In long struggle to recover, fear can be greatest foe
four small steps Angie Scardino's confidence plummeted as she confronted a set of practice stairs at Wingate nursing home in Needham. But with help and encouragement from physical therapist Christine Cochrane, Angie made it up and down three times that day. (Globe Staff Photo / Suzanne Kreiter)
It was a practice flight of just four steps, down in the basement therapy room -- or torture room, as patients at the Wingate nursing home in Needham call it. But to Angeline Scardino , it looked like 400.
Fifteen days after surgeons repaired her hip, and 11 days after her discharge from the hospital to Wingate, Angie was gaining strength and resolve. But she was losing the battle with fear.
The terror of falling again contorted her face and stiffened her 81-year-old body. Holding her breath and biting her lower lip, Angie pressed her forearms against the stair rails and forced her right leg onto the first step, then dragged the mended left leg to meet it. Aided and encouraged by physical therapist Christine Cochrane , who gripped a belt wrapped around her waist, Angie reached the landing, gasping for breath.
"Oh, God be with me," she whispered, as she turned to head down.
She thought of the four steps at the home in Franklin she shares with her daughter and gave herself a pep talk. "If I say I can't, I'll never get home and I'll never do for myself."
As Rita Erichsen battled to regain her will to live, Angie was facing an even more common crisis for hip fracture patients.
The paralyzing fear springs from the memory of the fall that caused the fracture, and the physical weakness that is brought on, or aggravated, by it. Some fear is perfectly rational, and the weakness, understandable. But together they can stall or derail recovery. The panic tends to be most persistent, when there is, as in Angie's case, no clear reason for the fall.
Because of these factors, about three-quarters of hip patients over 65 need inpatient rehabilitation at a nursing home or rehabilitation hospital, where they get physical therapy to strengthen their muscles and balance, plus occupational therapy to help them with personal needs, including dressing and bathing. Patients typically receive two to three hours of therapy each weekday as inpatients, and most get some therapy through visiting nurse agencies in their first weeks home.
But no one knows if this is the best way to combat weakness or fear.
Several ongoing studies are comparing rehabilitation approaches and may have answers soon. A few are focusing on fear of falling. Studies suggest as many as one in seven patients with hip fractures will break a hip again, greatly increasing their risk of death and disability.
So, for now, physical and occupational therapists attempt to reduce patients' fears by nudging them safely through the activities that scare them.
During her first two weeks at Wingate, Angie worked daily to strengthen her legs, progressing from bed exercises to leg lifts standing at the parallel bars. She advanced from a stiff-legged limp to a slightly uneven walk. She worked on her balance with ball tosses, and, in a cooking class, practiced letting go of her walker to open the oven.
Sitting in her room one day, she felt emboldened. "I think I'll do it myself," she said, pointing toward the bathroom about 20 feet away. Then the fear crept in. Dejectedly, she pushed the call button.
"She's not taking charge," said Nasreen Quddus , director of occupational therapy. "When she goes home, she should be able to take care of herself for a couple of hours."
Wingate's staff delayed Angie's discharge a week to build her confidence in everyday activities. Angie's daughter, Joanne Hogan , encouraged her to think positively, worried that dwelling on the fear would scare Angie into falling again. But Joanne also didn't want Angie to take any risks.
As Joanne arrived to visit one afternoon, Angie was eagerly leaning forward in her chair, resting her arms on the walker in front of her.
"Don't be sitting too far up in the chair" were Joanne's words of greeting.
"The beginning of the drill sergeant," answered Angie. "My daughter's already laid down the law. She said, 'You're not going anyplace without that,' pointing to the walker, 'and without me.' "
Angie had disregarded such edicts in the past, but now she was going along. She was determined to get home.