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Expert PhotoDeborah Quilter, writer, certified Yoga teacher and Feldenkrais® practitioner, is the Director of Yoga at the Martha Stewart Center for Living at Mt. Sinai Hospital in New York City and the president of Beyond Ergonomics, LLC. She is a partner at The Balance Center in New York City and presents regularly at the International Yoga Therapy Conference and the Rocky Mountain Institute of Yoga and Ayurveda. She is the author of The Repetitive Strain Injury Recovery Book and Repetitive Strain Injury: A Computer User's Guide and is currently working on a book about balance. Her website is RSIhelp.com.

Mom has been in the hospital for 3 months after bladder cancer surgery. I can't get her up off the couch. She says as long as she is lying down she feels okay. But if she sits up or walks, she is very weak. I tell her the more she lies around the weaker she will get. How do I get her to get up? Home Health Therapy comes only once a week. 

D'Ann from GA

You are so right to be concerned about your Mom. Lying on the couch is a surefire way to get weaker. I’m curious about the reason she won’t get up. Is she afraid of falling? Exercise will make her stronger, improve her balance and prevent falls. Is she depressed? Maybe some gentle counseling is in order.

Getting her motivated to move can be a challenge, but here are some things to consider. You might persuade her trusted doctor to talk to her. Check your local Y or senior center and see if they offer chair exercise classes. If you can get her to go to a group class, she might be more motivated because she’ll be missed by her friends if she doesn’t show up – and she miss them, too. I teach a senior Yoga class on Monday mornings, and my students were so upset about losing a class on holidays they asked me to reschedule for another day! They love practicing balance and getting strong together. I hope your Mom will, too!

Meantime, I recommend that you be sure you’re getting exercise yourself if you’re not already doing it. Sometimes what you do can be the most powerful motivator of all. Not only that, exercise will help you cope with the worry about your Mom. Good luck, and let me know what happens!

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I was diagnosed with MS in November 09, relapsing/remitting. I "need" to exercise my body. But I do not know where to start. I have a lot of upper body pain in my back area. I feel like maybe strength training would help, but I really know nothing about that sort of thing. I walk and ride my bike and swim weather permitting.

Melody from IN
A: Answered by Deborah Quilter

Thanks for your question about exercise and multiple sclerosis. Exercise can be quite helpful for people with "relapsing/remitting" MS. According to a study published by researchers at the University of Utah as early as 1996, "those patients who participated in an aerobic exercise program had better cardiovascular fitness, improved strength, better bladder and bowel function, less fatigue and depression, a more positive attitude, and increased participation in social activities. Since 1996, several additional studies have confirmed the benefits of exercise."

Your main concern is not to become overly fatigued or overheated. You can check with your doctor or physical therapist for specific guidelines, but you are already on the right track with walking and swimming -- in fact water exercise is particularly good for you because it will help keep you from becoming overheated. Stick to a stationary bike if you find your balance is off. Many communities offer special aquatics, Yoga and tai chi for people with multiple sclerosis. You should get personal guidance from an experienced physical therapist or fitness professional one-on-one about
addressing your back pain.

For more on exercise and MS, go here: http://www.nationalmssociety.org/living-with-multiple-sclerosis/healthy-living/exercise/index.aspx

Check out a chapter of the National MS Society near you: http://www.nationalmssociety.org/find-a-chapter/index.aspx. Talking to other people who have a similar diagnosis can be most useful, and they may lead you to the perfect group class or private fitness professional.

Whatever you do, keep looking until you find the right thing for you. I have a great photo of one of my personal clients with MS skydiving - I keep it in the front of my client record book for inspiration!

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Q: Is there a less strenuous way to get cardio exercise, especially if you’re out of shape?
A: Answered by Deborah Quilter

Many people think that you need to do vigorous cardiovascular exercise to work up a sweat and get your pulse racing for heart health. Yoga offers another approach with gentle exercise and easy meditation. ?According to Swami Satyananda Saraswati, a leading expert on yoga therapy, the stress of holding negative emotions such as fear, anxiety, unresolved emotional, marital or employment conflicts can adversely affect the heart. In addition, common physical maladies such as chronic constipation and overtaxing digestion can also lead to heart problems. The ancient sages came up with ways to keep the heart chakra, or energy center, open using yoga poses. ?The epitome of having an open heart would be someone like Mother Teresa, whose heart was big enough to love and care for the poorest of the poor. She thought the worst poverty was being unwanted, uncared for, unloved and forgotten by everybody. We can all open our hearts by showing kindness to each other. This can be as simple as telling someone you appreciate them or smiling at a stranger on the street. “Every time you smile at someone, it is an action of love, a gift to that person, a beautiful thing,” said Mother Teresa. ??There are also gentle exercises you can do. The physical exercises will expand your chest and increase your lung capacity. The meditations will calm your mind and release sadness, impatience, frustration, anger and other negative emotions that can be hard on your heart.? Be sure to wok with a trained yoga teacher to get the best benefits from yoga as safely as possible.

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My mom is 78 years old, has osteoporosis and uses oxygen for COPD. She lives with my 79 year old father who is unsteady due to neuropathy from diabetes. Three months ago my mom fell at home and fractured a bone in her neck. Luckily she recovered, but three months later she fell again. My father claims he can take care of her, but recent evidence contradicts this. She is able to walk, but refuses to use a walker. Getting in and out of bed seems to be a risk area. What can we do to reduce her risk of falling and what kind of in-home assistance would help? 

Laurie from CO
A: Answered by Jean Krampe, PhD, RN, CPHQ, CLM

Your question is very important to many older couples living independently and their children who are supporting their safety and autonomy. You may have some of these suggestions in place; consider which will work for your family. I'm suggesting a combination of measures used in the community and long term facilities for fall risk. First of all, if you have not already done this, ask your parent's doctor is he will authorize a OT or PT to come to their home to assess the bedroom and bathroom. These are 2 common risk areas for falls for the reason you describe. A specialist involved recommending grab bars, removal of throw rugs, and many other fall risk strategies often makes a greater impact than a family member. If you do not have a fall alert system in place, e.g. Lifeline, strongly consider this. You can find out about these systems in the Parentgiving store. There are strategies successfully being used in long term care facilities that you might want to consider: 1) have the bed low to the ground and 2) have a baby monitor in place, so you father will hear your mother if he is in another room. Finally, keep as close of an eye as you can and if you notice changes, highly suggest that your parents see their physician. Due to your mother's history of falls, she is now at a higher risk for multiple falls and sometimes, not always, slight changes in her health that may precipitate a fall can be detected early. Best wishes to you and your parents. 

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My husband and I are both RNs and are caring for his 88 year old mother at home. (He works full time and I stay at home.) She has a dementia, and last year fell breaking her femur. She was forgetful at rehab, bore weight on it and re-fractured it, requiring a second surgery. She has short-term and long term memory issues, which seem to wax and wane in severity. Our "sticking point" is her use of her walker. She doesn't use it safely all the time (refuses to use it, will walk around it, in between it and the chair, push it away from the bed before she goes to sleep). She fell in the bathroom a few months ago, resulting in a subdural bleed. (She was on Coumadin at the time.) When she is more "alert" we are conflictual about her walker. We realize that without it she will fall, given enough time. The result will be more of a burden on us, not to mention her decline in ability. When discussing this issue, she will become tearful, and while we do not yell, we are direct in telling her the probability that she will fall given her balance issues. She will respond, “I promise I will not fall," not remembering the recent fall and head injury. Do we continue to constantly remind her about the walker, or let it go and allow her to "decide" despite her dementia and real inability to make a rational safety decision?

Edy from TX
A: Answered by Jean Krampe, PhD, RN, CPHQ, CLM

Edy, you are raising some key issues that impact your family and many other family caregivers. Please know that sharing your story and raising your informed pointed questions will help others. I want to start by saying that there is no right or wrong answer. My response includes additional questions for you to consider. As you know, even using the walker will not necessarily prevent a fall and using it improperly may increase her fall risk. Secondly, it sounds like your mother-in-law cannot make an informed decision due to her dementia. As you may have seen in parentgiving.com, I am a firm believer in passive safety devices, chair alarms, monitors, bed in low positions, etc. Reason being, this is one proactive approach to caregiving that the caregiver has “control” over. If you have not tried these already, other cues and reminders, e.g. a sign on the walker (DON'T FORGET ME), trying to make it fun (call it a pet name that she may buy into), may help with the stress. One method does not work for all and many include trial and error. Placing furniture in key places for her to hold on to, when she does not use it, may be another thing to try. You have probably had a home evaluation by an Occupational Therapist or Physical Therapist. If not, talk to her doctor about arranging this.

From your questions, I know you realize you ultimately have “no control” over whether or not she will use the walker, no matter how much you enforce it. What you do have control over is how much you try to enforce it. You know her fall risk is very high, with or without it. You need to decide how much you will try to enforce using it. The bottom line is knowing what you have control of, deciding if it makes sense trying anything you have not already tried, and truly understanding that whatever happens, you have done your best. Hope this helps a little and good luck to all of you.

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My mother broke her hip nearly 5 months ago and then her elbow while at rehab, and is still unable to walk alone. For a yet to be determined reason her feet do not work properly (perhaps a form of foot drop or heel cord contracture or toes in point position). She has been home for 3 weeks and is having home health come in for physical and occupational therapy. She is only 69, but has suffered multiple strokes over the past 12 years and suffers from brain damage from strokes that has resulted in comprehension issues, plus there is dementia. She is also quite stubborn. While at rehab she was apparently irritated when she had to go to the bathroom and she felt the nurse was taking too long. She got up on her own and fell breaking (actually crushing) her elbow. Now that she is home, my Dad is her primary caretaker. We do have a nurse come in to help 6 hours a day. Plus my Dad has a walkie talkie by her chair that she often uses to call him when she needs help and he's not there. Sit to stand transfers to a walker are the most difficult for her. Once up she must steady herself and give her feet a bit of time to "wake up" and start working. She needs assistance for all standing, walking, bathroom breaks, etc... She is often very unsteady and we use the gait belt to support her and sometimes just to hold her up. Today, for some reason, she decided to go to bathroom by herself and then to get out of bed by herself. It is beyond frustrating. She seemed to be clear minded when it happened. Any suggestions on what to say to her to try and help convince her this is unsafe? 

Pamela from NC
A: Answered by Jean Krampe, PhD, RN, CPHQ, CLM

Pamela, first of all, you are to be commended for all you have done so far. You are experiencing a very challenging situation and I'm guessing it may feel at times there is no end in sight. You are not alone, as many family caregivers also work through these complex situations. Your mother has several things in her favor including your father to be her primary caregiver, your commitment and periods of understanding. I would offer a strong suggestion to maximize any and all passive safety devices that you can, if you have not already considered this. The walkie talkie works, as you report at times, but there are chair and bed alarms that would serve as an additional alerts when your mother does not call herself. Part of the challenge is really not knowing how much of the non-compliance or impatience is due to her illness or other factors, combined with the inconsistency. So I would suggest continuing with constant reinforcement of calling for help, commending her each time that happens to reinforce the good behavior, along with maximizing safety devices as I described.

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Do you recommend teaching elderly patients how to get up safely after a fall? Or do you suggest telling a person not to move once they fall, and in all instances call for emergency assistance before moving the patient. We have been training our home health aides never to move a patient after a fall, however, recent literature I've read is recommending teaching patients how to do a self-assessment after a fall, and if they are able to move they should try to get up.  

Roberta from NY
A: Answered by Deborah Quilter

I appreciate this question. I have not seen the recent literature and would be interested if you would please send the reference back in a reply. Perhaps other visitors would also be interested. I have consulted with another fall expert from the Physical Therapy discipline, and although she has also not seen this literature, we have these recommendations: It really depends on the circumstances of the fall and the cognitive level of the patient. It is unusual for a person without cognitive difficulties to attempt to get up if they are in pain. That is often, not always, the sign of injury. The home health aides are not trained to do an assessment, such as a Registered Nurse, however, every fall does not need an emergency call to an ambulance or trip to the ER. I have seen patients attempting to get up and unable to, due to the pain. This generally indicates an injury. I've also seen patients get up on their own, with minimal or no pain and no follow up needed. A person with cognitive impairment really needs to be assessed, as they are at risk for an undetected injury. And the bigger issue, with or without injury, is the underlying reason for the fall. All falls should be reported to the primary health care provider so that the underlying etiology can be assessed, and hopefully a subsequent fall prevented. Hope this helps. 

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Q: My mom, 93, fell several months ago, broke her hip, is living with me now (I'm an RN). She has recovered, but her knees are very unstable—she is basically wheelchair bound. She transfers with a lot of help, but still will try to stand, get up from the toilet, etc. My family and I try to watch her all the time, while giving her some independence. She has a bell to ring, is reminded of the consequences of falling. I am trying to let go of my frustration with this and realize she is an adult, making her choices, and they may result in possibly disastrous results. I am looking for validation that we are doing the best we can, and the rest is up to her. I think it comes down to her stubbornness and not wanting to "be a burden."
Patty from WA
A: Answered by Deborah Quilter

Patty, I appreciate your question.You and your family are definitely doing the best you can and much, much more. Family care giving is an emerging challenge and blessing. You describe "family caregiver fear of falling" and your "fearless" Mom. I would suggest 2 things to possibly help manage things a little easier:

1) Electronic Safety Devices: if you have not already checked into getting a chair alarm for the wheelchair, now is the time. You also might want to think about a bed alarm and baby monitor. These will assist you in keeping your Mom safe. Your watchful eye and ear are already in place. If she won't use the bell, these devices will help you. A mattress on the floor near where she sits and sleeps may be something to consider, as well. You did not mention her getting out of bed as a problem, but these measures will also help if that occurs and will lesson her fall. Many nursing homes use a low bed, actually almost to the floor, for their high fall risk elders. You might consider this.

2) Caregiver Respite: You and your family have taken on a full time job. You need a break on a regular basis, whatever that means to you. Caregiver stress, strain, burden, it has many names, but you are at risk. So please keep that in mind as you care for your Mom. Make sure the "oxygen is on you," just like they remind us when flying in a plane.

Good luck to all of you. 

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Q: I witnessed my mother fall last year and still feel guilty for not being able to prevent her fall. I am afraid she will fall again and get nervous when I see her moving around the house. What can I do?
A: Answered by Jean Krampe, PhD, RN, CPHQ, CLM

You are describing a phenomenon that researchers call “fear of falling.” This is a common problem for older persons after a fall. They are likely to stop moving, thus become frailer and actually increase the risk for falling. In your case, since you personally witnessed a fall, you are experiencing a concept not heavily researched, known as a caregiver fear of a family member falling. It is important to remember that having someone present when an older person falls is a benefit and avoids the possibility of lying without help for hours. It is also very important to keep in mind that inactivity actually increases fall risk. Thus, encouraging safe movements for older persons will decrease the risk of a subsequent fall.

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Q: My father used to like to dance when he was younger, but has not been able to for quite a while due to health issues. Is there a type of dance that he could safely participate in?
A: Answered by Jean Krampe, PhD, RN, CPHQ, CLM

Your question is a common one and raises a very important issue. Older persons feel a sense of loss when they can no longer participate in activities they used to enjoy. A modified, low impact method of dancing, such as The Lebed Method, would likely be quite enjoyable for your father. The Lebed Method, led by a certified instructor, can be done seated or standing. It includes low impact movements that are appropriate for all persons, regardless of age, health or ability level. The movements are choreographed to music the specific audience enjoys. More information can be found on the website www.lebedmethod.com

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