Blog – Coleen P. Kenny

My soapbox led me to post on Facebook, “If you could ask a geriatric expert a healthcare question about your aging parent or grandparent, what would it be?”

This is the first question and answer in what I hope becomes a blog series useful to all those struggling…

Q: How do you get patients motivated to get up and move around without getting them upset?

My mom is having this problem with my grandma. When my mom tries to get her out of bed, my grandma gets upset with my mom and then it’s hurt feelings all around.

My grandma is 87 and used to doing everything herself so i am certain she has got to be struggling with having to depend on someone to take care of her. Her broken arm is healing well, but I’m sure she is stiff and achey just from being 87!

The staff at the rehab hospital don’t have any ideas, and they are going to discharge her in the next week or two, so this information is going to help my mom when she brings grandma home… and me when my parents need care!

Some ideas to make it less stressful for everyone would be great!

A: My answer is threefold for this complex and not unusual situation.

1. Is her pain managed?

You hit the nail on the head when you mentioned “stiff and achey just from being 87.” Her arm may be healing well, but generalized pain is often overlooked. The frail elder may be comfortable lying still in the bed, but try to move those stiff old muscles and bones, and it hurts. In the hospital, nursing home, or at home, we need to assess pain during movement and not just at rest!! Then one key is timing the pain medication 45-60 minutes before therapy or getting up for the day.
Pain management in the frail elderly is a complex topic, and I will discuss it in a future blog.

2.Depression must be treated!

Anyone in a hospital or rehab loses both function and control; add pain into the mix, and your grandma has every right to, and every likelihood of, a clinical depression.

This depression is not something you or your mom or the staff can pep talk her out of or hug away or tell her to get over, or as one of my patient’s sons did today tell her, “There are people a lot worse off than you.” (I almost kicked him in the shin!)

There are new excellent anti-depressants with fewer side effects than ever before available; I have three medications of choice with my LOLs (little old ladies) depending on other factors such as appetite and pain. Again, in the interest of blogging brevity, depression in the frail elderly is another day’s topic, but please note I do not use fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft) in my frail elder patients.

3 Medical issues must be considered.

Is she uncomfortable due to constipation? Does she have a bladder infection? Is she dizzy when she gets up? Dizziness can be due to several issues but blood pressure should be checked lying, sitting, and standing (if standing is tolerated) and reported to the doc or Nurse Practitioner.

And finally, and yes, fourth-fold, sometimes the family member has to stop pushing. A dignity/control issue may develop with a “Who is the parent?” scenario. I acknowledge this becomes more difficult if your mom will be taking her home.

My thoughts and prayers are with my friend who sent this question, and with each of you reading this blog. Please pass it along if you find it useful, and be sure to comment and send me your questions!

—Coleen

Mom called last night to say she has to have shoulder surgery this coming Thursday. Could I be there?

“Of course. No problem, Mom. I love you.”

So I emailed the two docs I work with and the office staff to say I’d need two days off from work. Then I emailed the Education Coordinator and asked her to reschedule the Interns who were slated to spend three hours with me. Then I emailed my Nurse Practitioner student and told her I’d try to find someone else to take her that day so she wouldn’t lose 9 of the 145 clinical hours she needs this semester. Then I emailed the Director of the VCU Adult Day Center and told her I’d need to reschedule the storytelling I’d promised.  And I’ll need to let the nurses at Beth Sholom Nursing Home know I won’t be available to see patients those two days. I haven’t decided yet whether to reschedule the next day’s  dementia talk in Newport News.

“No problem, Mom. I love you.”

And truly, I do love her, and so far, in terms of long-distance caregiving, I have it easy. Mom lives independently. She still  works and drives and does her own laundry and grocery shopping. She takes care of her house and bills and she eats well. And she attended the Orthopedic appointment alone.

And, Mom only lives an hour north of my home. 

But the occasional episodes when I become Caregiver give me pause to think about those of you doing it from farther away and with much more fragile aging parents or family members. As a Nurse Practitioner specializing in long term care, I’ve spoken to many of you on the phone and when you’ve driven or flown hours to check on your moms and dads and friends.  

And I just want to say I’m in it with you and for you—contact me if I can give you an answer, a prayer, or just a little encouragement.

Coleen