Parenting Your Aging Parents

Parenting Your Aging Parents, Nov 18, 2002 by Francine Moskowitz, Robert Moskowitz

Dear Francine and Robert:

My aging father has been active and healthy his whole life. Last month, while playing tennis with a good friend, he injured his knee.

The doctor says it's a tear in his meniscus, and recommends rest and rehabilitation, with surgery as a possibility, if necessary, later on.

Can you tell us anything more about what's going on here?

Signed, Hurts To Walk

Dear Hurts To Walk:

There are really only two kinds of knee problems: mechanical and ininflammatory. Your father is experiencing a mechanical one.

Specifically, the ends of the bones in the knee joint are covered wiwith tough, elastic cartilage that helps absorb shock and allows the knee joint to move smoothly. They are also separated by pads, each of which is called a meniscus. These pads work as shock absorbers, cushioning the weight of the body as it pounds on the lower leg.

The meniscus is easily torn. It often happens while one knee is carrying the person's entire weight, especially if the knee then rotates, as it does when the person is hitting a tennis ball.

The implications and treatment of a tear depend on its location and size.

Although symptoms of a meniscal injury sometimes disappear by themselves, they normally persist until properly treated.

To avoid unnecessary surgery, doctors often recommend treatment programs that include muscle-strengthening exercises. These exercises should be done carefully and under expert supervision, so as not to worsen the injury. Most of these exercise programs include warming up the joint (by riding a bicycle), then doing certain exercises, such as:

[middle dot] Raising the leg and partially straightening the knee

[middle dot] Extending the leg from a seated position (with or without a small weight)

[middle dot] Raising the lower leg while lying face down on a table.

[middle dot] Walking in chest-deep water

[middle dot] Floating and kicking while holding onto the side of the pool.

If the meniscal tear is large enough, surgery may be the only effective remedy. With elderly patients, doctors go in most often to remove a small portion of the meniscus to even out the surface. They can remove the entire meniscus, but too often this leads to osteoarthritis.

If your father undergoes surgery to improve the knee, his recovery and rehabilitation may take longer than you think. He'll have to restrict his activities, but should do as much as he can, because putting weight on the knee actually helps it heal faster.

Rehabilitation usually includes specific walking, bending, stretching, and strengthening exercises.

Although your father seems to be in some pain, and his mobility is limited at the moment, there is every hope for a full recovery. The key is to cooperate with the physical therapist, who can usually help him recover his full range of motion and his previous agility.

* * *

Dear Francine and Robert:

My aging parents have told me they've started walking 30 minutes or an hour every day.

I know walking is healthy, but for many years they haven't done anything to stay fit. Plus, with early darkness and no sidewalks near their home, I'm afraid they're going to get hurt.

What can I do or say to keep them safe?

Signed, Suddenly Hoofing It

Dear Suddenly Hoofing It:

Walking is one of the best exercises for seniors. We suggest you embrace and support their decision to start exercise. But encourage them to be methodical about building up their strength and keeping themselves safe.

The key to the success of any exercise program is continuity and perseverance. It's best to set realistic goals, and slowly build up strength and endurance.

With regard to your worries, one fundamental guideline would be for them to warm up before every walk, and cool down afterwards. It's also helpful to do some simple stretching exercises before they hit the road. Your parents should stretch their hamstrings (back of the thighs), calves, achilles tendons and shins. This improves blood circulation and reduces subsequent muscle soreness.

Most seniors start walking without paying attention to proper footgear. It's a mistake. Good shoes will offer support, cushioning, and shock distribution to help prevent injuries.

The best walking shoes have firm soles and soft uppers. They should be sturdy, well-cushioned, snug-fitting toward the back of the foot, with wiggle room in the toes.

Since feet sometimes swell as the day goes on, your parents should be measured for their walking shoes in the afternoon, rather than the morning.

As they exercise, your parents should be alert for pain, swelling, tingling, or burning sensations in their feet. These can signal a serious medical problem. Red spots, numbness, or burning are other good reasons to consult a doctor.

Because the natural padding on the bottom of the foot tends to wither with age, and bones become more brittle, seniors can get stress fractures in their feet. As a result, the same terrain that was easy to walk a few years ago can be difficult and dangerous for them now. It's actually good for your parents to stay off sidewalks, streets, and uneven terrain in favor of grassy or groomed areas that are relatively flat.