>> I may no longer be a spring chicken, but I still want to cross the road and have some fun.

Stay with us as we talk with physical therapist Doctor Elizabeth Murphy about keeping older adults agile and mobile.

Next Kentucky Health.

>> Kentucky Health is funded in part by a grant from the Foundation for a Healthy Kentucky.

>> My favorite thing on TV, besides whatever's on KET isn't a show, but a commercial of seniors sledding down a hill.

This vignette shows that our inner child still lives within us, and that to safely satisfy and free it, we must make certain accommodations.

If you have awakened and suddenly find yourself older and not able to do as you want, you're not alone.

And oh, by the way, welcome to the club.

The question is, when is the best time to start preparing for aging?

Well, as the adage goes, there's no time like the present.

In the movie Toy Story, the character Buzz Lightyear, when asked about his flying, replied, quote, this isn't flying.

This is falling with style.

End quote.

The fastest growing demographic in the United States is people over the age of 80.

Many of us seek out plastic surgery and use tested and untested supplements, sundry potions and creams.

To paraphrase Buzz Lightyear, to try to be graceful in age with style.

To ensure that we age as best as we can, there are things that we can do to help preserve our mobility, prolong our ability to live independently, and in those instances when we must have assistance, be better able to help those who are trying to help us.

To discuss these techniques and more, we have as our guest today, Doctor Elizabeth Murphy.

Doctor Murphy earned both her Bachelor of Arts in Pre-physical Therapy Studies and her Doctor of Physical Therapy at Bellarmine University.

She is a home health physical therapist and has worked with several home health agencies here in the Louisville area.

Doctor Murphy, thank you very much for being with us today.

>> Thank you so much for having me.

Glad to be here.

>> How did you happen to wind up into the physical therapy world?

>> Sure.

So I am a klutz.

I was a big sports player.

I played tennis all the way through college.

But along the way got hurt numerous times.

So I myself was found in physical therapy.

So I have been through it multiple times.

And when I went to PT school, I actually went into it with the thought that I would work with more of athletes, kind of sports med rehab type stuff.

But as I went through school, I realized that I wanted to kind of focus more on daily activities.

What was important for people on a day to day basis, such as being able to stand up, sit down, walk to the kitchen, stuff like that, which brings a lot of meaning to many people's lives.

>> Yes, those activities are not overrated.

I can tell you.

But before we go on, one of the biggest problems, I think, with older people is them falling down.

So what are some of the problems with older people falling down, and what are the things around that that we can help do to try to minimize this and prevent this from occurring?

>> You know, falls are very multifactorial to say the least.

You know, it could be from strength deficits.

It could be even contractures impairments in their overall flexibility.

Of course balance.

If somebody has any dizziness, that's obviously going to put them at an increased risk of falls.

But then also simple things is how we live in our homes.

You know, what are the home factors that play into this.

You know, do we have certain setups in our home that are putting us at an increased risk of falls as well?

>> So like having cords, right.

Throw rugs and things like that.

>> Right.

Even just narrowed spaces in our furniture.

You know, if we have too little of a space between our coffee table and our couches, think about how much of a challenge that is on your balance to be able to maneuver.

So simple changes like that can make you safer in your home.

>> Well, here's a big list of things to ways we can do to prevent falls from from happening.

Tell me.

Tell me about a couple of these things and how important are.

>> So there are many different things in our homes that kind of place us at an increased risk of falls.

Kind of like how you already touched on the cords that run.

But then also, you know, our Bath rugs, they need to be more secured down.

We need to make sure that we have non-slip surfaces in our showers.

Those are easy fixes.

You know, we're not making full changes to our homes.

We're just making small adjustments to make them safer.

Even something as simple as proper chair heights, right?

If we have a really low chair, it's a lot harder to stand up from.

So if we had a higher chair or even got those little bed risers for underneath the leg post, that can make it easier to stand up from.

>> The commercial was help.

I've fallen and I can't get up.

Are those devices really helpful?

>> For sure.

Sure.

They've definitely come a long way over the years.

Now they even have like fall sensors.

So even if you aren't able to hit the button after you've fallen, some of them now have the capability to go ahead and call either your emergency contact or 911 if it senses that you have fallen.

So yeah, there are a number of progress made in those type devices.

>> So when we're talking about people trying to do things to obviously to keep them from falling, there are some exercises that people can do.

And you don't necessarily have to be up walking around doing them.

The things you can do in a chair, right?

>> Absolutely.

You know, especially for just generalized strengthening exercises, if somebody is at an increased risk of falls, we kind of defer towards sitting in that chair and doing some exercises.

You could always do some simple leg kicks, kicking that leg up straight, marching in place, rocking forward and back on your toes.

And of course, you can always do some arm exercises.

People normally don't have hand weights in their homes as they age, right?

It's just not something that they keep so easy.

Things that they can use are like cans of soup, vegetables.

Right.

That's a little bit less than a pound.

So it gives you an idea of, oh, that's a simple thing to use.

And of course stretching.

Right.

There are many times when I have patients who benefit from me just saying YouTube chair yoga, right.

There are different things online that we can utilize with technology to even further how our patients are doing outside of us, making visits with them.

>> So there are some real simple little things that we can do with all that.

What about standing because you made mention about that sometimes a chair height.

How difficult is it for some of the older patients to go to standing, and what can you do to help improve that?

>> Sure.

So as we age, and if we've had hospitalizations and spent time in the bed during that hospitalization, the primary muscle that we lose are our biggest muscles, our quads and our glutes.

And those are our primary workers for being able to stand up from the chair.

So if you think about those are being attacked first.

Normally when patients come home from hospitalizations, they do have that trouble from standing up from chairs.

Like I said, we could use bed risers, making sure you're sitting in a chair that's already a little higher, or something as simple as adding another cushion or pillow into the chair itself, just to kind of raise it up to make it easier for you to stand up.

>> But if you're trying to get somebody to exercise, sure.

To make it easier, what do you tell them to do?

What do you ask them?

Hey, do this.

Do.

>> Yeah.

You know what you could do as a lead up to it?

You know, to work on being able to stand up from a lower sitting chair is to do repetitive stands from an elevated chair height.

So if you had something like a bar stool, something where you're already up a little bit, if you did repetitive in that limited range of motion, that's definitely going to work on building up that quad and glute strength.

>> Is it better to have a chair that has armrests on it?

And is it better to have a chair that's more firm than soft?

Sure.

As far as getting out.

>> Of absolutely.

All those things make it easier.

You got to think about if you have those armrests, it's a heck of a lot easier to use those arms to help you get up.

You're not solely relying on those legs, right?

And then if it's a firm chair, you're not sitting down sinking into it.

Some of these soft sofas, couches, they have those soft cushions and they just kind of sink down into it kind of holds you back in there.

Makes it harder entirely.

>> Something we always hear about nowadays is core strength, particularly when we're talking about people with bad backs and all that.

What are we really talking about when we talk about core muscles, and what are some exercises that we can do to strengthen that?

>> Sure.

Actually, our core kind of runs from about mid torso to about mid part of our thighs.

Okay.

So it not only incorporates our abs and our trunk and all that, but also those glutes kind of that I was talking about.

If you're in bed and easy core strengthening exercise or bridges.

Right.

Bridges.

Yeah.

Where you're lying down on the bed.

Feet are underneath of you.

Right.

You got your feet bent so your knees are bent.

So your feet are underneath of you.

And you lift your bottom up and down.

Easy.

Simple.

Doesn't require any type of equipment, but very effective.

>> I've seen sometimes with people take a ball and put it between their legs.

Is that what does that do for you?

>> It's just a little bit of a different activation.

So you could do that even with the bridge.

But that's going to be working more of your inner thigh muscles.

They serve an important function as well, especially in your balance.

So it's definitely it's only going to make it a little bit harder and beneficial.

>> Is it natural that as we age we lose some muscle mass?

>> You know, just because age old thought is that doesn't mean that it has to be that way, right?

Really?

If we stay active, right, and we keep on doing the things, you know, day to day things such as simple walks, right?

Even just doing those simple activities can definitely help prevent the progression or regression in your overall muscle strength, for sure.

>> Activities of daily living.

>> Sure.

>> We must shop.

But yet I think some of us forget that it takes a lot of times two hands in order to carry things.

So how do you, you know, if you've got somebody that has mobility problems, what are some of the exercises you give them so that they can handle carrying their groceries or whatever?

And what does that allow them in terms of independence to do?

>> Right.

So it allows somebody to still live on their own as long as possible or as independently as possible, even if they're living with somebody else.

Right.

But it's simple balance activities.

Right?

Even if you're working on.

So you need both hands free to carry those things.

Simple things as if you're needing more support, say like with a walker or cane or anything.

If you stand at the kitchen countertop and try to stand there with your hands over the countertop and just keep your balance like that, right?

That's going to challenge that balance.

And then you can kind of progress from there.

You can stagger your feet, you can kind of put your feet closer together and work towards keeping your balance without those hand support.

And that can just be an easy progression for your balance for sure.

>> What about weights?

You know, we you know, are they a can.

Are weights a benefit or can they be a detriment to.

>> I mean appropriate weights okay.

Appropriate weights.

You know, that's why I was bringing up even the use of like a vegetable can or something.

You know, they're not overly heavy, right.

But it's an appropriate weight of what somebody that might be a little bit older might have to carry.

So you could look at even the cans, like how we were talking about are obviously like a gallon jug of milk would weigh more very appropriate to things that they would have to do every day.

>> But is it as much fun?

Yeah.

You want to, you want.

I'm working out with these weights and everything.

>> I mean, it's it's who has all these big weights though in their house as we get older.

I mean, it's just it's not it's not a serious expectation for me to walk into some of my patients and think that they have these weights.

So we just kind of have to get creative.

>> You know, got to get creative.

>> Got to get creative.

>> So tell me, in terms of quality of life issue, you know, using a wheelchair versus a walker versus a cane in terms of the strength things, can you exercise yourself out of a wheelchair?

I mean, there are no other maladies going on, but is that a role where you're trying to gain somebody with wheelchair and and how do you go about that?

>> Absolutely.

You know, it's very tailored specifically to the patient itself, obviously is I know you're aware of, but yeah, I mean, you can make serious strength gains like that to progress yourself from the wheelchair to being back, either walking with some kind of assistive device or maybe nothing.

It's all about how you kind of apply yourself as well, right?

So we come in as a physical therapist.

We're giving you exercises to do and normally exercises for you to do on your own, you know, and if you can continue to do those exercises when we're not there, think about those improvements that can be made much more exponentially than just if you're only doing it when you're seeing your physical therapist.

>> So you walk in the door.

What are you doing when you're evaluating the individual with whom you're seeing, and are you evaluating the individual?

Are you evaluating their home and are you evaluating?

>> Oh yeah, it's a full, encompassing thing.

So not only is it very much you pay attention to the patient and their physical limitations, cognitive impairments.

Right.

If we have a little bit of cognitive impairments, impaired safety, those things can put us at an increased risk of falls.

But you're very hyper aware of the home itself.

You know, you kind of are already taking in.

What does this house look like?

What are some things that we can adjust to make it safer?

Kind of like how we're talking about with adjusting the furniture, you know, picking up, throw rugs, taping down, throw rugs, checking out what shoe wear.

Right.

What footwear do they have on right.

Is it appropriate.

Is it giving them enough support?

Are they tied?

Do they need elastic shoe laces stuff like that.

That can be really easy solutions to make somebody safer in their home.

>> But I want to remain as independent as I can.

So what are you going to tell me to do so that I can I can go to the store.

Number one, I can walk to the store if I need to.

I can carry my bags.

So what are the things that are entailed when you're telling me, okay, you're lying down in that bed now, but we're going to get you to that point.

>> It's a small steps, right?

You can't.

What do they say about you can't eat.

What is it?

One bite.

Right.

It's the same.

Yeah.

It's the same thing.

You know, it's small little things.

So we start normally with lying down exercises.

People are pretty familiar, like all we talked about with those bridges.

But straight leg raises.

Just lifting your leg up straight out and down out to the side and in, you know, simple exercises that are still beneficial.

From there you progress to more of like our sitting exercises, kind of like we've already talked about.

And then further challenging towards standing.

It's all very specific based upon what the patient can tolerate.

Of course, you know, if they're going to be at an increased risk of falls with the standing, we might not have them doing them when we're not there.

We might just have them doing it when we have our hands actually on them, making sure that they're safe while they're doing it.

>> So what is the big difference, then, between getting physical therapy in the home versus physical therapy in an outpatient setting?

>> Sure.

So there are some qualifying things for a patient to receive home health.

So one, they have to be homebound okay.

So that means that no, they they can still leave the home.

It's just that it can't be very frequent.

It has to be short in nature and it has to be physically taxing on the patient itself.

So that is really the main thing for why somebody gets home health if they can't safely leave the house.

So as physical therapists come into the home, they're if somebody is able to leave the home consistently and get out and do things on their own, drive, that kind of stuff, then they're more appropriate for the outpatient setting.

Obviously, benefits to both sides, right?

Outpatient.

They can give you a little bit more of a push.

They got those machines okay.

You know, they just can do a little bit more with you where we just have those kind of limitations in the home, but equally served their purposes to say the least.

>> Yeah.

But it's so nice when you can do it all right there in the individual's home and everything.

What do you do with families?

Are you educating them at the same time you're doing?

>> Yeah, 100%.

If they have family that they live with especially, that just improves their carry over into what they're doing outside of our visits as well.

Family education can be on numerous things.

The exercises, it could be on those home adjustments that we were talking about and home health therapists.

We also deal with having to work on their medications, seeing how that plays into it, how that factors into it.

So educating even the family members on some of that as well.

>> You know, one of the things when Covid was going on, so much was happening with telemedicine, as you know, but now there are these look like there are these exercise or rehab programs that are online where people can, you know, log in to something.

How do you feel about that?

I mean, those benefit or do you still think it's necessary to have that inpatient stuff?

>> There were times where I know a number of home health agencies were utilizing kind of like a tele visit during Covid.

I have done it myself as well during Covid.

I personally do not feel that it's as effective.

It served its purpose.

It served its purpose.

But there's something about being with the patient.

Connecting with them kind of really help adjust how they're doing.

Certain exercises get my hands kind of on them and making sure they're doing it correctly.

Right.

Because sometimes when you're doing these telehealth visits, you can't see the big picture, right?

You can't see what's going on kind of around them to even make those adjustments.

>> So where do you stand as far as like when evaluating a patient with their medications?

Is that part of the deal?

>> Absolutely.

Yeah.

Because you got to think about even if patients are on certain kinds of medications like blood pressure medications, right.

If somebody is on a blood pressure medication when they stand up, their blood pressure may drop because of that.

That will make a patient dizzy, can make them fall, or at least at an increased risk of falls.

So there are a number of different medications that yeah, we want to be aware that they're on it and just kind of know how do we need to help their balance because they are already on that.

>> Tell me about canes.

What is the primary function of the standard little cane that we all see?

>> I mean, it's just an accessory to kind of improve that balance okay.

It's kind of a halfway point between you see patients using like a walker of some form and not using anything.

Okay.

It definitely requires a little bit more balance.

>> Okay.

>> But it, it just it improves your balance for when you just don't need those both hands on something at all times.

Okay.

It's just kind of a good halfway point.

And yeah, it it it does a good job.

Makes it a little bit easier for people to go up and down stairs if they're having to do that more consistently.

So there's a number of reasons when we would progress away from the walker to a cane or back.

>> I am convinced most of us are not using canes properly.

>> Yeah.

>> So if you got a bad leg, which hand do you put the cane in?

Or if you're just for weak, does it matter?

And how high should that cane be?

>> Sure.

Yeah, there are many people that use a cane.

Wrong.

I sit there in public many times and I will go up and correct people, so watch out for me.

But yes, if you have like a bad leg, say on your right leg.

Yeah, if your right leg is your bad leg, then you want to use your cane actually in your left hand.

It's because when we walk naturally we do opposite arm, opposite leg.

And it kind of serves as a counterbalancing mechanism, engages our core a little bit more.

And so yeah, that's how you have it offset.

And then the height is if you were standing and had your hands down to your sides, you want it to hit about where the crease in your wrist is.

Yeah.

>> All right.

Then there are these canes that have four points of the tip.

Is there any benefit of those over the cane that just has the one single point to it?

>> The real benefit is that it stays there when you put it there.

Right?

I stand it there.

I let my hand go.

If I'm sitting down, it's still going to be there.

But most people don't use them correctly, okay.

When they have that four point, you're supposed to have all four points on the ground when you're using it, but you'll see people, they kind of rock it on, rock it on, which is actually not how it's supposed to be used.

So most of the time, for most of my patients, I will recommend more of just the straight cane.

Okay.

People seem to use it a little bit safer and more compliant with having it on the ground at appropriate times.

>> What about a walker?

We've talked about that.

So when do you when does the person need to have a walker and should it have wheels.

And why don't why do they all have these tennis balls.

Yeah but go ahead.

When do we start to use the walker.

Yeah.

What's the.

>> Benefit of.

Depends.

You know, if somebody is just you'll see patients.

Sometimes you go into their houses and they've been using a cane, but then they're using the other hand to grab hold of the walls, the furniture, anything to kind of have that extra stability.

That's a dead giveaway.

Oh, shoot.

They need both hands.

Right.

So that's when we look into kind of a walker benefits to having the wheels.

Of course it's easier to move.

You know it's not start stopping as you're walking.

But there are many times when that standard walker without the wheels is appropriate, especially if somebody say, doesn't have can't put weight through a certain leg and they're having to hop, right.

We want a little bit more stability.

We want that standard walker versus the chances of that walker sliding out from them.

Those tennis balls.

Yeah, I mean they serve the purpose.

They keep the floors from getting scuffed up.

But there are many different different options out there.

Skis, caps there's plenty of different ones.

But people love those tennis balls.

>> What do you find when patients are in wheelchairs?

Do you have those folks tend to use more of the same kind of exercise like you do for the chair exercises, or do you have to really change things around for them?

>> Of course, it depends on what kind of their comorbidities are and everything what their diagnosis is.

But yeah, starting with simple seated exercises are a great way for people in wheelchairs to kind of get that exercise.

Of course, even propelling that wheelchair.

Right.

If we are in a wheelchair and you're having to move those wheels with your hands, if you're pushing your feet as you're kind of pushing around in that wheelchair, those are all going to carry over towards improved strength as well.

>> So what are the things that you're doing to make sure that in 50 years, when you turn 70, that you're still able to get out there and play tennis or pickleball will have taken over everything.

So what are the things that that you recommend that we should do and that you're telling yourself, okay, I have to make sure and do this.

>> This and this.

We're all guilty of falling into the trap off the bandwagon, right?

Of doing the exercise.

Personally, you know me, I'm a pickleball player.

That's my go to finding something that you enjoy doing, right.

It's not a job for me to go out and play pickleball.

You know?

I enjoy doing it.

It gives me the exercise that I need, gets me moving, gets my heart rate up, all positive things.

I also stay active with my kids.

You know, I'm coaching one thing, running this, all that kind of stuff.

So I'm just busy.

And that's kind of the stage that I'm at right now.

There have also been stages in my life where I've really been dedicated towards getting into the gym and taking these workout classes, and that's just currently not the season I'm in.

But it doesn't mean that I can't come back to it.

But those are all opportunities for us to continue to.

>> Prove ourselves.

We should do just do something.

Just keep doing it.

>> What you enjoy doing.

>> What you enjoy.

>> Doing, what you enjoy doing.

Because what is it going to do?

You're going to actually do it, right?

>> All I can think about is hearing that stupid sound of that pickleball pong pong.

And I wish I had invested in wiffleball.

>> Stuff, I know, right?

>> Elizabeth, thank you very much for.

>> Of course, thank you for.

>> Having me fun talking to you.

And you've given us some really, really interesting tips.

I'd like to thank you for being with us today.

As you have seen, while gyms are nice, one does not have to be a member of one to do the exercises that maintain or improve upon our abilities to perform the activities of daily living.

It is interesting to see how easily exercising can be incorporated into our daily lives, and how the great benefits can be obtained.

Just because we're getting older doesn't mean we can't have fun.

Let's not let anyone or anything or the calendar stop us.

If you wish to watch this show again or watch an archived version of past shows, please go to ket.org.

If you have a question or comment about this or other shows, we can be reached at KY, health at ket.org and I look forward to seeing you in the next Kentucky Health.

And please, if you're out on a pickleball court and you see somebody that looks like Elizabeth, please take her down for me and I'll be very happy.

Have a good day and we'll see you next week.

>> Kentucky Health is funded in part by a grant from the Foundation for a Healthy Kentucky.