do 'everything' vs. full independence. A PT can help you to set achievable goals that your father can reach and that most importantly can increase the joy and fulfillment in his life. And it is important to remember that maintaining what he CAN do will help contribute to his health and slow his functional decline. Walking and full independence does not necessarily equal a full and happy life. Best of luck to you.