Learn from Carole Blueweiss a Doctor of Physical Therapy discussing how to get our loved one to move more.
https://www.kathysconsulting.com/
https://www.caroleblueweiss.com/
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Kathy 0:02
Hi, I am Cathy, and the host of this podcast, I have been a geriatric nurse, and helping seniors and their families for the past 10 years. I am passionate to educate all those who are on this caregiving journey with me.
Welcome back to this podcast, and I'm going to be doing an interview this time, I'm interviewing Carol Blueweiss. She is a Doctor of Physical Therapy, a geriatric clinical specialist, and a movement educator. On top of that, she also has her own podcast, Wisdom Shared, the reason I wanted to talk to Carol and share her with my audience is that when I go into so many homes, my biggest concerns are falls. So that's why I wanted a physical therapist to talk to us because they're the ones that really address a lot of these issues that have to do with falling. Tell me when you're looking at an older person, especially. And when there's concern about falling, what are some things that you're looking at to evaluate their risk of falling?
Carole 1:16
Well, there are certain standardized tests that we do. And we usually do at least three, because they all measure different things. And it really depends on the person, and how they are in terms of their physical abilities as to which tests are chosen. But there's no one test that can say, Oh, you're at risk for falls, I'd say the most important test is time it takes to walk, I think it's six meters, six meter walk test, they've shown in research that your risk for falls, increases with the slower walking speed, depending on if you are community ambulator. Or if you're somebody just getting out of the hospital and you just need to be safe at home, it's important to do a test that shows how fast or how slow Are you walking, because depending on that and comparing it to a chart of norms, it is a reliable way to to judge the risk for falls. And then another one is called the TUG test, which is basically sitting in a chair, walking from the chair about 10 feet turning around and sitting down again. And again, that's compared, the time it takes to do that is compared to norms, which of course are just norms, but it gives you a ballpark figure. And then there's walking at your regular pace, and then there's walking at your fastest pace. And then there's also dual tasking. Having someone do that while they're counting backwards, or multiplying by seven. Because that's a real realistic situation where people aren't just like walking 10 feet turning around and sitting down, they're thinking about something and you want to see how are people those kinds of things. But again, it always depends on the individual. And you want to do though, that those basic tests, another one is what's called the Romberg test where you have someone put their feet together, their feet hip width apart, maybe have them one foot behind the other, do each one of those with eyes open and eyes closed. And that gives the therapist information and, and the client information about their balance system. And it's all together, those three things kind of give a lot of information in a very short amount of time. And you can really know if somebody is at risk, or how much risk or are completely safe, pretty much to go home from the hospital and also to be safe in a nursing facility or to be safe in their home. And or to be a community ambulator.
Kathy 4:03
when you do those tests about how long does it take you to do that type of evaluation.
Carole 4:09
It really doesn't take long. But it will takes a long time as you're talking to the person and you know, getting them set up. And it depends on what kind of facility you're in daily. You can do those three tests in 20 minutes. And then ideally you have time to work on something specific that the person needs. But actually in doing those tests, you're still giving therapy so to speak, because you're walking you're you're getting up from standing to sitting position you're there shouldn't be any real coaching going on. But just by virtue of moving you're getting some treatment and that usually leaves about 10 minutes to do some other treatment. It's tricky. That's probably the trickiest thing about working with anybody really in a clinic is the time because ideally we'd have more Time, then we have and it would be considered a third maybe of the treatment, and then the rest would be much more treatment. But given that many clinics, you're lucky if you have half an hour one on one, that would take up about two thirds of the half hour. Ideally, you have an hour and then more time to do other things. Right. So they're not the assessments aren't done every time you see them, they're done generally, as needed, or once a month.
Kathy 5:25
Correct. So once you do an assessment, so let's say you're like, definitely they need physical therapy, you do your assessment, how do you in a simple lay? Way? How do you sort of develop a plan from there?
Carole 5:42
Well, I guess I'd have to ask you to be more specific, are we talking about a plan at home or a plan, in the hospital setting or a skilled nursing facility. And I only say that, because it really, again, depends on the environment, and how much assistance the person might have, because a lot of these things need to be done with some supervision.
Kathy 6:06
Correct. So I think I would probably imagine more in the home most of the time, the clients, we see they sort of go hospital, then they go rehab. And so when they're in a lot of those settings, they are getting a lot of intense treatment, either nursing or rehab. So the families are not, they're kind of involved in that they're kind of kept apprised of the process, but then all of a sudden, when they go home, the families become a little more involved in this process, because, you know, they feel like they're more responsible for mom and dad or their loved one at that point. So probably it would be more, if they're in the home, you know, they've had probably some therapy, and it's, they can go home now. So they have a little bit, I guess of independence, but they still probably need some therapy.
Carole 6:53
Right? Well, you know, my belief is everybody needs therapy, it's like, you know, personal training, you know, we can always be better, we can always be stronger. And especially if you're coming home from medical facility, you know, they're basically discharging people much earlier than they used to, because they need the beds. And then there's the insurance criteria. So you're not necessarily being discharged, because you are just fine, you're being discharged because they need the room. So usually, home care is covered if you have Medicare, if you are homebound at home. And that would be I think two to three times a week, somebody would come in and evaluate whether you need PT, OT, whatever services. And if you're deemed high level, in other words, that you're not homebound and you're able to leave the home, then you'd get prescribed outpatient physical therapy. And in both cases, and even when you leave rehab, the ideal situation is that you're given home exercises. And those are the one way to keep up a little bit with a routine to stay stronger. They're usually given at the level that they are at at that time. The ideal scenario is that they get reevaluated, let's say they're home, and they're discharged. With just home exercises, that somehow they get checked on again, because probably, if they've been doing the exercises, they become too easy. And then they need the next level of challenge. It's a little tricky. Some would say like home care, it's very hit or miss because they come in maybe for 15 minutes, you don't get a whole lot done. So these days, it's really very important that people do their own exercises, whether it's with the home health aide with a family member, or even themselves, but it's my big thing is motivation and creating a routine. The other thing I would say about that is in an ideal situation, I think you're teaching the person who's going home, how to make their everyday life exercise, every time you get out of a chair, or every time you sit down. If you've been given proper coaching about that, that will strengthen a whole lot of muscles and give a lot of flexibility and range of motion to many joints. So that can be an exercise and that would count. And as a matter of fact, one of the tests given not necessarily for falling but just for a very good general conditioning test is sit to stand. And you timed somebody how many times they can stand up in 30 seconds. That's a very important skill. And you can instruct the person to let's say put more pillows on their chair to make it a higher surface. So that makes it easier. And then you can instruct them as that gets really easy. They can take the pillows away. And so I think it's important to empower the people when they go home to explain to them the different levels like so when you get to like being able to do 20 of these. And it seems easy. Then go ahead and make your surface lower or do it while you're passing a can of beans from your right hand to your left hand, or do it while you're looking right and looking left. And there's because there's all kinds of scenarios that therapists are trained on how to make the exercise more challenging. And because people don't get so much consistent therapy, it's important that somehow the client can know themselves how to challenge themselves. I think the most dangerous thing about working with people that are older is that actually, ironically, they don't get challenged enough. I think the idea is that if you're just kind of getting by and you don't feel like it's difficult, it's too easy.
Kathy 10:40
You know, I really liked what you said about making everyday life exercise. That's such a profound statement. Can you expound on that? A little bit, like find that motivation is so hard, but I like what you said is make everyday life exercise, so maybe it won't feel like a chore to them?
Carole 11:01
Sure. Yeah. I mean, I think that it sounds so obvious, right? I mean, I don't know when exercise, there's a whole book written about that when the word exercise started. But basically, it's about movement, just understanding that, well, probably sitting in a chair for more hours than you're standing is not a good idea. So the idea that bending down, for example, to put dishes in the dishwasher, that's considered squatting, and you're working your hamstrings, your,\ coordination, your thinking, your hands are doing one thing, your feet are doing another thing, if you if you take that activity, and you bring in breathing, and you bring in, what is the lighting situation, is it dark in the kitchen is it light in the kitchen, all that will have an influence on the difficulty of the exercise. And so if you're having difficulty doing something like that, you'd probably want the lights on very brightly. Because that helps you have better balance. And if you want it to be more challenging, you could dim the lights, let's say I mean, that's just one example, you could be standing on a floor, which makes it easier for your skeleton to have better balance, or you can make it more difficult and stand on a pillow. And that makes it more challenging. In general, if you just do it the regular way, it's good exercise if you just keep moving because so bending down to get the clothes out of the dryer bending down to put the clothes in the washing machine lifting the clothes in and of itself, that's weightlifting, you know, just everything you do basically can be considered an exercise, it's just a matter of using your imagination and creativity to make it challenging. What I like to, to give as is for balance is when you're going to brush your teeth. First of all being aware, it's very important awareness like so you know, what's your safety parameter. So if you need to have two feet, and you need to be holding on with two hands in order to brush your teeth, and then you can let go obviously with one hand and brush your teeth, if that's all you feel safe and comfortable doing that, then that's what you do to challenge yourself in that situation, you would want someone near you that's guarding you. And ideally, you would do that and have a challenge. So maybe stand on one leg and do it. And you might only be able to do that for one second. But the idea is that you keep trying to do that over time, over days and weeks, and you'll see that it will increase because your body will learn. So our brains are very plastic. You know, there's all the research coming out now about neuroplasticity. So if we don't use our bodies, we're gonna lose those connections in our brain. And reversely. If we use our bodies, our brain wakes up and can make new connections at any age. So it's really important to understand that because then that's I think motivating. So you want to you want to be challenged you it's okay, if it's difficult, changing the surface that you stand on changing the lighting situation, changing the height, those are all ways that you can increase or decrease your actual environment to make a task more or less difficult. And the trick is finding the right the right amount of challenge.
Kathy 14:03
You brought up something that I thought about because a lot of times when I'm visiting with people who are thinking about bringing some help in the home, I always say Are you having trouble changing your sheet? Because sometimes you're like, I don't know what your caregivers can do. And so I've always said, they've always told me Oh, yeah, that's the hardest thing for me to do is change my sheet. So I've always like, well, our caregivers can do that. But now you've challenged me to maybe I need to say, our caregivers will help you do that. So maybe they can do some of that process of putting on their fitted sheet. And then the caregiver can help them so they're doing it together. And so that still sort of an exercise for them. So that's kind of what you're saying, right?
Carole 14:41
Yeah, I mean, that's a great example of, you know, there's something called learned disuse, and that's when you do everything for somebody and that tends to happen in nursing home. So it was a big study about that how half the group were told they had to let say what are the plants and half the group were told they did not have to. And, you know, eventually the ones that weren't challenged, lost much more skill than the ones that were constantly, you know, let's say watering the plant. So yeah, ideally, you're you're working up to where you are at the time, so that that skilled assistant would do just enough, the person needs help, but not too much. And not not too little. But for sure, not too much. And then that person will feel also a lot of this is emotional. And you know, it's a whole person. And when you when you get older, you just feel like, you know, it's harder to do things. And it's frustrating. And you're not able to, especially if you've come back from a situation where in the hospital, so the more you see that you can do for yourself, it builds up your self esteem and your self image. And then it also will help motivate you to continue to move and do more and more.
Kathy 16:01
Do you find because I'll be honest, you know, my dad has been doing tennis habitat, all that stuff, and the pandemic hit. And he went home, sat in a chair and watch TV, so he didn't get COVID. But now he doesn't walk very well. But he also lives alone. Do you find that people who live alone? Does that sometimes cause him to sit more? Do you know if there's anything on the research? Or am I just shooting out of left field on that?
Carole 16:26
Well, I'm sure there is I can't cite any specific studies. But I can say that research does show that being social makes a huge difference in everybody's ability to cope with almost everything in life. And especially as you get older, because the tendency is to be more alone and to have depression, and to feel isolated and not useful in society that in and of itself will start that decline. Whereas if, if, on the other hand, you have that social interaction, or the group of guys saying, Hey, let's go out for a walk, or let's go to the pool into our exercises, or let's go for a round of golf, or let's go eat anywhere really walk to the corner, no matter how difficult that might be, just having that social connection makes for a much more likely scenario that that person will move. So it's, it's very, very difficult during this COVID time when people are isolated, and they can't be social. It's a huge challenge. And it's really unfortunate. So that's where, you know, you have to be on the phone with your dad talking to him. But in my experience with my own family, you know, for some reason, that's a good research studies. People don't necessarily listen to their family members. So best to maybe get a friend of that of your dads to call have them call your dad and say, Hey, let's at least talk on the phone and let let's let me see your kitchen, let's FaceTime let's do a little walk around our houses, you know, you just have to be creative, but it's it's tough with the technology. And the older people at this point, some of them are better than others. And so it's a challenge.
Kathy 18:01
The other thing that I've noticed, and in older people, I think it was first time it was actually a friend of mine, you know, his wife was in the hospital, she walked in, but then she didn't. She wasn't walking when she came out, you know, five or six days laying down. So she didn't have use of her muscles. Or another lady, she went in the hospital. She's like, why can't I walk? And they like you haven't used your muscles in like six months, when they get to a certain point. Is that? Is that something that's going to be hard to reverse as they get older? Is it difficult to reverse? Is it better to prevent? What are your thoughts on that one?
Carole 8:35
Yeah, my first question would be, where were these people that they were bedridden for that long, because that's pretty unheard of in this day and age, because we all know how lying in bed I think it's two weeks can reverse any kind of forward momentum you've had in terms of muscle building, and you can lose a lot of muscle mass. And that on top of the fact that at a certain age, we have what's called sarcopenia, which is a lessening of muscle mass, which tends to happen physiologically as we age. So it's not that we can't gain muscle. Absolutely we can. It's all the more reason why the last thing you want to do is rest too much, or stay in bed too much. So for sure, it's about prevention that that never happens to begin with. And then it really depends on the person's, you know, was this person, an athlete, and then they can have that kind of gung ho like, I'm going to work through this, I'm going to get better, I can see where this can go. And they have that attitude already in their system versus someone who was always a couch potato, and they're going to be at a much less advantageous situation because you can't change someone's behavior. Let's put it this way. It's very hard to change someone's behavior at a time when they're already being challenged. Physically so then, so that so to answer your question, you should just never let that happen.
Kathy 19:53
Right. I wish that was true. You know, it's just difficult. Like you said, my dad's long distance my brothers they do Live in town, we all work and it is hard to get over there and be like, Come on Dad, let's, you know, let's move. And I didn't realize what was going on, because I live twelve hours away. So to wrap it up, if you were to give, you know, a couple of recommendations, I know you've covered them in detail. What would you recommend to, you know, family members of older people or older people to try to, you know, prevent falls and not lose those muscle masses,
Carole 20:28
the first thing I want to say is encourage them to move. And I have to say that the reality is that sometimes saying those things to somebody who you've said this to over and over again, it's just doesn't get abided by. And I think that just has to be discussed and talked about, ideally, your loved one, your family member should be moving more. But the reality is that they maybe could be depressed, or they may not want their daughter telling them what to do. And then that could all backfire. The textbook would say, encourage your family member to move as much as possible, do as much as possible for themselves, engage in social activity, be with your friends as much as possible and laugh a lot, because they say laughter is a remedy for for everything. And if you have some, you know, feeling that you're isolated, or you have pain to reach out to somebody so that you can get help. And, of course, there's a lot of social networks out there that are set up to help people that are aging, like SilverSneakers. And AARP has a lot of programs, there's a lot that's out there. And it's just a matter of finding what your loved one wants to do and motivates them to do. And often I think that once they do something that they enjoy, then they'll want to do it again. So if someone's reluctant to go, let's say join a swimming group, but they do it just once, and they feel how they feel afterwards, then they're more likely to go back or just you know, takes time. And it takes connecting with that person so that they trust you that you have their best interests in mind that that they should listen to you. And you just have to also find a way within their behavior or their interests, what will make it motivating for them.
Kathy 22:24
Those are great pieces of advice. And I do want you and the reason I was drawn to you, when we took this podcasting class together and then connected over different things is you also have a passion for caregivers, though, most of your podcast relates to parents who have special needs children. So just give a little blurb about your podcast in case people do want to listen to your podcast, give us the name. And I'm just you know, a couple of sentences about what it's about.
Carole 22:52
Sure, I started a podcast called wisdom shared, I had come across parents who had extraordinary children with with challenges that, unfortunately, in our society of ableism, were just not necessarily taken seriously or seen for what they are and a lot of misunderstanding. And yet these parents were just so such advocates and have learned so much in their struggles to to work with their children, and obviously get them the best education, the best therapies and all that and I and I thought Wow, there's so much that gets reinvented and reinvented and reinvent and reinvented. What about listening to these parents so that other parents could hear what others have done and how they've coped and it's sort of morphed. It has morphed into more than just children with disabilities, it's morphed into people with challenges, and how relatives and friends and have dealt with it, and what can we all learn from them as healthcare workers and teachers, and parents who don't have those challenges? How do we treat these people and maybe become more aware that just because someone looks different, or acts different, maybe they need a little extra connection, not to avoid them, as, as often happens in our society of this able normal, you know, way of being then and then the other thing too was this, it's so confusing now with learning what's true and what's not true. And I and I really wanted to get these parents to talk because it's their story, and they are experts of their own lives. And no one can really argue against that, or no one can really not believe them because it's coming from them. So I thought it was just a nice reality check just to be able to listen to someone and, and just hear a story.
Kathy 24:45
And you know, I listened to I haven't listened to all yours. But you know, I think I told you about the one that you interviewed. I think she had cerebral palsy. And then like the next week, I met an adult and they had their little card and I was trying to figure out what were those things that the mom wanted? To interact with her daughter, and I really enjoyed that. So you never know when you're going to encounter these people in our society, and how they want to be approached and not stared at and different things.
Carole Speaker25:14
Katherine, I have to say this, and I'm so glad you brought this up. What it comes down to also is that if we are lucky to live long enough, we are all going to have a disability. And I'm learning that from these parents. Why? Why is it that we have to struggle so much to meet the criteria of this normal? Why can't there be more accessibility? Because there are people, you could get hit by a car the next day, and you were all of a sudden in that category? Of course, you could live long enough, eventually, you might need an elevator. So we're all in the same boat. And in the aging population, it's a great, I don't know if it's a metaphor, or what but to look at growing older, as a well, let's I have I have a quote that I found that _____says, she said, aging is not lost youth, but a new stage of opportunity and strength. I think that no matter how disabled, we become, you know, we're still our same person. We just can't do what we did before. And we have to build a different strength to live the life we want to live. And I think these parents of these children are learning prematurely, maybe, but they're learning what we're all end up learning eventually. So we might as well start thinking about these things.
Kathy 26:45
Thank you. Thank you so much, Carol, I appreciate you being on the show and sharing your podcasts information. And also just all your knowledge of physical therapy, I could pick your brains forever. But we also know we have to live in a time limit.
Carole 27:02
So maybe I'll come back. Anytime, Catherine and thank you for inviting me i It was a lot of fun talking to you.
Kathy 27:07
Just to wrap up. That was Carol Blueweiss, physical therapist, as well as geriatric specialists of movement educator and a podcaster. I found this information very helpful. I hope you did too. As I'm going to be thinking, how can I help my own family members? How can I help my own nursing practice, as I encourage all people, but especially those that are struggling to move more?
Kathy 27:44
If you have found this information helpful feel free to share it with someone else. If you wish to contact me you can at info@kathysconsulting.com. Remember, this podcast is meant for informational purposes only, and not replace the advice of your medical