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Toni Talks about PT Today

How Old is Too Old for Therapy?

Published July 9, 2013 5:31 PM by Toni Patt
Today at lunch we were talking about how much older our patients are today compared to years past. Someone observed that many of our older patients just want to stay in bed. They are worn out from living. She went on to say that when you've reached 90 years of age, you have the right to stay in bed.

In many ways, I agree with her. Advanced age, and all the changes associated with it, wears down the human body. Additionally many neuromuscular diseases and dementia are progressive. The longer one lives, the worse the effects of the disease become. There comes a point when the person simply can't generate the motor response to get out of bed or do anything else.

Oldsters seem to adapt as they continue to age. Many accept the need for a RW as a normal part of the process. Others are happy to remain in their wheelchairs if for no other reason than to prevent falling. One reason I'm frustrated with long-term care is the unspoken goal of getting everyone up and walking again. At some point it just isn't possible. That doesn't mean the person might not benefit from therapy if the need arises.

Being 90 also doesn't mean someone can't be spry and active. The best person I ever played Wii with was 92 years old. I've had many 80-year-olds walk circles around people 20 years younger. There is an entire subgroup of geriatrics for elite athletes in that age range. I ride with a woman in her 70s.

But some older people are just worn out. Yes, there are benefits to getting out of bed. Yes, there are benefits to being active. But there is some point for everyone when the negatives outnumber the positives. I've had patients who slept all day no matter whether they were in bed or a recliner. Others are so limited by their compromised health that they can't generate the energy to move. Getting out of bed must feel like running a marathon to them.

To them, being old might be enough reason to refuse therapy. We're still going to try. I just won't push them as hard.

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I agree with you Toni. I work per diem now in a skilled nursing and rehab facility (used to do it full time,) outpatient is my full time work now. But I've always wondered, why I'm seeing these elderly patients that just want to be left alone to sleep or enjoy T.V, or whatever. There are those that do want to get better and are able to participate, and I love working with them and pushing her to get well. But, I wonder when the patient's right to refuse services, vs. money, or even what a family wants, will actually be looked upon as an acceptable response.

Michelle Merritt, Physical Therapist July 16, 2013 12:50 PM
Sparks NV

Great post! Our society seems more concerned with quantity of life rather than quality. Not only quality, but a societal norm of quality...up and walking.

I think we need to respect individual choice as to what constitutes personal quality of life. I may be spry at an advanced age or I may be worn out, but how I spend my time should be up to me. It might be the last shred of dignity and self direction I have.

Dean Metz July 9, 2013 11:20 PM

Toni, I loved your blog today! I agree wholeheartedly. Aging is really an individual experience. My favorite story is of a patient that was 96 and had to get back home in two weeks as she was graduating college!(and she did!!) And others have lived a full life and seem ready for that next transition. Today, I was thinking about this very thing when working with an elderly patient who may not be appropriate for a therapy program. She was quite content to watch the birds play on the feeder outside her window. Sometimes the most compassionate thing to do is allow them the safest mode of being. All things considered a wheelchair can save a patient from long term suffering. Thank you for sharing your thoughts Toni.

Karla Grimmett, Council Grove, KS - PTA/Wellness Coach, Council Grove, KS July 9, 2013 6:29 PM

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