When is the right time to put my mother in law in a wheelchair?
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?
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.
Another thing that was not mentioned is her age. That can also, be a factor. Plus, why not ask her. After all if she is in her right mind and able to speak for herself. Why not ask her how she would feel about using a wheelchair. I am only 62 and cannot walk a long ways. I use a scooter not a wheelchair for places that require me to walk a long distance. I do walk small stores or around the house however, large store's or malls are just to much for me. The pain gets to bad. Using a wheelchair/scooter at times is not a lifetime decision. It does not mean she has to use it all the time. She can still walk when she feels able to and use the scooter when she needs to. Even if it is around the house. The small scooter I have does not even require a special van to use it. It is a shopping scooter and only weights 43 lbs. yet electric. I love it and everyone stops me to ask how they can get one. I only paid $699.00 for it and it has paid for itself many times over. Check into something like that for her. Just a thought.
I am so sorry - I input a long answer a while ago but it did not upload.
thank you for your help and comments. Mam is not able to discern her ability to use a chair - she is 95 and is in the mid-final stages of dementia. we are working in partnership with the PCP and PT and they have not indicated a time when she will need to be in a wheel chair. The PT did a fall risk assessment in Mom's house recently at our request and tells us we are doing all that is needed with grab rails and our new bathroom with wheel-in shower.
your answers have given me the best guideline - "we will know when it will be"! Sadly I think we are getting there soon. she is also unable to use a scooter but is using her walker. she does stoop badly and can't straighten so I still worry about her toppling over. I hold onto a big chunk of her coat so if she does go down I can at least break the fall a little! The car park is only a short distance and as long as she can keep on doing that it will give her some exercise.
thank you again for your help - just knowing there are caring peop out there is Marvelous!