How do you start the journey from bed to toilet?

[IlPrincipeBrutto]

A few years ago, a video was posted here showing a possible way to train someone with very limited mobility, like an old, weak person, all the way to being able to assume the squat position. It started with piling up bumpers, up to the person's hips, and get them to sit down on the pile. At first, the range of motion would be minimal no more than a couple of inches; as training progressed, bumpers were removed, thus shortening the stack and increasing ROM, until the person could get all the way down.

Simple, effective and easy to implement.
The method shown assumed that the person being trained could stand.

Here's the question; imagine you have an elderly person who has been in bed for over two months in a row and has basically lost their ability to stand unassisted. How would you start training them with the goal of eventually getting them to be able to squat (for example, on a toilet)? Another way to state the question would be: how do you get someone from the horizontal to the vertical position (we already have an idea on how to go from vertical to squatting) ?

I am aware of all the caveats that apply to this situation; nothing written here is medical advice, every situation has to be evaluated on its own merit, preferably in person, it would be better to look for the advice of a professional and so on.
I would still be grateful to anyone who would like to give their opinion about this.

Thanks,

IPB

[Mark Rippetoe]

Use the side of the bed to sit on, assuming it's high enough to be at about 150-degree knees with feet on the ground. Lock out the knees for sets of 5, holding the erect position at the top for several seconds.

But really, this person is already dead. I'm sorry.

[IlPrincipeBrutto]

Many thanks for this, much appreciated.
I suppose that if the side of the bed is not high enough, it's easy to raise it using material that is readily available in a domestic environment, like folded bedsheets or blankets.

But really, this person is already dead. I'm sorry.

Just curious; would you say the same of anyone who has been confined in bed for a long period of time because of health issues (for example, someone suffering multiple fractures in an accident, or someone with burns on a lot of his body) ? Or does your judgement also depend on age, as in this case, or on other factors?

IPB

[Mark Rippetoe]

It's the age. A huge loss of muscle mass for an elderly person is a very accurate mortality predictor.

[Lee Pinac]

Some of the major things I've learned being an ICU RN for almost 17 years is that humans are not made to be horizontal for any length of time. Our bodies are made to be vertical. Like Mark said,

It's the age. A huge loss of muscle mass for an elderly person is a very accurate mortality predictor.

Even sitting someone up on the side of the bed, as soon as possible, will help immensely with maintaining trunk control. People over the age of 50, lose muscle mass and become deconditioned rapidly. Get them vertical and weight bearing asap.

[JFord]

Many thanks for this, much appreciated.
I suppose that if the side of the bed is not high enough, it's easy to raise it using material that is readily available in a domestic environment, like folded bedsheets or blankets.

Just curious; would you say the same of anyone who has been confined in bed for a long period of time because of health issues (for example, someone suffering multiple fractures in an accident, or someone with burns on a lot of his body) ? Or does your judgement also depend on age, as in this case, or on other factors?

IPB

In general, I agree with Mark’s assessment. However I have seen frail elderly patients rehab’d after prolonged bed rest who’ve been immobilized due to certain conditions (mainly orthopedic causes).

The common denominators for those rather rare successes that I’ve seen are have been excellent cognitive function and a high level of motivation. Both are necessary (but not sufficient) for success. Where is this person in both of these qualities?

What was the reason for this person’s prolonged bed-rest? I’m guessing that there is another serious, chronic medical condition that caused this (possibly including depression).

[IlPrincipeBrutto]

It's the age. A huge loss of muscle mass for an elderly person is a very accurate mortality predictor.

I hope I am not abusing of your patience if I ask one last question. Difficult though it might be, the loss of muscle mass can be reversed; so what if it is indeed reversed? And is there a time scale within which the restoration of muscle mass has to happen to make any difference?

Thanks a lot for taking the time.

IPB

[Mark Rippetoe]

See Dr. Ford's post above. And remember that muscle mass is not the only component of lean body mass that has been lost.

[IlPrincipeBrutto]

What was the reason for this person’s prolonged bed-rest? I’m guessing that there is another serious, chronic medical condition

First of all, I appreciate you taking the time to reply.
As far as I know, the prolonged bed rest was not due to a chronic condition, but to complications following some medical procedure. I'm sorry I don't have more details right now. I can say cognitive function is very good.

Thanks again to all of you for your insights.

IPB

[Jdcuth]

If I could be indulged with an interesting case

I remember I was a junior doctor (resident) on an elderly rehab ward and picked up the notes (paper in those days) of a new patient. They were several inches thick. He had been admitted and diagnosed with a very nasty peritoneal tumour. They had tried to put him off surgery, but gone ahead and he spent many weeks after circling the drain. There then followed many weeks of rehab with what sounded like astonishing if slow progress until he was sent to me. I went to his bed and in amongst the other very frail patients sat a man in his 90s dressed like a colourblind pimp with dozens of very funky colognes on his dresser. I found out he was a ww2 paratrooper and had survived 2 gunshots during the war and was looking forward to getting back home.

The only reason I remember this story is how it is the complete opposite to the outcome of nearly every other case of severe illness I saw in the elderly patients I look after.