Can my elderly mother regain muscle mass?

April 14, 2008 6:23 PM

Can my elderly mother regain muscle mass?

84 year old mother has degraded from cane to walker and of late can barely transition from wheelchair or bed to standing position. This follows various medical problems (stroke eight years ago, renal problems, etc.) but nothing new specifically related to muscle mass. Yes, I know that as we get older we tend to lose muscle mass.

Legs and arms are like sticks; cognitively she is ok and on the phone can sound middle aged. Following medical hospitalization, she is now in a rehab hospital with daily occupational therapy and physical therapy with the objective of returning home.

The rehab hospital seems like a pretty good place with knowledgeable RN's along with intelligent and compassionate PT and OT staff. However, PT and OT together account for only 2 hrs/day. For 22 hours she is on her back or in wheelchair. There may be a rule prohibiting patients from trying to walk (even with walker) on their own - not sure about that.

Questions:

1. If you are off your feet for 22 or 23 hours/day wouldn't leg muscles of even a healthy person tend to atrophy?

2. Is it normal or sensible that a rehab hospital limits "standing up time" to less than 2 hours a day?

3. She has osteoporosis but refuses to take fosamax - any bearing on muscle atrophy?

4. Are there any specific exercises that she could perform in bed or from wheelchair that would help?

Thanks everyone & I know you are not docs.

posted by Kevin S to health & fitness (12 answers total)

I have a friend whose mother was of a similar age to yours, who broke her leg into many pieces and required surgery. The first doctor she went to did not want her to put any weight on it afterwards and basically had a regimen that required nursing home care and it was assumed she would never walk again. My friend sought other medical advice and found another doctor who put her in pt. She was walking and living back in her own home in 12 weeks. So it has definitely been done, but I can't imagine that being off your feet for so long can help do that.
posted by hindmost at 6:33 PM on April 14, 2008

Are the PT/OT staff asking the nursing staff to let your mom help with her daily cares? Like, are they encouraging your mom to help with transfers, or moving her arms around for dressing or brushing her hair, or things like that? Are they allowing her to move her wheelchair along with her feet? Those things might help with your mom's recovery, but that you might not notice because they aren't occurring during your mom's designated OT/PT time.

If I were you I'd talk with the therapists...ask about what they're doing and see if there are things you can do to help. I would most definitely just do what they say...they're the most familiar with your mom's condition. You wouldn't want to attempt anything that would cause her to injure herself and set her therapy back.
posted by christinetheslp at 6:57 PM on April 14, 2008

I want to just recommend Sit and Be Fit, google it.
posted by parmanparman at 7:14 PM on April 14, 2008

My mother's a physio, and has countless stories of elderly patients who are losing strength, whose doctors have told them not to walk, etc. In many of these cases, simple exercise (simple as in bouncing a balloon up and down with their arms, lifting very small weights with their legs while in bed) enabled them to improve beyond belief.

I'm not a physio, so don't take that as an authoritative exercise regimen, but it's definitely something that can be worked at. Speak to your mother's carers, maybe look into getting someone to come in privately if they don't have much time?
posted by twirlypen at 7:40 PM on April 14, 2008

It's a tradeoff- nobody wants to tell an older person to push themselves because they might break something. But then the longer they enfeeble themselves, the harder it is to get back to regular life.
posted by gjc at 8:14 PM on April 14, 2008

Perhaps water aerobics (or even light exercise in the pool). At her age, range of motion and just general strength building would be best, but the pool is fun and easy on the body.
posted by The Light Fantastic at 10:24 PM on April 14, 2008

Water aerobics+protein shakes
posted by ruelle at 5:22 AM on April 15, 2008

IANAHealth Care Professional. You want to help Mom stop losing muscle and bone mass, and maybe regain some. She needs to eat a lot of healthy food. Shakes, salads, baked sweet potatoes with butter and sour cream, pecan pie, etc. When I visited my frail, ill, elderly Mom, I made all the food she cooked when we were kids: mac & cheese, potatoes au gratin, bread pudding, tuna casserole, apple pie. Eggs, toast and fruit for breakfast, grilled cheese sandwiches for lunch. I gained 5 pounds on that visit, and I think she gained 3. She needed the weight; I didn't. So, every visit, take good food, and sit and talk to her while she eats. Or visit during meals and bring your meal; many people eat more if they have company.

Next is exercise. Get a beach ball, and pass it back and forth. Play her favorite music and see if she'll get up and dance with you and the walker. People exercise more when it's fun, so any games you can think of that will get her moving will help. Get a Wii; I swear every Nursing Home should have a couple with WiiSports; it's pretty good exercise that she can do in a chair, and it's fun. When people laugh and have fun, they breathe better, and their motivation improves.

Make sure your Mom gets some real sunlight so she can make Vitamin D. Fresh air is good, too.

Get your Mom checked out for depression. Old people are often chronically depressed, and it stops them from being active, and they get more depressed. All this time with your Mom will make her happy, and that will help her health, too.
posted by theora55 at 7:50 AM on April 15, 2008

[13 years practice in geriatric medicine]
Lots of good comments here, especially from theora55.

Nutrition is vital. Lots of calories (forget about cholesterol), plenty of protein. She will need to eat calorie-dense foods (i.e., fatty foods). Is her appetite a problem? If so, ask her physician to review her meds and eliminate anything that isn't essential.

Obviously, physical activity is the most important. She should spend very little of the daytime in bed. She should be gotten up on her feet several times a day. Likely, the facility doesn't have the manpower to do this.

It might help to have her seen by a geriatric medicine specialist. Check your yellow pages. If that doesn't work, send me a message and I may can find one for you.
posted by neuron at 11:54 AM on April 15, 2008

There's an awesome book called _Strong Women Stay Young_ which discusses musclebuilding in the elderly. You may want to check it out.
posted by bananafish at 12:41 PM on April 15, 2008

1. Yes.
2. Normal, but not sensible. It's likely a manpower issue.
3. Not so much on muscle atrophy to my knowledge (IANAD), but bone density does make a difference as to what exercises are safe for your mother to perform.
4. Yes. I would recommend a conversation with her physical therapist. They are likely a little overwhelmed, so you may have to be a little bit persistent bordering on pushy to get this to happen, but you should make sure that the PT prescribes your mom an exercise program that she can perform in bed or in a chair. She should be out of bed every day if there is no medical reason not to. She should be on her feet walking every day if there isn't a medical reason not to. Walking is good medicine.

If the PT has a reason that your mother is not on independent ambulation on her floor, find out why not, and get a time frame that the PT is working toward changing that. It's possible that the PT or the nursing staff feels that your mother is at high risk for falls -- find out why. Is it her judgment, her strength, her medications, her bone density?

If the PT gives your mom an exercise program, work with your mom if you can to make sure she's understanding it and performing it.

Best of luck!
posted by jennyjenny at 4:08 PM on April 15, 2008

Everyone, thanks very much for your thoughtful responses.

Hindmost, twirlypen - it's encouraging to know that others have succeeded !

christinetheslp - i think pt staff are doing what you say except not insisting that she do the "wheelchair along with her feet" exercise. Unfortunately, one of the problems is that my mother has never liked physical activity - so part of the problem is my mother's own lack of initiative (even though she knows she should try harder).

theora55 - bringing her food as part of visits is a great idea - we've done a little of that but I will try to rev that up a bit.

jennyjenny - thanks for your specific responses. RE #2, as much as I like (& respect) the staff it makes absolutely no sense to me that a person who can't walk largely because of muscle weakness is exercised only a couple of hours per day. I do suspect the issue is manpower and it's handmaiden - insurance. Truth in advertising: offical pt/ot activities are about 2 hrs/day. The staff encourages hall roaming in the wheelchair, but mother doesn't like to do that - so some of the fault is her own.
posted by Kevin S at 6:45 AM on April 16, 2008