How Old is Too Old for Therapy?
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.