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Toni Talks about PT Today

I Want To Do It My Way

Published November 18, 2008 4:17 PM by Toni Patt

Anyone who works with elderly patients knows they can be stubborn. They latch on to things from years ago and refuse to change. This becomes obvious when they are receiving PT. I can't count the number of times I've been told "I always do it that way."  The "it" can be transfers, ambulation, choice of assistive device or shoes. It doesn't matter to them if their "way" is unsafe or not functional. It doesn't seem to matter if a new deficit is preventing them from doing things as usual. They will still tell me, "That's the way I've been doing it. That's the way I‘m going to do it."

Elderly patients can be resistant to change. It can be a challenge to get some elderly patients to understand the old method is no longer safe, functional or even possible. I've been told I'm wrong. They will try to prove to me I'm wrong by showing me how well their way works. That can be scary to behold.    Sometimes I find myself wondering how some have managed not to fall. Another thing I'm told is their way is easier.  It doesn't matter how involved their way actually is.  It's always easier. I've had patients become resistant because I won't let them transfer or walk their way.  It doesn't seem to register that they can't do it their way anymore. Pointing this out doesn't help.  There's always a reason.  The bed is too high.  It's the wrong kind of walker. The chair at home is different. 

Transfer training is a good example of this. I've had patients work much harder than necessary to do it their way.  I've had patients refuse ADs because they insist one isn't necessary. They tell me not to hold on when they transfer. They tell me I need to lift them because that's what the caregiver at home does. When it's safe I'll let them try. Usually they fail. Sometimes I'm wrong and will be the first to admit it. Even when someone is open to alternatives things can be challenging.  Many elderly don't like to be helped. Often they allow me to hold on if I promise not to help. That's safer than some alternatives.

Disbelief that something isn't possible is also a problem. Many times I'm told, "I could do this before I came into the hospital."  Of course that's usually pre-joint replacement, pre-stroke or pre-surgical procedure. That kind of stuff will slow someone down. These patients are easy to work with because they recognize there is a problem and therapy is necessary.

Others simply believe therapy isn't necessary. These patients insist they'll be fine if I will just help them up.  Sometimes they're right. Usually they're not. Often that's enough to gain cooperation with therapy. The worst of these are those who lack safety awareness. They don't see the point of therapy because they don't see a problem in the first place. They'll tell me they fall. In the next breath they'll tell me they walk just fine. I've had them tell me they won't fall if they use the walker. But they don't like to use the walker so they fall. It can be next to impossible to convince these patients to work with therapy.

My favorite group of elderly are those who insist they'll be fine once they get home. These patients won't get out of bed. They'll just lay there and tell me they're fine. They'll be still be saying this when the ambulance comes to take them to the SNF. A closely-related group are those who will work with therapy. They make good progress. At some point they tell me they'll do what I want but aren't going to do things that way when they get home. These patients know how to do things safely and properly. They simply aren't going to do so after discharge. They really make me want to pull my hair out. 

I like my geriatric patients. They can be a challenge, especially the hard-headed ones, but they're a great group to work with. I'll take an 80 year old over a 50 year old any day. When I run into problems I talk to them as an adult and explain why I want to do what I want to do. I also ask questions because sometimes there is an underlying cause for doing things the old way. Then we can work together on the solution. There is still a small group of these patients who aren't going to be easy to work with. They're just ornery. That's a Texas term.  It means mule headed.


Ornery-possibly mid irish term. Not really of Texas origin. %0d%0a

donald meadows December 1, 2008 9:43 PM
robertsdale AL

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