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My Mom stays in her room almost all day. She has leg pain and I take her to a rehab facility. They massage her calf and put heat on her leg which really isn't doing much for the problem; She had 2 compressed fractures of the spine requiring surgery 3 months ago.This was an outpatient procedure. The rehab tech doesn't beleive the leg pain relates to her spine. She is taking pain meds and I have an appointment for her with a pain management clinic. My concern right now is her lack of appetite, wanting to stay in bed all day, and not wanting to bathe. She is 100 years old and has signs of dementia. I need guidance on how to deal with these issues.

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You are right. Staying in bed all day will just hasten immobility. I wouldn't be surprised if she bypassed needing a wheelchair and went right to being bedbound.

As for her appetite have you tried Ensure or Ensure shakes? A can of Ensure, some ice cream and a little milk. You can't force her to eat (or to do anything else) but try tempting treats. Favorite foods. You've probably tried all of these things already but again, you can only do so much. You can't force food down her gullet. Have you asked her what she'd like to eat? There are so many articles here regarding elderly people who don't want to eat. Maybe you can get a few ideas from them.

Staying in bed all day is the worst thing an elderly person can do. She will become weaker and weaker if she's not up and moving around at least every 30 minutes. But once again, how to get her to get up if she doesn't want to? You can entice her with a movie or some other activity she enjoys. Don't bring her anything while she's in bed, make her get up and get whatever it is she needs. And her lack of desire to bathe may be tied in with weakness from staying in bed. If she feels weak she's not going to want to bathe. Getting her out of bed is the key to all of this, I feel. I work in home healthcare and we have patients who need home healthcare because they've been in the hospital, in bed, and they lose all of their strength so that we have to come in and do PT and OT with them for weeks so they gain their strength back. I'm sure you've been told all of this at the rehab facility. And if she's going to rehab on a regular basis but laying in bed the other days that will undo any good the rehab is doing for her.
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When they stop eating, you call the MD and ask if it is time for Hospice. It's usually a sign of things shutting down. So sorry. The pain from muscle contraction is also an end sign.
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What are you expecting from 100 y/o woman. Her time has come.... she is slowing down and getting ready to depart... I am sorry, but you should call hospice.
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A lot of these symptoms sound like my own mother, who is certainly not ready to die. And we have plenty of 100 year olds in my family, some of whom are having health issues, but none of which are volunteering to just let someone pull the plug on them. So, let's not assume this woman is ready to die without more information.

If the rehab isn't helping, maybe you should consider stopping it. There's a difference between not wanting to eat and refusing to eat. My own mother has no appetite and doesn't care about food but will eat because she knows she has to to keep up her strength.

It's possible that she doesn't want to get out of bed, bathe, eat, because of the pain. Or, it could be the dementia. Or, it could be something else. I found out that my mother didn't want to bathe because she feels dizzy, for example. It turned out to have nothing to do with dirty habits or dementia, just that she feels like she's going to fall. However, she had a hard time explaining it, so the problem went on for a long time before I discovered the real problem.

As for being in a wheelchair, it's not the end of the world. Lots of people end up in wheelchairs and scooters. If there's a way to prevent it, that's great, but I'm not clear that this is as much a problem, possibly, as finding out what's causing her pain.
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My mother is 94, with dementia. We are fortunate because, even in her dementia,she knows she needs to maintain mobility. She enjoys walking to a window where there is a bird feeder and blooming flowers on the windowsill (cyclamen, Christmas cactuses, spring bulbs...whatever is in bloom). On sunny days, spending a little time outside on the deck or on the walk in front of the house is fun. If you use a wheelchair (we have one for places it is not possible for her to walk the distance), she can certainly get out of the chair (outside, for instance) and walk a bit. While my mother has pain in her legs and is often very unsteady, there are still things that motivate her. As I say, we are fortunate; but maybe you can think of simple things she used to enjoy to provide motivation. Would a walker be helpful?
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NanSea, I went through this with my father during his final months. I kept trying, but I knew he was slipping away. The pain in his legs grew worse, sometimes he fell, he didn't want to eat -- not even the sweets he had once favored. Beyond these things, his temperature and blood pressure got lower. We kept making food for him and doing the normal things, but the rest I put into God's hands. Let your mother be the guide in telling you what she wants. If she is nearing the end of her time on earth, it may be more important for her just to be comfortable and not so worried about being fixed. There will be a lot of signs when the end is nearing. I think contacting hospice is a wonderful idea if you want to keep her at home.
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Mmm. Massage and heat won't do that much if they don' t get her moving. Some people get some mileage as far as pain control by using a nasal spray medication called Miacalcin (aka calcitonin salmon) which is primarily to improve bone density. It is not real potent for bone, much less so than bisphosphonates (like alendronate), andyou have to assure adequate vitamin D and calcium intake too. Low vitamin D levels make aches and pains worse as well, your mileage may vary with that. And I'd second J Nelson's thoughts - using an assistive device whether it is a wheelchair to get out and about with you, or a scooter to get out and about more independently (BIG boost to morale if you can do it!) and get a little sunshine, or a walker to get around the house, could end up being a huge benefit to quality and maybe even quantity of life.
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100 yrs old?I think anyone would be worried at that age.
(My concern right now is her lack of appetite, wanting to stay in bed all day, and not wanting to bathe. She is 100 years old and has signs of dementia.)
Your trying to pervent the unpreventable at 100 yrs old.You can't force feed her.And can't force what is not wanted.If you can't bare to help her anymore contact hospice.At 100 yrs old your not gonna get her to run a 4/40 track lap anymore.If don't use it you lose it.At a 100 yrs old is there any to use anymore.
It's time to let things be what they are.And enjoy the time you have left.
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I have heard that if they are eligible for & receiving Physical Therapy that they would not be able to get an MD order of 6 months or less which is the requirement for hospice to even do an eval. Hospice is not as easy an order to get. After letting my mom hang on too long & regretting it I have tried to get dad an evaluation from hospice & failed a couple times. He is in PT right now at his NH. The 2 things being available to the same patient just don't gel.
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Let her indulge in whatever she is still able to enjoy. Spend time with her, even if it is just sitting by her while you read a book, recall happy times if she can. Don't expect her to push herself, she hasn't the strength and pat yourself on the back for being her loving advocate.
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My father was on PT and OT during his last months of life. My mother thought if he would get up it would make him better. My father didn't want to do it, and I realized that there was no point to it. Everyone knew my father didn't have long to live, but still there was the PT and OT. He had a small stroke during one of the PT visits, so I cancelled PT. Mom wanted to continue the OT, though. Was it useful? No. After a few appointments his time had come and he went to the hospital. And then the hospital put him on PT and OT. WTF! The man is barely alive and every organ in his body is going. PT and OT? They talked to us about transferring him to a rehab program upstairs and sent me looking for a SNF to transfer him to. Finally after two days I said, "We want to call in hospice" and all the craziness ended. Unfortunately, hospice arrived a few minutes after he died that afternoon.

If someone can be helped with PT and OT, it is great. But there does come a time when wisdom has to be used. I would have saved my father a lot of grief if I had advocated better for him in those last two months.
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I should add that one solution does not fit all. We can't know what is best for others, because we aren't there. All we can do is share our experiences.
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Wow- 100 years old. I am surprised doctors were willing to do surgery on her. Is she feeling helpless because she can't get in/out of bed or reposition herself? I believe in the old "use it or lose it" mentality- if she had the ability to "help herself" in bed it could improve her self-esteem and build strength at the same time. We see this all the time- my product prototype kept my father home much longer when he was in the low nineties.
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My father went through a similar phase last year. He's "only" 88 now and still lives in his house. For all of 2012 he had chronic leg pain, the cause diagnosed as his spine essentially crumbling. We started with pain meds and pain management with physical therapy. From February to Thanksgiving, he went from 130 to 124 pounds. From Thanksgiving to Christmas, he went from 125 pounds to 115 pounds and refused then therapy. He was also increasingly confused, calling me in the middle of the night demanding to know why I wasn't there at 3AM to take him to a non-existent doctor appointment, calling me by his sister's name, and acting surprised when I told him his sister died 5 years before. I picked him up and took him to live with me. My family and an in home therapist seemed to get him moving a bit, but not too much changed for a few weeks. I then read about drugs that increase appetite (usually an unwanted side effect), and realized that many of them are antidepressants. We tried Mirtazapine (Remeron), and he started getting up out of bed a week or so later. He went home after another month, and is now up to 123 pounds. He still has some back and leg pain and is by no means running around, but when I consider that about a year ago I was calling people and telling them to come see him as I didn't think he would be with us long, it is really wonderful. Antidepressants can be risky for the elderly, but I figured he had nothing to lose. BTW - he would NEVER take something for being depressed. Many of his generation see that as for "crazy people". I had the doctor explain it to him as something just to increase his appetite.
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I also think it is time to talk to her doctor about hospice. An evaluation does not commit you to using it. But if Mom's body is shutting down now, having some guidance from compassionate professionals and volunteers who understand the dying process is very helpful to the patient and the caregiver.
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How long has she had leg pain? Where specifically is it on her leg? is it possible because of her imobility she has a DVT (deep vein thrombosis) blood clot? Usually a clot will give calf pain, be warm and maybe red.
The fact her appetite has decreased indicates she is failing, but check for dehydration. Low electrolytes can give cramps. What is her code status? If she does arrest what will be done?
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At 100 years young, there still may be some glimmer of hope for improvement in strength, balance and coordination. Trust what your physical & occupational therapists recommend.
But remember, at this advanced age, it may be inevitable that your parent just does not have the will to improve.....and it may be their time to let their physical body go.
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God bless her for lasting to 100! With dementia, it is terminal, and there is not much you can about that. Ask the doctor what he/she thinks and if she could benefit on hospice. My best wishes to her...
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NanSea. She is 100 years old which of course you already know. She is tired, her poor old body is worn out. She had spinal surgery 3 months ago, that is a very big deal anytime especially if you are 100. it takes time to recover. taking her to the rehab simply wears her out. She is taking pain medication which of course she should be but they play havoc with the stomach and cause severe constipation. Plenty right there to kill anyone's appetite. As far as bathing is concerned it is just too much effort. Don't try and drag her out to the shower give her a bed bath in a nice warm room with plenty of soft towels and a fresh warm nightgown.
Everyone please stop torturing your loved ones because it is good for them. Would you rather they spent their final time on earth happy and comfortable or miserable being put through the routine because it will keep them strong. There is a happy medium out there so at least half the decision needs to be the elders. You can boost appetite and improve depression but when the time comes let the good lord and Mother Nature direct your action. If hospice won't come in you can at least go to their office and talk to them. Many Drs keep urging a patient on because they take it as a personal failure when someone does not "get better' or worse still dies. the PT has their orders so they make the patient complete the exercises. Everyone knows their body best so when you have had enough just say"NO"
Throw rocks at me if you like I really don't care but I feel so bad for all these 90+
old ladies being put through the hoops. Only another 15 years and I can climb into my wheel chair and sleep all day. I will stay strong enough though so I can get back into bed when they say I must stay up for another hour.
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The best thing to do at this point is to make Mom as comfortable as possible at any care level.
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My mother in law is 101. Always been in ALFs not needing SN but also her LTCP ran out after a certain number of years because she was put in the ALF before it was necessary. Had they allowed her to stay in her home a little longer like she wanted the policy wouldn't have run out. Even though she doesn't have a life threatening illness of any kind except old age she has been put on hospice in her new ALF. It has been a good hospice agency & she is still getting up in the wheelchair going to the dining room for all her meals. She is not self-transfer but is fine once up. There are those at 108 that are healthier than my parents with alz were & are at 85. Age is only a number. I am so envious of my mother in law compared to the suffering my parents have endured due to the alz. & being in NH because there wasn't money for an ALF with better care.
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My question is my mother is 99 years old..does eat well..She fell and we got her a wheel chair to use..she was always using her walker before the fall..(out of bed) now she just wants someone to push her in the wheelchair and not use her walker..concerns are won't this make her legs weaker and she will never regain strength or desire to use her walker..
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You can remove the footrests of the wheelchair and your mom can use her feet to navigate. That's what they do for all the people in assisted living where my mother lives. She putters around all week like this, then uses a cane (with my assistance) at my house most weekends. Best of both worlds. Few or no falls.
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tahoetata84, the question that pops into my mind, no disrespect intended, is "So what?" She's 99 yo. Would it be so terrible if she spent the rest of her life being pushed around in her wheelchair?

Well, yes, there would be a downside to that. If she becomes so weak that she can't transfer from the wheelchair to the toilet or to bed and to a recliner, that would be a handicap. So it might be a good idea to walk with her and the walker every day, or to consult a PT about gentle exercises she could do to maintain some strength.

Otherwise, a wheelchair is pretty safe. She's much less likely to fall in that than with a walker. She may be able to scoot herself around using her feet, or her hands on the wheels. This will give her a little independence. Make sure her environment is wheel-chair friendly.

My advice is to consult a physical therapist about ways she can maintain enough strength for transfers and safe ways she may be able to manipulate the chair. Beyond that, how cares if she never uses the walker again?
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Oh, one thought is making sure that her potassium levels are up to snuff. Some diuretics used for BP, strip the electrolytes from your system, so perhaps a banana or supplement in her shake may help with those muscle pains.
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I was leary of writing and asking due to the people who respond with the unhelpful answer as "so what" it is the suggestions and ideas that we would like..age and the number do not reflect my mothers attitude..she wants to have some independence and being pushed in a wheel chair the rest of her life is not what she would want..she is still at home with 24 hr care...so please just good suggestions for peoples questions...not the hint of rudeness thanks tahoetata84
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tahoetata, the not walking "ataxia" is often a side effect of some medications. For example, patients on Haldol for a long term develop Parkinson's symptoms and Ataxia. In most cases, stopping the meds is not a viable option. Ask the Pharmacist if the ataxia is caused by medication she is taking.
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Can you contact her osteopathic doctor, or others if she doesn't have one, and ask for home PT to strengthen her legs? Or did she have PT after her fall?

There's a little device that's like bicycle wheels that can be used to pedal while sitting down; it's like working out on one of the stationery bicycles but doesn't require sitting on a bicycle and balancing. She can use it while sitting in the wheelchair.

The device can also be put on the table, clamped down with large building type clamps, and she can exercise her arms.

A therapist could also give her exercises to do to strength her foot muscles.

Another that my father had after falling was sitting and catching a ball about the size of a beach ball, thrown by the therapist or by me. If it's thrown straight, then slightly to the side, those deviations train the person to learn to move sideways to catch the ball while remaining safely seated.
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