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My 96 year old mother in law broke her hip about 2 years ago. She made a pretty good recovery but has since been prone to falls. She has fortunately not suffered anymore fractures but the last time she fell she was using her cane. Since that time we have insisted that she use her walker. It seems like she is much less mobile and we’re wondering if using the walker is inhibiting her mobility. She is also showing signs of dementia and we are struggling with her nutrition since her appetite is very poor. Any advice would be greatly appreciated. We live in a rural area and many of the support systems aren’t available here.

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A walker will certainly inhibit mobility but it may prevent some bad falls. The problem is usually getting elders to use them, especially if there is dementia. I had an awful struggle with my mom not using her walker. My dad is still living and in a nursing home, he’s 90 with advanced dementia but he’ll still try to get up from his wheelchair and take a fall. It’s so frustrating but really not much you can do.

If you can get MIL to use a walker be sure to get one that suits her. A rollator type may not work. Maybe just a simple lift n step type. My mom did well with the rolling type for awhile but as her dementia increased She couldn’t control it, set the brake and so on.
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Not sure if a walker actually prevents a fall. It may provide some stability and support when getting around.
I think what happens is not using the walker properly and poor posture when using the walker is more detrimental and that is more of a problem that can cause a fall as well.
Adding to that the poor nutrition leads to more fragile bones poor muscle strength. This can cause the lack of mobility since there is less activity due to poor strength.
I would also eliminate any trip hazard in the house. Rugs, thresholds, throw rugs, electric cords that dangle, poor lighting, shoes, clothes and odds and ends left on the floor.
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In my opinion those fancy rollators with built in seats are really designed for sidewalks or for people living in places with long open hallways (like in facilities), they are often too big, heavy and clumsy for using in a typical home where you need to dodge furniture, fit through narrow doorways ans halls and manoeuvre in a typical bathroom. Both my mom and my sister's FIL did much better with an old fashioned 2 wheel walker, I bought "skis" for the front of mom's to help it glide more easily over carpets.
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At 96 the walker is a good idea because there now is too much loss of bone density, of muscle and ligament, of EVERYTHING, but worst of all there are bound to be balance issues, which take most folks down. The new standup walkers that keep you straight, your spine stretched and your arms up and resting often work really well. At 96 you are limited. There is no way to get young again, and there is going to be a slow slide down with little improvement. Support systems will help little and you may be looking at a time when there is no mobility other than a wheel chair. I am afraid that taking away the walker could lead to disaster of broken bones which at this point could spell the end.
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Mother used a cane for a long time. She wanted a hip replacement, even though her do told her she would 'downgrade' to having to use a walker during rehab, and very possibly for life.

Went through with the surgery, and she rehabbed poorly and is now 100% dependent on the walker. It's sad, b/c the cane was not large or annoying. The walker does provide the kind of support she needs, but it was sad to see more deterioration after surgery.

Another thing about walkers--too many people don't use them properly--they are 'chasing' after them, rather than using them for proper support and posture.
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texasrdr22 Sep 2020
My Mom pushes her walker like a wheelbarrow and grips it for dear life! She pushes down so hard on the side handles that it makes it difficult to move it along the floor! I try to get her to walk closer to the front of the walker and be "in" it rather than push it along in front of her, but she does not seem to like "my" way of operating the walker! She prefers to be hunched over staring at the floor.
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Just thought of this..there are "Up-right walkers" where the person is walking upright rather than hunched over. Seems to me this would be better posture for a walker but not sure if Medicare would pay for one or if they pay for just a "standard" walker.
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texasrdr22 Sep 2020
Medicare won't pay for that type of walker and they are VERY expensive. I priced one for Mom at about $700! Yikes!
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My mother has been using a walker for quite some time now. Insofar as her decline in mobility since using the walker, that, in my opinion, is sort of a "chicken and egg scenario". Regardless of what has caused her to need her walker, it is where we are right now, and where we will stay.

She has both a rollator and a conventional walker. During her first stint in rehab, once her roommate got a rollator, well, she just wouldn't quit going on and on about getting one herself! She had never been a "keeping up with the Joneses" kind of person, but by golly, she went into full envy mode once she saw that fancy walker with the seat!! "Look, it has a seat, I can sit down whenever I need to, I will be much more willing to go out and walk with it because it has a SEAT!!" Yeah, no. Didn't motivate her at all to go out and walk. And now it's sort of moot, because among other issues, she has some serious balance problems, walker notwithstanding.

I agree with CWillie's assessment of a walker vs. a rollator. The rollator is really to big to get through regular sized doorways. And when she was on a steady IV solution, she got herself so tangled up in the rollator - there are waaaayyyyy more "pinch points" on a rollator than a regular walker - I had to unhook her from her pump to get her untangled. It is also quite a bit more heavy and takes up more room, even when folded up, that make it more trouble than it's worth to bring in the car. Also, as mom has become so much more frail, it's weight makes it very hard to get over the door saddles between rooms.

If your LO is someone who is inclined to be outside, however, the seat could come in handy if they need to rest frequently. Since the rollator has 4 wheels instead of 2, it does maneuver a little more easily over uneven ground.
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Dosmo13 Sep 2020
I used a rollator after two knee-replacements and spinal surgery (3 separate surgeries). Had 2 aluminum walkers at first, with tennis ball "feet" which PTs always recommend.
( I already had an aluminum walker, and told my home health nurse, but she insisted she could get me one from Medicare, so she did...got me one identical to what I had. Sorry poor taxpayers, but she wouldn't return it. Go figure!) I used the aluminum walker as directed for a while as I recovered.
But then I then bought a rollator! It was clumsy at times but it got me moving again! I walk everywhere now, perfectly on my own, no walker needed. But love my rollator with its seat for moving boxes, laundry, groceries etc etc. I live alone and I think it now prevents falls by allowing me to do many chores safely.
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By virtue of the fact that your MIL needs a walker her mobility is compromised. My own mother fought off using hers for ages, insisting she didn't need one and was doing fine without one. She's fallen over 48x that I'm aware of to date, even when she finally DID start using the walker.

My father fought off the need for a cane until my DH brought him to Walgreens and told him to pick one out, he'd wait. Then came the need for a walker, which he refused, of course, and wound up falling & breaking a hip which led to his death 10 months later. His mobility was compromised, as is my mother's, for a long time before he actually admitted it.

When I had a full hip replacement in 2017, I used a walker with no problem or resistance at all. I saw that it helped me, that I needed it, and it was there to assist me in getting back on my feet independently. Of course, I wasn't suffering dementia either, to the best of my knowledge, so my brain power wasn't compromised.

My mother's favorite saying is "It's a great life if you don't weaken." Your MIL probably hates admitting that she has a 'weakness' that requires her to use a walker. If so, she's sitting around more than usual as a result.

You might want to look into getting some Ensure or Boost shakes for her if she's suffering from a poor appetite. Or make her some smoothies yourself in the blender. Sometimes the elders prefer something they can drink rather than chew, especially if it tastes sweet (dementia gives them a HUGE sweet tooth). Keep in mind that a sedentary human being requires far fewer calories than we THINK they do to survive. So don't worry too much if she's not eating as much as you feel she should be eating. A few bites at each meal, supplemented with a snack here and there, should do the trick. Experiment to see which foods she seems to enjoy, and eliminate the ones she makes a face at and won't eat. No use in arguing such a thing at this stage of the game. In fact, I bring a couple of bags of junk food to my mother in the ALF every Sunday when we go for a window visit. She says she hates the food they serve her (she's gained 40 lbs, however) so she can supplement her diet with her favorites snacks. She'll be 94 in January; it's up to HER now what she eats or doesn't eat.

I think you should allow your MIL, at 96, to be less mobile if that's what she seems to want. Don't push for her to be active; it makes no sense, really. She's earned the right to do as she pleases and besides, with dementia, you can't really argue with them....it's impossible! It only gives YOU heartburn and becomes a losing battle.

Good luck!!!
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Is Mom going over carpet, if so maybe skis will help her glide better.

https://www.supportplus.com/cgi-bin/hazel.cgi?ACTION=DETAIL&ITEM=FG1462&websource=SPGOOGLE7&source_code=SPGOOGLE7&utm_source=google&utm_medium=cpc&utm_medium=cpc&utm_source=google&utm_campaign=shopping&gclid=Cj0KCQjw-uH6BRDQARIsAI3I-UdzZJV3fLHn8evKIuEX6U2V3gecKvvwv3kqRCMcK3nEDj6yzMm1lbAaAgPlEALw_wcB

If going over hardwood then put tennis balls on the back legs. You cut an X on them then slide them over the end of the leg.

You may want to see if you can get a therapist in to show her how to use a walker safely. Get an order from her Dr. Medicare should pay for it. The therapist will adjust it for her comfort and show her how to correctly use it. Rollators are not for everyone. They can get away from some people.
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Your MIL may feel insecure even with a walker if she has been falling more often. The walker would offer more stability and therefore more safety than a cane. At 96 your MIL may be experiencing general muscle loss and weakness and not have the energy to be more active. If she would comply, Physical Therapy might help her maintain some muscle tone. I wouldn't take the walker away hoping to make her stronger. That would just make it more likely that she would fall again.
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Megwin Sep 2020
The way I read and understood the first post that I sort of objected too - was that the mother of the poster died eventually - and it was felt that she died because of not being able to handle a walker. I agree that the one with four wheels can be dangerous - you have to still have some mind left to operate the thing - the brakes and all - and on an incline it will roll away if you can not hold on. By the time someone gets to that point, there should actually be some help available when the walker is used on long walks and outside. So yes - it has to be used correctly. I have that one with the tennis balls - and I am unable to use it - it does not move at all on carpet in the house and my floor is covered in some material that is "slideproof" if there is such a word.
Here is what I found posted on line about all this - and I agree totally with this. I am a retired nurse and do have a bit of experience with aging and the problems it can bring - so I do know how frustrating it can be for any caretaker to deal with the elderly that have such severe problems that they are unable to understand the simple things of the brakes on the walker - but they are much like the brakes on a wheelchair - I am actually more afraid of the motorized versions of mobility devices than I am of the wheels on my walker - I am 80 and now very limited with my moving and walking. Here is what I copied:
Elders are often reluctant to get (and consistently use) a mobility aid, even though these devices can play a key role in helping them continue to lead safe and active lives. It is important to ensure they are using the proper mobility aid and using it correctly. A physical therapist or occupational therapist should conduct an assessment, prescribe a device, and educate the patient on how to use it.

Maybe some of us are living too long these days??? lol - hmm
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My mom fell while using a rollator. Would never touch it again. Much preferred the lightweight Walker with the tennis balls. Aunt recently had Pt to make sure she was using the walker correctly. She wasn’t. She loves it in comparison to her cane but had to be convinced to give it a try. She was not trusting the cane. It was the dementia. Wanting to hang onto every structure or person in reach. She used the cane successfully for years. I had to put the cane away to get her to use the walker. In her case, mobility increased. She seems to trust the walker more. Aunt will sit all day if not encouraged to move about. Once she gets going she does great. Her pt recommended the rollator so we will try it but I do worry about the brakes. I’m also considering a wheelchair for outings. My mom sat a lot her last year of life but she was very committed to therapy. She had it a few tines a week and made sure to get up and walk several times a day. I think you have to consider the individual.
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We had a walker, two rollators, and two wheelchairs that we used intermittently for different things and depending on how strong/stable he felt. We did have skis on the walker. Encouraged him to walk as much as possible, but he started using the transport wheelchair to scoot around the house on his own because he felt more secure and it was small enough to maneuver around easily. He would often forget the walker and just grab onto the furniture or limp across the room, which scared the dickens out of me.
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A physical therapist told me a cane is dangerous, because people put too much weight on it, lose their balance, then pivot and fall sideways. A cane is only safe(ish) if you use it with one hand and have the other hand on the wall. In other words, using it outside the home is not a good idea.

A walker is a pain in the neck because they're always banging it into the doorways and furniture, but by design it requires them to use both hands to use it, and they have to be facing it to walk anywhere. The ones with wheels aren't good for anyone of your MIL's age -- they really should be for much younger folks. (My mother never could figure out the hand brakes, so we gave up on it, thank goodness.)

She's 96 and sounds like she's slowing down and heading for her eventual end. Let her eat what she wants, when she wants. Offer her a small breakfast, then a snack every couple of hours and see if you have better luck that way, but honestly, if she's not hungry, she's not hungry. I have a relative who lived to be 102 eating little more than fried chicken and Oreos the last 15 years of her life. If she hadn't, maybe she might have made it to 105, but why? She died with a smile on her face.
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My mom started with a cane. She then moved to a walker. She fell many times. There is no way she could walk without a walker. With Parkinson’s she has numerous mobility issues.

It’s tricky to know what is the best thing. My mom would like nothing more than to sit in a wheelchair because it is absolutely exhausting for her to walk just a short distance.

When I spoke to her doctor about her wanting to be in a wheelchair he was adamant that she should continue to walk.

She’s well into her 90’s and still going but every step is painful. So who knows how long a person can push themselves? It’s so hard to know.

My mom continually said that the doctor did not know the pain and fatigue that she felt. She had a point. It made me feel awful for her every time I would hear her say it.

Parkinson’s is a dreadful progressive disease. There isn’t a cure. Those who suffer with it will never improve. Many eventually end up in wheelchairs. I think that has to be an extremely difficult challenge to care to a person in a wheelchair.
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PAH321 Sep 2020
NeedHelpWithMom - My 92 year old Mom who used a walker fell multiple times this year resulting in fracturing a hip and then later a leg. She ended up having to use a wheelchair. She is unable to propel the wheelchair on her own and an electric wheelchair is not an option due to issues with eyesight. Using a wheelchair has not protected her from falls as she has slipped out of the wheelchair twice onto the floor and also fallen once when the aid was trying to transfer her to the wheelchair. She now has a broken foot from one of those falls. She is also now completely dependent upon others for absolutely everything. Sitting in the wheelchair for hours is making her weaker every day and she is at risk for pressure sores and a host of other problems. She has very little quality of life. I know there are lots of people who use a wheelchair and for them it has been beneficial. Unfortunately, for my Mom it has not. From this experience, I agree with your Mom’s doctor — continue to walk as long as possible as the ramifications from going into a wheelchair could ultimately be much worse.
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Check into reason for frequent falls. She may have spinal stenosis, common in seniors. Possibly correctible. Walker may help prevent falls, but may also cause user to trip.
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There's a good aging care article on the most common reasons to fall. I'll try to add the link.

7 Things That Cause the Elderly to Fall- AgingCare.com
https://www.agingcare.com/articles/falls-in-elderly-people-133953.htm
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About the walker, in our case the neurologist told Mom to use the walker all the time, in house and out, rather than the cane to prevent falls. The last thing you want is a fall. She had multiple falls and months later we found out she had broken a vertebrae in her back causing excruciating pain.

If she can still learn new things a walker with wheels should be fine. Once she learns the brakes and internalizes that it should be automatic.

I am not an expert!
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Tricky...hospital ER admissions with falls are often because of a walker or canes..read the research...yet some..like my mom are frequently unsafe without the walker.. I always tell mom ...use it when you feel unsafe..she uses hall handrails for daily walks...the walker only when absolutely needed..As a recently retired geriatric nutrition clinical person I would offer her home made milkshakes with fruit added..Also add Dry skim milk powder for extra protein if no kidney issues...offer grape juice {usually well accepted}..try custards, puddings, and cream soups..Try mashed potatoes..can add skim milk powder to those and cheddar cheese also...If she like try pitted dates, ....lots of small meals.....Commercial nutrition drinks taste vitaminy and are not as well accepted. I used to taste taste them before we ordered them for our residents...GOOD LUCK..
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The walker may not be inhibiting but her reaction to it is obviously inhibiting her. BUT the alternative is worst. Falling and breaking her hips. You might see if a different kind of walker might make a difference. My sister uses one with a seaat and she loves it because she can sit down anywhere she wants. It also has a little storage area and she gets have her "stuff" with her when she walks. You might try that
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I would suggest a rollator instead so that she can sit whenever she feels like it. Walmart has for around $50 ish it has a built in seat, often with a bag under neath to carry items with you. SOme have handle breaks some do not. If she can still walk at 96 she is blessed.
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Jannner Sep 2020
If she has dementia a rollator is too difficult to use. I have one and inquired about one for my mother but her cognitive skills weren’t good enough. They forget to lock the wheels and that’s bad news
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I feel some sort of evaluation of your Mothers mobility by a physical therapist would be beneficial. That would determine which type of mobility aide would be most appropriate for her. I dont know what type of walker you are currently using with her, but perhaps it is the specific type of walker that is limiting her not the walker itself. Standard walkers can be painful to use for someone with bad shoulders, for example. 4 wheeled walkers with seats can move too fast for some and scare the person. The 3 components to balance, which are vision, sensation and inner ear balance may be declining and need to be addressed. I feel it's much better to stay mobile with the appropriate device than to limit walking and lose function and strength. I'm a therapist, by the way.
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Ask your noms doctor for a video doctors visit. She can order home physical Therapy after that. My Mother in law broke her hip at 95. The inpatient rehab said she had to use a walker. The home physical therapist asked if mom had used a walker before before we said no. He said with her dementia she would not probably remember to use the walker. He worked with my mother in law on balance when walking and using walls if needed. My mother in law lived to 97 and never used a walker and never fell again. She stoped doing stairs after the hip. If you decide to go the route of a home physical therapist. See if your community has a rolator and walker with front wheels only you could borrow for your mom’s first few sessions. Let the physical therapist help you come up with the solution. As far as eating less that comes with aging and your moms end of life journey. Keep mom hydrated. My moms taste buds and likes and dislikes changed monthly towards the end. Loved cheerios, tomato soup, ice cream, slowly she pushed them aside. She did well with vegetable soup, boost, I found a good shake mix with fiber and protein. There are some clear protein drinks like protein 20. All you can do is try your best and down the road never question the could of, would of, should of. That will drive you crazy if you do. Wishing you the best.
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NeedHelpWithMom Sep 2020
This is true. My mom had several rounds of home health with physical and occupational therapy. It helps a lot.

They do have to continue the exercises after the sessions end. Unfortunately, my mom wouldn’t do as much on her own and would regress.
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I think my mobility would be inhibited and limited and clumsy if I walked with a 4 foot by 3 foot buffer around me.
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Megwin Sep 2020
I totally agree with you - I used the cane with four feet for many years, but like I mentioned in my post above - the time has come when I lost my balance with it. I was able to grab on to furniture or something and prevented my falling, but I had enough sense to know that I would have to switch to something that would give me more support. A walker sure does help, much more than the cane. So here is a point - if I did not use it - I would not ever be able to get out of my chair and walk - so no more movement. With the walker - I DO get up and do my chores and take care of my two little dogs and all that. So there is more walking and movement with the walker - as far as abdominal muscles, yes - they get a little sore sometimes, but I have to remember how limited I now have become, so it is not really a choice. I have the wheelchair - but that is another method to totally stop all movement unless you can still get out of it. I do not think that should be used until totally necessary. The other consideration is, since I live alone if I did NOT use the walker, I would be in the nursing home, separated from my little dogs, no longer in my home and truly unhappy, since I have been a very independent person my whole life. The three or four legged cane is not the answer when you are dealing with certain problems - and there are many of those.
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My 87 year-old mother used a cane for a few years. Once she started having more health issues, I switched her to a walker. As long as she's getting up, and moving around like she used to, her mobility should stay the same. At least this is what her doctor told us. I "make sure" she gets up and walks every couple hours. The less they move around, the worse they will get.
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disgustedtoo Sep 2020
Yup, use it or lose it - I can't remember how many times my mother told my father that. When it came to herself? PAH! The MC place even had some light exercise classes for the residents, just to keep the moving. Mom? Nope, I did that for years (she would periodically join some weight reduction/exercise class, but then just gain it all back!) Her "thing" was to sit and read, newspapers, magazines, but especially sales flyers! Some of the other women residents would walk the loop after meals, several times around, just to stay active, but not mom!

A combination of sitting too much and yummy ice cream bars, she gained 20# her first year there! I do believe the lack of moving (she was self mobile for about 2 years too!) contributed to weakness and now she refuses to stand or walk, so she's in a wheelchair. Combined weight gain, high BP (on meds for YEARS), lack of movement, etc has led to a recent mini-stroke, so she'll not be walking any time soon.
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The walker helps with balance. A cane does also but not to the same extent.
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She could try a four-footed cane. Start in a therapy-like setting.
If mom seems comfortable and steady, use it on short outings, but always with supervision.
When mom is alone, she should rely on the walker.
Make certain it is set at the proper height.
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Make sure the walker has wheels it helps it glide but will not roll away. I was worried about that. I also talked with the physical therapist, the wheels made it easier otherwise she would have to stop, pick up and move forward again. My mom had knee replacement and she did well with the wheeled walker. Loss of balance with a cane which is what she used before surgery. She can really book it in the house with that walker rolling. Also as someone said make sure it is the correct height.
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I would definitely stay with the walker due to her falls and the hip fracture. Falls can be the end for many your mom's age. My mom uses a rolator walker due to bad knees and very bad balance. PT did come to her house and did cycles of therapy. He also adjusted her walker to the proper height. PT will review items around where she lives making sure bedside commode and toilet/shower has all safety needs met. A great help.
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Using a Walker will deffiently help prevent falls.

My 96 yr old Dad went from a cane to a walker a couple years ago.
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Having a walker prevents her from having bad falls. It has helped mom out tremendously.

As for the meals, why not give her appetite increasing teas like dill, fennel, and ginger. Try mixing them up like giving her fennel tea one day and ginger the next and so on. It works on my mom.
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NeedHelpWithMom Sep 2020
I never knew there were teas to increase appetite. I’ve never been a big eater and should gain some weight.
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