When is the right time to put my mother in law in a wheelchair?

Mam's aide asked...

My M-i-L is having difficulty walking. Each week she is taking more time to move along, is moving slowly and sloughing her feet. She holds on to anything she can get hold of to steady herself - she is fearful of falling. She has not fallen, thank heavens, and we are always with her to steady her and hold onto her arm to help her balance - the physiotherapist recommended that she move under her own steam to keep her muscles strong. She has exercise each day and has recently had physiotherapy.

She also has hardening or the arteries in her legs, bends deeply and cannot straighten up and finds it hard work to walk the distance from the house to the parking lot.

We have worked to keep her out of a wheelchair as we think she will lose more of her musculature. My question is, when do we put her in a wheelchair?

Expert Answer

Bonita Lynn Beattie is the vice president for injury prevention for the Center for Healthy Aging, part of the National Council on Aging (NCOA). She directs the NCOA's Falls Free Initiative, which is developing and implementing a national action plan to prevent falls and fall-related injuries in older adults.

When to use a wheelchair to prevent falls in what seems to be an increasingly frail older adult is a difficult question to address without having observed the older adult in various settings. First off, let me extend kudos to you for obtaining a physical therapy consultation and for helping your mother-in-law follow-up on the prescribed exercises.

My first question would be if you have discussed this particular concern with the Physical Therapist and as a follow-up question what was his/her clinical judgment? If you have not, I suggest you do so as he/she knows your mother-in-law well and should have a professional opinion.

Another question is whether she currently uses a walker to assist her now? Again without the opportunity to observe her my first thought would be to consider the use of a walker. It should be fit to her and she should be instructed in using the walker safely as accidents do happen from ill-fitting walkers and unsafe use. The Physical Therapist would be able to do that and should be consulted. In my opinion a walker would give your mother-in-law a larger base of support, more confidence and may help in providing some alleviation of the back stress.

I would also ask how far it is to the parking lot, which you describe as the primary issue. A rule of thumb is if the older adult is SO TIRED and in such pain after walking a distance that it is hard to enjoy the outing you should consider a wheelchair to assist in those outings. Again, I suggest you consult with the Physical Therapist and if indicated, get safe instruction in the fitting and use of a wheelchair.

I would also suggest in partnership with your mother-in-law you do home safety assessment and plan some simple modifications that might be warranted such as tub/shower grab bars or a tub chair and hand-held shower head, add more lighting and other measures to improve the safety of the home. Research tells us 58% of falls occur in and around the home. The CDC's National Center for Injury Prevention and Control has a nice home safety assessment tool that I recommend, you can find it and their brochure on preventing falls online at http://www.cdc.gov/injury/.

Keeping your mother-in-law moving and active, doing her prescribed exercises, promoting safe walking and getting out of the house to engage socially are wonderful insights you have. She is lucky to have you and your husband helping her stay independent. Thank for the question.