Helping Your Loved Ones Stay Strong and Healthy as They Age with Dr. Mitchell Straub, Vital Rehab and Wellness

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[00:00:31] What you want, when you want it, where you want it. This is The MESH. Hello, we're so happy you've joined us. Today we're talking about helping your loved ones maintain their strength, their balance, and their overall well-being. Specifically, we'll talk about the intersection of well-being with physical therapy and how it can help seniors stay mobile and active.

[00:01:02] Welcome, I'm your host Karen Summey, Project Manager for ACAP Community and an active family caregiver. If you're listening to our live broadcast, today is Friday, April 4, 2025, at 12 noon Eastern Daylight Time. Both my guests and I are live in the chat panel as you watch the show we recorded last week. We're standing by ready to take your questions and comments during the broadcast.

[00:01:27] To join in the discussion, simply sign into your YouTube or Google account to access the chat panel on YouTube. If you're listening to our replay, you can also sign in and leave comments below your video screen, and we'll get back to you very soon. So let's dive in. My guest today is Dr. Mitchell Straub, owner and founder of Vital Rehab and Wellness in the State College, Pennsylvania area.

[00:01:52] Dr. Straub holds a doctor of physical therapy degree and is the only practicing physical therapist in Center County, Pennsylvania, who is board certified as a geriatric clinical specialist, which allows him to deliver superior results for his clients. And we're happy to say that he also serves as chapter coordinator for ACAP Center County in State College. Dr. Straub, welcome to First Fridays with ACAP. Hey, welcome.

[00:02:22] Thanks. Thank you, Karen, for that wonderful introduction. And thanks for having me and looking forward to diving into our discussion today. Thank you. We're so glad you're here. And I have really been looking forward to our conversation today. You know, I think most people want to stay healthy and strong as they age at any age. But as we move into our senior years, we encounter challenges that don't always allow us to do as much as we'd like.

[00:02:50] And it gets even more difficult as we go. So we're talking today a little bit about staying strong and healthy and how that relates to physical therapy. So could you just start by telling us a little bit about physical therapy itself and when that is prescribed for people? And when it is, what are their goals when they come to physical therapy? Absolutely. Absolutely.

[00:03:16] So if you look at our organization, the American Physical Therapy Association, they'll describe physical therapists as movement experts, exercise specialists. And that's really what it boils down to, whether we're working with an infant all the way up through all years of life. We're looking to help people move better.

[00:03:41] And in this specific case, and in my case, what I do every day, it's helping older adults move better, move more independently. And a lot of people will say, you know, when should I do physical therapy? When's a good time? And, you know, really, there isn't a bad time to dive into physical therapy and to start it.

[00:04:07] If you find that you're losing a little bit of your independence, if you find that you aren't, if tasks are becoming more difficult, you're having more trouble getting around the home, or a loved one is noticing that, that would be really an excellent time to get physical therapy involved. Because so often, physical therapy is almost viewed as a reactionary measure. You know, we're involved after something happens.

[00:04:37] And one thing, especially with my company and what therapists are starting to do all over the country, is we're trying to be viewed as a more proactive measure in the health field. You know, so let's get therapy involved before something happens, before a loved one falls, before they're hospitalized because they're not moving as well, whatever it might be.

[00:04:59] Just trying to be involved earlier on so that that aging process goes so much more successfully. I'm really excited about what you said about prevention and being proactive because so much of what we see in our health care system today really deals with sickness and taking care of things after they have occurred. And I would love to see us move more in the direction of prevention and proactivity.

[00:05:26] So we're talking today about caregivers and their relationships with their aging parents. And we really could be talking with anyone about physical therapy concerns, but we'll focus it a little bit on caregivers. And, you know, it can get difficult for caregivers who may not recognize that an aging loved one needs physical therapy.

[00:05:49] So what are some signs that will indicate to them that maybe it's time to seek professional help? Yeah, that's a great question. And there's one huge factor that I educate everyone on. And almost every time I say it, people are almost shocked or surprised. And the number one thing caregivers should look out for is walking speed.

[00:06:17] And how fast is my loved one moving? Ask yourself, is mom or dad or whoever you might be caring for, does it seem like they're maybe taking longer to walk to the bathroom? Is it, are they taking longer to walk to the kitchen to grab a snack or whatever it might be? We know in the physical therapy field that the number one best predictor for fall risk is a decrease in walking speed.

[00:06:47] And when people hear that, they're like, oh, well, I told mom or dad to slow down. I told them to be careful. I told them to be cautious. And actually, the slower we walk, and we've studied it a thousand times, the slower we walk, our likelihood of falling goes through the roof.

[00:07:05] So if you notice that your loved one is having more difficulty, isn't getting around as quickly as they used to be, that should be a very tell sign. Okay, you know, we should look at getting mom or dad some help here because something's going on. Something caused that. That's why they're going slower. What is it?

[00:07:27] Let's address it before it leads to falls, injuries, hospitalizations, all of those things that come after a fall can happen. So that's one of the biggest things. But really any change in their independence, you know, you find that you're helping mom and dad more with anything. They're not able to do all of their self-care activities. It might be appropriate to get an occupational therapist involved.

[00:07:58] You know, they can't get up and down the stairs like they used to. I'm doing more of their laundry. Whatever it is, something's going on that they're not able to do that. Let's figure it out and see if we can help maintain that independence as long as possible. So then you take a little bit off your plate as well if you're not having to do as much as the work as needed as the caregiver. Right. And briefly, can you give us a quick definition of the difference between physical therapy and occupational therapy?

[00:08:28] Absolutely. And sometimes it's easy to do and sometimes it's hard. My wife's an occupational therapist. I'll be explaining it sometimes if I'm talking to a client on the phone because we have physical and occupational therapists in our practice. And I'll explain it and I'll hang up and she just glares at me. She's like, what were you talking about?

[00:08:52] But the easiest way to explain it is that physical therapy focuses more on movement and walking and balance. And occupational therapy will focus more on self-care tasks. We call ADLs, activities of daily living.

[00:09:15] Or IADLs, which would be more of like writing checks, grocery shopping, meal prepping, things like that. They focus a lot more on those tasks. But obviously you can see there's so much parallel between the two disciplines because if your balance isn't good, you're going to have a hard time cooking meals or going grocery shopping. Absolutely.

[00:09:38] There's so much interchange, which is why we encourage our clients to utilize both physical and occupational therapy when they're working with us. Because even though there is so much interchange between what we do, there's two very different trainings and schools of thought. So there's times where I don't see something, but when one of our occupational therapists is involved, they have all these great ideas.

[00:10:07] And I'm like, oh my goodness, I never even thought about that and vice versa. So it's a really good complement between the two. All right. Thank you for that explanation. I really was not certain of the difference. So I appreciate that. Any other signs people need to be looking at before they seek out help? Those are really the big things. Okay. You know, really paying attention to what has changed.

[00:10:35] Are you having to help more as the caregiver? And if so, so often we think, we just write it up to, oh, you know, mom or dad is getting a little older. It's just age. And that's certainly not true. Just because we are getting a little bit older doesn't mean that all of a sudden we can't care for ourselves. We can't do different things. We can't take care of our home.

[00:11:01] So if something's causing that and we don't know what, it would be a good idea to figure out why that's going on. Okay. Thank you. So many of us worry as caregivers and our care recipients also worry about losing their independence. That's a really big thing to stay in your home and to live the life that you've always had and to keep enjoying that as you get older.

[00:11:27] So how can physical therapy help seniors to maintain that mobility and continue doing the things that they love to do? Yeah, that's a great question. That's so big, you know, with older adults not wanting to lose that independence and trying to stay in the home that, you know, they've built and have raised a family in. And there's usually so many memories attached to that home.

[00:11:55] And losing their independence, they view as kind of that first step to maybe losing all of those memories and not being able to be in their home anymore. So working on that independence and helping them keep as much of it as possible is such a big focus of what we do. And it starts on day one with our evaluation. We're going to look to see what is it?

[00:12:23] What things are you having the most difficulty doing? What are things that you wish you could do more of? And insert whatever answer you can think of. You know, it's playing with grandchildren. It's being able to cook a meal for my family again. It's I just want to be able to take care of my home. I would still want to be I don't love the laundry, but I'd rather do it than somebody else. Cooking, cleaning.

[00:12:52] It's any of those things. So we're going to look at all of those different tasks and look at the body and see what is it? Why? Why is that difficult for you? Is it a range of motion issue that you can't get down and clean your floors? Is it a strength issue that you can't get up and down the steps? Figuring out what is the underlying cause? That's the biggest thing.

[00:13:19] What exactly is happening that you have lost this ability? And then going from there and treating that ability with all of the different tools that we have, whether it's working on balance, range of motion, mobility. And then this is another great area where occupational therapists get involved is sometimes everything that we do is physical therapists to build their strength.

[00:13:46] Sometimes there's an underlying cause that just it isn't in the cards. So then we need to look at modifying tasks or introducing adaptive equipment. And that's where occupational therapists can come in and just make a world of difference on the different recommendations that they might make. And that's where having both disciplines involved really can make or break a lot of cases. Right.

[00:14:12] Well, as someone who has been to physical therapy in the past, I have always appreciated the fact that when I go in, the therapist kind of meets me where I am. And no matter how much I might worry about going to that session or thinking, am I going to be able to do this? I always find that the therapist is very aware when I walk in of what's going on with me and the reason I'm there.

[00:14:38] And then they very gently start me where I am and kind of build up my strength and get me to the place that I need to be. And it's been so very helpful for me. And so I very much appreciate what you do. And I appreciate it as a caregiver as well and knowing some of those things. You know, my mom, we're so blessed to still have her with us at almost 92 now.

[00:15:05] And she is losing some of the things that she loves to do and the things that make her happy, like being able to crochet. That's always been a big thing for her, and she's losing that ability. So your conversation so far is even persuading me that perhaps I need to see if there's a way we can get her to maybe an occupational therapist. I think that would be correct.

[00:15:29] And see if they could do something to strengthen her hands a little bit so that she could enjoy that thing she's always loved. So that's a conversation I think we may be having soon. There you go. Yeah, okay. And that leads right into my next question, actually. For caregivers who want to be more proactive about their loved one's health,

[00:15:51] what exercises or daily habits do you recommend to promote the strength and the balance and their overall well-being? Sure. And that's one we field a lot. And it's always sometimes a tough conversation because, you know, you as the child kind of providing some caregiving efforts,

[00:16:18] maybe sort of have the answers to the test, if you will. And it can be difficult a lot of times to get mom or dad on board with different things. You know it's important for them to exercise, but it's really hard to have that conversation. And when it is had, it's often met with resistance. And we have a couple different strategies that I generally recommend to caregivers to try.

[00:16:49] But one thing that's important, too, and I'll say this first, is understanding also that our loved ones, our older adults that we're providing care for, that's still a human being. And they still have autonomy of choice. And it's our role to maybe educate and recommend, but also understand that at times they're comfortable with where they're at.

[00:17:18] And no matter what we do, they're not going to make a decision that sometimes is best for them, and we know that. So I always lead with that because I think that's an important thing to understand. But also there's some tips and tricks that we can use to be as persuasive as possible without mom or dad taking our name off the wheel.

[00:17:46] And the very first thing I do is I say, you know, maybe most health systems now have some sort of portal where you can communicate with doctors and stuff. I have found 100% of the time that the older adults will listen to a guy or a gal in a white coat a lot more than they're going to listen to a family member.

[00:18:09] So shoot your doctor a message before an upcoming appointment and say, hey, you know, I think mom or dad would really benefit from some sort of exercise or movement routine. They really don't do much at home, and I noticed it's affected them in X, Y, and Z ways. Would you please, during their follow-up, would you please just mention, ask them what they're doing for exercise and maybe recommend that they start exercising, maybe recommend physical therapy.

[00:18:39] That I have found to be super powerful and very often not met with a lot of resistance compared to you walking through mom or dad's door with a couple weights and telling them to try and exercise a little bit. So that's one way to go for sure.

[00:19:01] Another route that I recommend, and it's no different than what we would do, is therapists, is this idea of what we call motivational interviewing. And just trying to understand what it is for that older adult. What motivates them? What are some things that, why do they get up in the morning? Why do they leave their bed? Why do they come out into the living room? What is that underlying factor that pushes them to move forward?

[00:19:31] And as we get older, those questions sometimes are harder to answer. But if we can find that answer and if we can identify some sort of meaning to life that that older adult still has, then we can lean on that to try and encourage exercise. I have found one of the most powerful motivators to be grandkids.

[00:19:53] You know, so you want to be able to play with your grandkid, get up and down off the floor, pick them up, give them a hug, all of those things. Sometimes that can be a tremendous motivator to encourage some movement.

[00:20:10] You know, I really like the idea about the motivational interviewing because as children, we grew up with our parents and we probably think that we know them very well. But the reality for many of us, particularly as we approach caregiving years, is that we've been out of their home for many, many years. And the people they were when we lived with them has probably evolved just as it has for us.

[00:20:39] And we may not know anymore what really motivates them. I know that my priorities change as I age. And so how can I imagine that my parents' priorities haven't changed as well? So I really like the idea of just asking them because they're still in charge. They're still the parent. They still have their own life and their own independence. And what they choose to do with that is still their decision.

[00:21:09] So I really like the idea of just asking what that all means for them. Yeah, and I think as you were mentioning that I thought back to a recent conversation I had with one of my clients who her family is very involved and not in a bad way. They're trying to encourage her to do more and more. And she needs that. She's someone who probably could move a little bit more than what she's doing.

[00:21:37] And she said that her and her daughter went out shopping over the weekend. And the daughter was trying to encourage her to get some new outfits and try some things on. And she just kept saying, I don't want to. I'm not interested. She lives alone. She doesn't get out of the house much. And the daughter had said, well, you always used to like to dress up.

[00:22:00] And yeah, you know, 20 years ago when she left the house and her and her husband were still dating and going out for meals and stuff. Sure. I'm sure she did. But now that's not motivating to her. That's not something that inspires her to get up and out of bed in the morning.

[00:22:23] And that's a great example of how we change as we age and what becomes important and what's a priority for us and what motivates us. That's right. So if people want to, if our viewers today want to take some sort of action and they're observing some of these signs that you've told us about, what do they need to do to get started on this journey?

[00:22:51] Do they need a doctor in a doctor's order to reach out to physical therapy? How do they get started and kind of how does that process go? Sure. So sort of a tricky question. It is different in every state as far as how physical therapists are allowed to practice. knowing that probably a good chunk of your audience is in the North Carolina area, I should have done some research before this.

[00:23:21] That's okay. We actually have a national audience. So you tell us the general kinds of things and know that each person in each state has to figure out how they do it in their state. That's right. That's right. So some states allow what we call direct access. So the therapists are allowed to practice autonomously without a referral from a doctor.

[00:23:46] Other states, they still require a script from a doctor before starting. But my biggest recommendation is don't wait. If you see something going on, be proactive. Don't wait for that first fall to occur. Don't wait until you're exhausted and burnt out from helping mom and dad to get extra help on board. It's never too early.

[00:24:14] And older adults can always build strength. You know, I talk to so many people that think, well, how is therapy going to help? Well, my mom and dad, they're 86. Like, why? And we can, no matter how old we are, we can still build muscle. We can get stronger. We can still move better. So don't wait. So to answer your question, reach out to your family doctor.

[00:24:40] If it's something that you think is needed, get that script for physical therapy. Get in touch with your local therapy group and get set up because it's certainly not going to hurt. And more times than not, it's going to be a great thing for you, for your loved one, to prove the situation for everybody. Right. Well, I'm a big fan, and I really appreciate all that you've said today.

[00:25:06] Is there anything else before we close that you have a real desire to tell the folks who are listening today about, you know, their strength and their well-being as they age? I guess my closing statement would be, and I kind of already alluded to it, but movement is for everybody. And it doesn't, again, it doesn't matter if we're 25 or if we're 95.

[00:25:33] If we have the ability to move, we should be doing it. Every day of the week, we should be getting up walking. At least a couple times a week, we should be doing some strength training, whatever that might look like that looks different for everybody. A couple times a week, we should be doing some balance training. And again, that looks different for everybody. So that's where it's really important to get a professional involved,

[00:25:59] because it would be very irresponsible of me to hop on here and run through a list of things to do, because it's so different for every individual. And that's why it's so important to get involved with a professional as quickly as possible, so that you can get on a nice individualized plan. That's going to help you, your loved one.

[00:26:25] And yeah, that's my biggest cry, is that anybody and everybody should be moving. And there's some very small exceptions in there. But for the most part, we all should be moving and exercising. And sometimes some of us just need a little more encouragement and help than others. And if that's your loved one, hopefully I provided some helpful tips today to help get there. You've certainly given me a lot to think about.

[00:26:53] And I just want to thank you, Dr. Straub, for the great insights and the tips that you've given us to stay strong and live our best lives in our senior years. It's something we all strive for. Absolutely. It's important. And anything I can do to help spread the word to keep people moving and age successfully, that's what it's all about. Great. I want to thank you, our viewers and listeners, for being with us today.

[00:27:23] Hopefully this information is something that you can take and be proactive about for yourself and your older loved ones. If you haven't already done so, please be sure to click the Like button below your video screen. And if you'd like to hear more of our broadcasts, be sure to click the Subscribe button as well.

[00:27:47] We also want to say thank you to Pace at Home in Newton, North Carolina for sponsoring all of our caregiver community podcasts and to every age, our sustaining partner. Please join us again on Friday, May 2nd for our next episode. You can view the replay of today's program through our ACAP community website at www.acapcommunity.org

[00:28:12] or find the audio podcast as part of the Mesh Network of online shows and podcasts. You'll find our podcasts on any platform where you listen to podcasts as well as on our website. If you visit our website, we hope you'll take a few minutes to learn more about ACAP, our free educational programs for caregivers, and our local community chapters offering in-person programs. And if there are other topics you'd like us to address on our first Friday's Lunch and Learn,

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