Aging & the Ultralight User's State of Mind
While preparing for an article on transitioning wheelchair users from manual, self-propelled mobility to powered mobility, Angie Kiger, M.Ed., CTRS, ATP/SMS, clinical strategy and education manager at Sunrise Medical, wanted the opinion of a friend who has used an ultralightweight manual chair for roughly 40 years.
What would you think, Kiger asked, if I said you needed to switch to a power chair?
“He had a very visceral response,” Kiger said, “which didn’t surprise me at all. He said, ‘It freaks me out, quite frankly.”
Is Age Just a Number?
While popular wisdom would have us believe that age doesn’t define our abilities, the human body does change as we get older, no matter how we feel emotionally.
And while it’s understandable for the “manual to power” discussion to cause strong reactions, Kiger said that suggesting changes to an ultralightweight manual chair can also be difficult for a long-time user to hear.
“I think the biggest obstacle is that the clinician may see that something has changed [with the user], but it’s the acceptance from the end user, who will say, ‘Whoa, I have to change something?’ The big question is going to be why. Because for example, they get used to propelling a certain way, even if they aren’t propelling efficiently. It’s the way they’ve always propelled.
“There’s a huge stigma about moving to a power chair, or even switching anything out on a manual chair. Oh, you needed to add that to your manual chair? You look more disabled now.”
That could explain why middle-aged clients who’ve self-propelled for decades can resist a clinician’s suggestions, even if those clients are noticeably struggling.
Kiger said of her friend, “Every time we talk about propelling his chair, he cringes a little bit, because he says he knows.” Not long ago, her friend had to install a lift to make transfers easier. “It’s not just propelling the wheelchair. He said he had to come grips with his shoulders [and install a lift]. That was a huge ego blow. It’s getting to the emotional point of being ready to say that, because you just feel more disabled. Not to mention all the other aspects of your life that are going to be changing.”
Dealing with the Aging Process
Longtime self-propellers, of course, also experience the natural consequences of aging.
“The fact that people don’t like talking about is weight gain,” Kiger said. “It’s not just a matter of the looks of it — ‘I went from a 16" wide to an 18" wide.’ You could be pushing around more weight, asking your upper extremities to push more weight. Unless you’re an elite athlete and you don’t gain weight. But most people do.”
So how do you convince longtime clients that perhaps the time has come to consider some changes? Kiger said for some users, seeing is believing.
“You’ve got to do the mat evaluation,” she said. “You’ve got to do the strength testing. Numbers speak. If he says, ‘I want the same old chair,’ I say, ‘Hop onto the table and let me take some measurements real quick.’ If I get him at being 2" wider than he thinks he is, and I have to explain why, it’s a little easier for folks if you’re able to show them the numbers and the measuring tape.”
And ultimately, it helps to know your client and how he or she processes information and makes decisions.
“We just don’t take enough time to get to know people, like ‘Oh, here comes Mr. Smith; he needs all the facts in black and white.’ Or, ‘His wife makes all the calls on this equipment, so I have to be sure to pitch this to his wife.’ It’s a triangle: the user making the decision, the funding, and clinically what they need. It’s a careful balance.”
For users reluctant to make major changes, Kiger suggested compromise: “Maybe this time, we go with this set of wheels. Let’s give that a try, as opposed to changing the entire frame.”
The bottom line might be that everyone, wheelchair user or not, finds it hard to accept the changes that come with aging, especially when we think of our younger selves.
“There are some times you’re not going to win,” Kiger said. “The user is going to argue, and you’re not going to change them. If you push them and say, You have to get this one, I’m the expert, they’re going to say, ‘Uh-huh, thank you.’ And they’re going to put it in their closet and still use their old one. So maybe, compromise.”
This article originally appeared in the November 2017 issue of Mobility Management.