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Who makes the decision that someone should use a wheelchair full time instead of walking when that person is not necessarily able to make the best decision on her own?


Mom (92) fell and broke her hip at the end of February and then fell and broke her leg in June. (She used a walker while walking.)


She is currently in a nursing home for short term rehab. She is able to stand up with assistance and can walk at least 100 feet. They are working with her to see if she can use her hands to move a wheelchair herself.


I think rehab will recommend walking for short distances and use of the wheelchair for longer distances.


However, I think that two of my three siblings think she should now use a wheelchair only (no walking) to prevent another devastating fall. I think I am beginning to agree.


Mom’s primary care doctor retired. I consulted with another primary care doctor in the same practice, but she has never met my Mom and told me she cannot make that determination now.


Her orthopedic surgeon said that continuing to walk - at least for shorter distances - would help prevent the atrophy that could occur if she were in a wheelchair full time.


I am just so confused. I just don’t know what to do or who to consult. If all siblings decide a wheelchair is best, do we just try to get a prescription for a wheelchair from a doctor?


Any help is appreciated!

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My mother has severe spinal stenosis with extreme leg weakness bilaterally. We walk her most days with two assists and w/c behind her short distance in the house only. One usually navigates the w/c. We walk her most days for exercise. She uses a w/c whenever she goes out. She has a custom w/c. Medicare will pay for the chair if she is eligible. Doctor has to fill out forms and submit to Medicare. We also do range of motion exercises in her chair/bed to prevent atrophy every day. The w/c is Solara brand. It costs about $5,000 if self pay, but with your mothers mobility problems and history of falls she might be eligible. Good luck!
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My question is; "How are her bones?"

So many seniors fall because they have a spontaneous break and the fall is not the cause but the result of the bone breaking.

That is what I would want to know before I decided to keep her in a wheelchair fulltime. If her bones are swiss cheese then she will be safer in a wheelchair, because she will probably have more spontaneous breaks, but if her bone density is good I would keep her as mobile as possible to avoid the many problems that come with being wheelchair bound.

Best of luck finding the correct path forward.
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jacobsonbob Aug 2020
Yes, my mother had two spontaneous breaks about a year apart--the femur in each leg. Fortunately, she didn't fall, it took surgery and an extended period of rehab/physical therapy after each one to be able to walk again. She was in her mid-80s at the time, and still with normal mental abilities. If this had happened five or more years later, the situation would have been very different.

A bone scan, if not already done, would be very helpful in determining the course of action. After my mother's one leg broke, she asked the osteologist if the other one was likely to do so, and he told her "they have the same 'history'--osteoporosis" and sure enough, a year later the other one broke. Fortunately, she was still able to walk unaided for a few years afterward, but I always felt concerned that a hip might also break. As she got older, she eventually used a walker, then a wheelchair and then finally bedridden.

I guess if one has severe osteoporosis, the choices are "fall and break it now" or have it break spontaneously later on--neither being a pleasant experience (to put it mildly).
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Listen to her orthopedic surgeon. Unless your sibs are doctors or PTs how can they know what is best? Not-moving is the surest way to decline. Make sure Mom does NOT walk without a walker, and has supervision when she is walking. Then, keep her moving.

Get her videos of seated exercise programs to practice daily. Make sure she is taking all medications and supplements that have been prescribed. Also, look at her living environment and remove all fall risks.

Getting in and out of bed can be dangerous for a short person if their feet don't hit the floor when seated on the edge of the bed. Make sure she knows how to do this safely, or that she knows to call for help and NOT get up hserself.

PT can teach her how to move safely, but you have to make sure she can do what she was taught or she can't be independently mobile. That is different from being wheelchair bound.
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First comment I have is..Your mom has dementia she will not remember that she can not walk and will try to stand up from the chair she will succeed and she will fall again. So using a wheelchair will not prevent another fall.
I would say if someone is with her, if she is wearing a Gait Belt and she is using a walker that is great. She will use muscles that will atrophy if she is in a wheelchair all the time. With someone with her that can aid her and guide her down if she begins to fall that may prevent injuries. But I would not let her walk on her own.
(not to be cynical here but...an orthopedics income is based on mending bones that have fractured so I am sure that is one of the reasons he says to keep her walking..what do the people doing the rehab / PT say? what would they do if this was their mom?) And you have to keep up with the PT at home doing the exercises that will help her are you and your siblings willing to do that daily? Will your mom participate?
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If she had been living somewhat independently then that is obviously no longer going to be an option - you say she is in a nursing home for rehab, where is she going after that?
I agree with Grandma1954 that a combination of the two is better - some walking is very beneficial to help retain the strength to assist in transfers, bathing and toileting because once the ability to even stand momentarily is lost it is a whole different level of care. In a facility setting that could mean carefully guided walking as part of routine PT, at home it means someone would need to supervise and guide every step.
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You probably need a wheelchair regardless. She should continue therapy even after coming home.
Its very difficult to prevent falls. Are the falls caused by her osterporosis?
I would listen to the surgeon to keep her mobile as long as possible but be prepared knowing the wheelchair is in her future.
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Good morning.

These are very difficult decisions for sure. Smiles to you as my dear 89-year-old Mother would have rather have been pushed around in a wheelchair as opposed to using a walker, so I had the opposite problem. I wanted her to walk because I didn’t want her to lose what little muscle that she had.

My Mom walked with a walker and a gait belt, which proved invaluable, and supervision within the house. I would put my Mom in a wheelchair only if we were going out of the house. We also did daily chair-type exercises with her.

We don’t like change, and we certainly don’t like seeing our parents decline. Why don’t you take cues from your mother on what she should do?

If you decide to put her in a wheelchair, just make sure she does daily chair exercises to keep up the muscle, well I would do that regardless of walker or wheelchair.

I think the key here is assistance / supervision when she moves from point A to point B no matter what means she is using.

You and your sisters will make the right decision. Best of luck to you. And your dear mother!
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earlybird Aug 2020
Great advice, Shay!
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I cannot agree more with the idea of continuing some kind of range of motion/muscle strengthening exercises to minimally keep the movement ability the best as it can be.

Mother is one fall away from a wheelchair, FT. And what she doesn't 'get' is that will mean she is Hoyer lifted into it in the am and put back to bed in the evening and will not be able to move about her small apartment. The doors are simply too small and cannot be widened.

After her many surgeries--both ankles, knees and one hip..she was good with PT until the PT stopped coming in home. She never did a single exercise again.

You really want to put off the wheelchair dependence as long as possible. It changes the dynamic of everything. In mother's case, it will require daily aides and she does NOT want that. Or placement in a facility. She REALLY doesn't want that.
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Grandma1954 Aug 2020
There are Swing Clear Hinges you can put on a regular door and it will allow the door to open fully giving you another 2 inches or so of clearance. So it is possible that with a regular WC or Transport chair you could get through a regular door.
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Wheelchair only is a great idea - as long as you don't mind her getting pressure sores, losing muscle tone and possibly bone density too, and above all missing out on exercise.

If your mother is able to walk one hundred feet, she can walk. What she should be encouraged to work on is balance (her physical therapists will address this); and she will need continuous monitoring to ensure she does not mobilise unattended. Is she able to recognise the need to press a call button and wait, or can she not be relied on for that?

Do you know what caused the falls?
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If your mom still has the use of her legs, let her walk. If you can walk with her, that might give you some peace of mind. Get a prescription for a wheel chair (I prefer the transport chair because it is so much lighter to deal with), but only use it for Dr's appointments where she may have to walk long distances. My husband has LBD and I have him use a walker around the home, but use transport chair for long distances. By allowing your mom to continue to use her legs, will help you out greatly.
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My mother can walk 150'; I help her up/down so she can use a walker inside our house and a wheelchair anytime we go somewhere. Being able to stand and walk even a few steps is very important in maintaining a senior's health and well being in a home or AL situation. The walking senior can assist with transfers, doesn't develop bed sores, has less joint pain from arthritis, and less risk of blood clots. After falling late 2018, my mother was mostly bed bound for a couple of months and her pulse and blood pressure went up during the period of inactivity. As soon as she started using the walker in PT, both pulse rate and blood pressure came right back to normal and have stayed there. Being somewhat mobile also allows Mom to feel more independent and improves her mood. I have to watch her carefully when she's seated somewhere because she forgets she needs help and will try to get up and take off (sometimes without her walker) but I believe the improved quality of life is worth the effort.
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Listen to Mom's orthopedic surgeon's advice. Wheelchair should be used as a last resort for mobility and safety.
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My mother went into a wheelchair last May at 92 years old b/c there was really no other choice. She has bad neuropathy in her feet/legs and had fallen about 36x by that time. While she was in the hospital for pneumonia, both the neurologist and the regular doctor agreed that it was past time she used a w/c full time, that there comes a point in time when there is no other choice. She was also suffering bad vertigo for a couple of years b/c she had insisted on walking with the walker, but had no idea where she was in space due to the neuropathy, and the inability to see well or hear well.

She's never had pressure sores or significant muscle loss, and can still get up and down to use the bathroom by herself. She still falls, but not as often as she did before getting into the w/c full time. She lives in a Memory Care ALF and has gotten physical therapy a few times, but she really has no desire to exercise or move her body much, which is her prerogative. You can always get your mother PT as necessary to keep her moving about a bit if she does become wheelchair bound.

I agree that a w/c is a last resort for a few reasons, but also this: if it's necessary, do it. Forget about exercise and all the what if's............safety comes first, so if everyone (including the PCP) is on the same page about mother going into a w/c, then move forward with that decision.

As a rule, Medicare will pay for ONE appliance (either a walker or a wheelchair) once every 5 years; you will need a doctor's written prescription for either, and they can submit it directly to Medicare and you can have an appliance delivered. If she does go into a w/c, I recommend a high grade gel cushion for her to sit on for added comfort; Mountainside Medical is a good website for ordering such cushions: https://www.mountainside-medical.com/search?type=product&q=gel*+wheelchair*+cushion*

Best of luck!
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The Doctor can, but a PT is more specialised in this area & can make good assessment of what the person can still do.

My relative uses a wheelchair part-time (for longer outings) but has continued to walk around at home. There have still been falls but I honestly think these would still happen regardless.

To improve safety, regular PT sessions, falls alarm, getting more supervision have all been added.

I was like your siblings. After sooo many falls I was thinking my relative should start using wheelchair full-time. But after more info from the PT, I saw it's more complicated. Doctor had ordered a bone scan too to help weigh the risks. Both Doc & PT said to walk until she really couldn't.

I would explain to the sibs there are pros & cons to walking or wheelchair & encourge them to trust the PT/Doctor's advice.
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It's so hard when the siblings are well meaning, but disagree. I think that your best steps forward (and nothing is guaranteed) would be to put this in the hands of the professionals, the Physical Therapists. They are a wonder, and often better than doctors. Remember, there is a downside to wheelchairs also, lack of mobility leads to blood clots and other problems, to bed sores. Even walking a little bit and with help will help prevent that. Get an excellent cushion if W/C is the choice. Remember also that the new walkers where you stand up straight, and there is an elbow rest for elbows and the hand hold is at breast level are often easier and a lot more support and help, and stretch out the spine as well. This is a hard decision. Wishing you good luck.
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Imho, a lot of the answer of being in a wheelchair full time or not, will depend on a whole host of things: how severe the leg break was, the 4 month difference from leg break and the hip break, the new PCP's and the orthopedist's recommendations.
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My dad is in rehab, also for falling issues. He used to use his 4-wheel walker at the AL but had fall after fall until he created compression fractures in his back. He has been in reah for quite some time now and they have determined he should not use his walker, but have taught him to assist in his transfer from his bed to a wheelchair with a 2-wheel walker. The physical therapists there have done an excellent job of showing him new skills and he now knows he will always be using a wheelchair.
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Leave her in SNF. She’ll fall again at home & wont do any physical therapy at home. You’ll have to stay home and take care of her 24/7 hugs 🤗
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Srlewy Aug 2020
My mother fell, suffered memory loss, and could not even take one step for weeks. She did go to rehab for about 6wks, now gets around fine w/o a walker of any sort. I think it truly depends on the individual, their stage in aging, and input from the medical experts, She did get in home physical theropy and occupassional theapy for 2 months after she was home. Just saying, for some, it is possible to return home and not be wheelchair bound after a fall.
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She needs to be able to use a walker in a consistently correct manner if she's to keep it.  A lady we know is wheelchair bound due to her own lack of compliance.  until I met her, I never thought the words "reckless" and "walker" would ever be used in the same sentence.  BUT, trust me, this lady is completely reckless with her walker.  She will only use it properly *if* a nurse or therapist is right there coaching her the entire time.  So, we know she's got the ability to do it right.  We're not sure if she's forgetting how to do it right when she's on her own with walker.  She is and always was a "don't tell me what to do" type of person, so I think it's also her stubbornness coming through as well.    She got her walker taken away (doctor's orders) and is now wheelchair bound.     She tells us she can use walker just fine - which leads to a circular argument in which we call her out on the reckless walker behavior and she says she's just fine to use walker.   And so it goes.   Her past behavior (intentional or not) cost her the walker.    Even after that, she did have one instance where she got up and fell back down into the wheelchair with minor injuries as well, so they will still have falls pretty much no matter what.
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