With an increasing trend of in home elder care, there are many issues for caregivers to consider. One of the most important is the issue of exercise. Physical activity can make a huge difference in anyone's quality of life but especially in the case of older people to recover from injury after a fall, to regain function after impairment from a stroke, and to maintain or improve overall flexibility strength and mobility.
For the next few minutes we will discuss what needs to be done and how caregivers can help insure that their loved ones are getting what they need. Joining us for this discussion is Dr. William Bulman. He is a general internist in the Department of Medicine at Columbia Presbyterian Medical Center and he is also a clinical instructor of medicine at the Columbia College of Physicians and Surgeons. He maintains a private practice in internal medicine in Manhattan.
Also joining us is Christina Baldasari, a licensed physical therapist on staff at Doylestown Hospital in Doylestown, PA. In addition to many years experience in in-patient therapy, out-patient rehabilitation, and home care, Ms. Baldasari also runs aquatic physical therapy programs and has done much work with brain injury patients. Welcome to both of you. Thanks for being here.
I would like to start with you, Ms. Baldasari. Often families will bring an elderly relative to live with them immediately following a stroke or other injury such as a hip fracture. What is the first thing a caregiver should do to address the need for therapy and rehabilitation?
Following their stay in an acute care hospital or rehabilitation hospital, usually they should discuss these things with their doctor. The doctor usually coordinates with the physical therapist, occupational therapist, and sometimes social worker to find out what the needs of the patient are. And that is where I step in and we do an evaluation of the patient. We see what their muscle strength, balance, and ambulation are like. We come up with a plan for their discharge. A lot of times that incorporates talking with the family and getting the family involved in teaching them exercises.
WILLIAM BULMAN, MD: You make a good point. It is actually important to do before a person is sent home from the hospital. The majority of in-hospital care at the end of a person's hospital admission is usually in preparation to get that person back into either their old living environment or into an alternative living environment. That involves, after a hip fracture or a stroke, a great deal of in-patient physical therapy. If the family can participate in that physical therapy, learn what the therapist is doing with the loved one in the hospital, and learn from the physical therapist how to continue those exercises on the outside, it makes it much easier once that person is brought home to live with the family.
LISA CLARK: How often is it necessary for an outside physical therapist to come on a regular basis to help a patient?
CHRISTINA BALDASARI, LPT: Usually the therapist will come out 2-3 times a week and that is usually for 3-4 weeks. After a period of time, they re-evaluate the patient and see if on-going therapy is necessary at that point. All along with the home care, we constantly are teaching the family members the exercises.
WILLIAM BULMAN, MD: It is very variable. It depends completely on the type of injury or the type of disability that the person has sustained. After an acute stroke for example, very intensive physical therapy for someone who has had a significant stroke in terms of their functional loss is necessary to optimize the chance that the person will get as much function back as they can possibly get back.
LISA CLARK: I have a question directly related to that. The aging process by itself takes a toll over your physical ability as the years go by but when you have had a catastrophic event such as a stroke, a fall, or some sort of injury, the temptation might be for the caregiver to coddle their patient and not force them up. He's tired or whatever. Why is this such a bad idea?
CHRISTINA BALDASARI, LPT: Well first of all, everyone needs conditioning. But a patient that is deconditioned really needs to improve his muscle strength, his cardiovascular health, and all of this to sustain a longer life. If you put it in those words to your family member or say I'm doing this for you -- we need you, we love you, your grandchildren need you and that is why we want you to maintain these exercises and keep going because we love you.
WILLIAM BULMAN, MD: It is very common for a very catastrophic injury to take a previously independent, fully functional person and turn them into a dependent person. The degree to which they regain the function that they have lost depends a lot on the injury but also a lot on how hard they work after the injury in their rehabilitation. It is sometimes very difficult to motivate individual people to do that. It is very important to get the family that is helping take care of them in on the motivational process.
LISA CLARK: How do you do that without turning into a drill sergeant?
