Rehabilitation Strategies for Elderly Patients with Osteoporosis

Q: Rehabilitation Strategies for Elderly Patients with Osteoporosis

Hello, Li Li's online friend： Based on your description, your grandmother has osteoporosis and has been bedridden for a long time. <br>Regarding osteoporosis, it is generally understood that bone density begins to gradually decline after the age of 35, with a significant loss occ

Elderly rehabilitation

Hello, doctor.
My grandmother is currently 93 years old and has osteoporosis.
Last year, she underwent a vertebroplasty, but due to unsatisfactory results, she can only lie in bed now and is unable to get up, although she can still turn herself.
However, there are some issues:
1.
Due to negligence, we did not pay attention to her legs.
Because she has been experiencing pain in her lower back, she has been sleeping with her legs bent, whether on her side or lying flat.
It has been nearly 6 to 7 months without straightening her legs, and the muscles in the back of her thighs feel very tight (it seems like they have shortened).
We have tried to help her stretch them, but it is evident that she cannot straighten them.
What should we do at this point? How can we proceed with rehabilitation? We feel very careless and guilty.
2.
She occasionally turns to sleep on her side, but she is unable to sit up, and her body feels somewhat stiff.
We have purchased a nursing bed, but we are hesitant to raise it too high because her hip bones hurt.
Given this situation, does my grandmother still have a chance to stand up?

Li, 20~29 year old female. Ask Date: 2006/03/15

Dr. Xu Zhenrong reply Rehabilitation

Hello, Li Li's online friend: Based on your description, your grandmother has osteoporosis and has been bedridden for a long time.
Regarding osteoporosis, it is generally understood that bone density begins to gradually decline after the age of 35, with a significant loss occurring after menopause due to decreased hormone secretion.
Mild bone loss is referred to as osteopenia, while more severe loss is termed osteoporosis, which leads to increased fragility and risk of fractures.
The complications of osteoporosis include 1.
fractures 2.
kyphosis 3.
back pain.
It is particularly important to note that elderly individuals with vertebral compression fractures who experience pain and are unable to move may benefit from the use of a back brace to prevent further deterioration, along with medications and rehabilitation devices for pain relief and gait training to avoid prolonged bed rest.
For individuals who have been bedridden for an extended period, the lack of physical activity can lead to a decline in various bodily functions and increase the risk of complications such as respiratory infections, pressure ulcers, deterioration of cardiopulmonary function, and vascular embolism.
In terms of rehabilitation, it is essential to encourage or assist them in performing simple exercises, such as active and passive range of motion exercises and turning movements.
If there is muscle tightness, family members can assist with soft tissue stretching and massage within the patient's tolerable range or slightly tight joints.
When performing passive exercises, the following points should be noted: 1.
Each joint's movement should be guided by the patient's comfort level, avoiding pain or excessive tightness, and should be within the maximum normal range to prevent further injury.
2.
Movements should start from the proximal large joints and progress to the distal small joints, including all planes of joint activity, with each movement performed ten times as one set of passive range of motion exercises, repeated two to three times daily.
3.
When reaching the end of the range, hold the position for ten seconds without bouncing to achieve gentle soft tissue stretching.
4.
For stroke patients or those without external injuries, passive range of motion exercises should be initiated as soon as possible within three days of hospitalization for limbs and joints that cannot move actively.
5.
For postoperative patients, any bed exercises should not interfere with the healing of wounds or fractures and should not involve drainage tubes.
In fact, bedridden patients can also perform some simple exercises, but it is crucial that all activities are within the patient's capabilities to be effective, and there should be no discomfort following the activities.
If there are any questions, it is advisable to consult relevant medical personnel.
Regarding your inquiry about whether the patient can stand again, a further assessment of their overall condition is necessary to determine this.
It is recommended that you take the patient to a rehabilitation outpatient clinic for a detailed evaluation and examination.
Thank you for your question, and I hope this response is helpful to you! Director of the Rehabilitation Department, Taipei City Hospital, Hsu Chen-Jung.

Reply Date: 2006/03/15

More Info

Rehabilitation strategies for elderly patients with osteoporosis, especially those who have undergone spinal procedures and are experiencing prolonged bed rest, require a multifaceted approach. Your grandmother's situation is indeed challenging, but with the right strategies, there is potential for improvement in her mobility and overall quality of life.

Understanding Osteoporosis and Its Implications
Osteoporosis is a condition characterized by weakened bones, making them more susceptible to fractures. In elderly patients, especially those who have undergone surgeries like vertebroplasty or kyphoplasty, the risk of complications increases due to prolonged immobility. This immobility can lead to muscle atrophy, joint stiffness, and even further complications such as pressure ulcers and respiratory issues.

Addressing Muscle Tightness and Joint Stiffness
1. Gentle Stretching and Range of Motion Exercises: Since your grandmother has been in a flexed position for an extended period, her hamstrings and hip flexors may have tightened. It’s crucial to introduce gentle stretching exercises to help alleviate this tightness. You can assist her with passive stretching, where you gently extend her legs while she is lying down. Ensure that these movements are slow and within her comfort range to avoid pain.

2. Positioning: Encourage her to change positions frequently, even while in bed. This can help prevent stiffness and improve circulation. Use pillows to support her legs in a more extended position when she is lying down. This can help gradually stretch her muscles and improve her comfort.

3. Active Assisted Movements: If she is able to move her legs slightly, encourage her to perform small movements, such as bending and straightening her knees while lying down. This can help maintain some level of muscle activity and prevent further stiffness.

Promoting Mobility and Independence
1. Gradual Sitting Up: Since she struggles to sit up, consider using a wedge pillow or a reclining chair that can help her transition from lying down to sitting up more comfortably. Gradually increasing her sitting time can help her body adjust and strengthen her core muscles.

2. Physical Therapy: Engaging a physical therapist can be invaluable. They can provide tailored exercises that focus on strength, flexibility, and balance, which are crucial for her recovery. They can also teach you how to assist her safely during these exercises.

3. Assistive Devices: If she is hesitant to stand, consider using a walker or a gait belt to provide support when she attempts to stand or take steps. This can help build her confidence and reduce the fear of falling.

Pain Management and Comfort
1. Pain Management: Ensure that her pain is well-managed, as discomfort can significantly hinder her willingness to participate in rehabilitation activities. Consult her physician about appropriate pain relief options, which may include medications or alternative therapies like heat or cold therapy.

2. Comfortable Environment: Make her living space as comfortable as possible. Ensure that her bed and seating arrangements are supportive and that she has easy access to necessities to minimize the need for excessive movement.

Long-Term Outlook
While it may take time, with consistent effort and appropriate rehabilitation strategies, there is potential for your grandmother to regain some mobility. The goal is to enhance her quality of life, reduce pain, and improve her ability to perform daily activities. Regular follow-ups with her healthcare team will be essential to monitor her progress and adjust her rehabilitation plan as needed.

In conclusion, while your grandmother's current condition poses challenges, a structured rehabilitation approach focusing on gentle stretching, mobility enhancement, and pain management can lead to improvements. Engaging healthcare professionals for guidance and support will be crucial in navigating this journey.

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