Daily activities can be very difficult to perform and limitations can be very difficult to manage when someone is very sick or frail. Having a partner - a family member, friend, or caregiver - can be helpful.

The common needs of the very sick and frail relate to the need to complete everyday chores and housekeeping and to transportation. Moreover, about half of the very ill or frail live in environments that are not well-suited for persons like them. Information about assistive devices is also often needed to help with everyday activities.

Aids for dressing, cleaning, eating, and homemaking can help with limited joint motion and strength. Many aids can be made from inexpensive materials (e.g., wrapping handles of utensils with foam tape for better gripping when hands are weak and painful, and joint motion is limited).

Splinting is sometimes prescribed for a painful joint. Common splints include "cock-up" wrist splints and elastic wrist/hand supports. Splints for arthritis are extremely useful. When both sides are involved, try the splint on the most important side first.

Very sick and frail persons are at risk for falls if they are unable to stand from a chair without using their arms and have poor vision. Prevention of falls is important. The best ways to prevent falls are to:

• review the list of things you can do to make your house safe
• keep upper thigh muscles strong by doing exercises (see below).
• talking to the doctor if there has been a fall. Medications can be a cause for falls - persons on three or more medicines are at the highest risk.

Problems with legs can affect your balance. Your doctor usually checks your balance by asking you to "get up and go" from a chair and stand for a few seconds on one foot.If you are unsteady with these tests, exercise the legs (see below) and practicing balance can be helpful. A walker, cane, or crutches may also be needed.

Canes and crutches increase stability, support a weak leg, and reduce stress in the hips, knees, ankles, and foot joints. A cane most often is used on the side opposite the painful or limited leg. The grip should be large and positioned to cause only a slight bend at the elbow when leaning on the device. When you stand straight, the handle should just reach the wrist joint. A four-legged "quad" cane is more stable than a simple cane and is used for people whose legs are weak and not stable. Only 25% of your body weight can be carried by a regular cane, but a lower arm crutch is able to support twice as much. Crutches that reach your armpit may increase the risk of falling backward.

If you have poor balance and leg weakness, and also have weak arms, a walker is a better aid, since the base provides maximum support. Using a walker may improve strength to allow you to graduate to a cane or crutch. Wheeled walkers are useful for people who may not be able to lift a walker. Such walkers can be hard to move over thresholds and plush carpets. Walkers should be fitted in the same way as a cane.

Ankle-foot supports stabilize the ankle when you are standing. At the same time, they help people lift the toe area of the foot when walking.

A few people require a wheelchair at home because of limited endurance or because they are at an exceptionally high risk for falls. With long-term wheelchair use, the main issues are ease of transfer, stability, cushioning, and the angle of the backrest. Before selecting a wheelchair, a home assessment must be performed to evaluate floor surfaces, door widths, ramp widths, and height of the stair tread.

Aids are very helpful to assist movement from a sitting to a standing position or to use the bathtub and toilet. Proper installation and adjustment of the height of these aids is important. A home visit by a physical or occupational therapist may be needed to ensure their safety and usefulness. Safety bars and rails should be mounted on wall studs, the floor, or clamped to the tub or toilet where the most useful side of your body can help the transfer.

When transferring to the bed, chair, or toilet, it is generally easier to move on the most functional side. The "good" side will be used to lift or support you until you can pivot 90 or 180 degrees. Once the turn is complete, you must be certain to feel the seat touch the back of your calves before sitting.

Balance problems can also be caused by nerve damage or medications. See your doctor if you feel dizzy or fall often.

Exercise, Relaxation and Fear of Falls

To manage their physical and emotional needs the very sick or frail most often want information or help with exercise and relaxation. Depending on their background some approaches may be more effective than others. For guidance about relaxation the very sick or frail person should think about those times when she or he was most able to relax and what they found most relaxing.

Exercises for someone who is very sick or frail depend to a great degree on what actually can be done. Chair supported exercises are most often useful.

Fear of falling is common and greatly limits quality of life, helpful exercise, and, of course, fear of fall makes it hard to relax.

Accidents seldom "just happen", and many can be prevented. Because accidental injuries occur more often in later life and result in more serious injuries, attention to safety is especially important for older people.

Protect yourself and your loved ones! Check for harmful things at home, at work and during recreation.

At home are:

• Stairways and halls well lit?
• Loose rugs and extension cords in the way?
• Handrails sturdy and 30 inches higher than stairs?
• Medicines and poisons locked or out of reach?
• Outside steps, ramps, and walkways repaired?
• Water heaters set so that water will not scald skin?
• Smoke detectors in working order?
• Emergency exits planned and quick and easy to unlock?

Falls are the most common cause of fatal injury in very sick and frail persons. When we are very sick or frail, the following "little things" can make a big difference to prevent falls.

• Have vision tested regularly and properly corrected.
• Make sure that medicines are labeled with large print. Both illness and the side effects of medicines increase the risk of falls. Use egg cartons or special containers to lay out pills correctly.
• Limit your intake of alcohol. Even a little alcohol can disturb already impaired balance and reflexes.
• Use a cane, walking stick, or walker to help maintain balance on uneven or unfamiliar ground or if you sometimes feel dizzy. Use special caution when walking outdoors on wet and icy pavement. Have a grab bar installed in your bathroom if you are the least bit unsteady.
• Wear high-collared shoes that have rubber soles and low heels. Avoid wearing only socks or smooth - soled slippers on stairs and waxed floors. They make it very easy to slip.
• Approximately 5% of adults have a lot of problems feeling dizzy. If you feel dizzy, use caution in getting up too quickly after eating, or lying down or resting. Low blood pressure may cause dizziness at these times.
• Make sure that the nighttime temperature in your home is no lower than 60°F. Prolonged exposure to cold temperatures may cause body temperatures to drop, leading to falls. Most older people cannot tolerate cold as well as younger people.
• Maintain a regular program of exercise. Regular physical activity improves strength and muscle tone. This will help you move more easily and keep your joints, tendons, and ligaments more flexible. Many older people enjoy walking and swimming. Mild weight bearing activities may even reduce the loss of bone due to osteoporosis.

1. DO Understand that quality of life depends on much more than your disease, your medicines, and your medical care. Quality of life depends greatly on your social activities, where and how you live, and how you choose to respond to your problems and concerns. Spiritual beliefs may also have an impact on your quality of life.

2. DO try to stay socially active and try to understand as much as you can about how to manage problems that might come up.

   For people like you with similar illnesses and finances, those who feel that their quality of life is positive are much more likely to be socially active and feel pretty confident they know what to do for their problems.

3. Don't be afraid but also know that fear is common. About 8 out of 10 persons who have a negative quality of life list 2 or more fears. About half as many (4 our of 10 persons) who have a positive quality of life have this many fears. So many persons who are very ill have some fears.

   Yet people as sick as you who are socially active and understand as much as they can about managing problems have the least fear.

4. Do make your own list of Dos and Don'ts. What is best for you may be different from what others say or do. You need to make your own list. The other tools on HowsYourHealth can help you make your own list. Before you use these tools or make your own list, quickly review some Dos and Don'ts ideas from someone like you. You may find that some of the ideas that would be on your dos and don'ts list.

The common needs of the very sick and frail relate to the need to complete everyday chores and housekeeping. Transportation is another common need. About half of the very ill or frail live in environments that are not well-suited for persons like them.

Less common, but very limiting are needs for assistance with hygiene and toileting.

To manage their physical and emotional needs the very sick or frail most often want information or help with exercise and relaxation. Information about assistive devices is also often needed to help with everyday activities.

Talk to your partners honestly about your most important problems. When there are many problems, help your partner understand the most important. Once you deal with your first priority, you can work on the next problem. Big problems are best solved by breaking them into smaller problems. The earlier small problems are managed, the better the result. (See also Problem Solving)

* Talk to knowledgeable people and learn about what has worked for others. You are not alone. Others have been through similar problems.

* Be honest with yourself; recognize your strengths and limits. Be sure that you understand your feelingsabout accepting and giving help, changing behavior, dealing with change, and dealing with sickness. Make a list of strengths and limitations.

Your partners should always try to recognize problems that limit your ability to perform your usual activities and take part in social events. If the cause cannot be treated, you might want to try assistive devices and support services. Examples of support services include:

• transportation services
• social services
• homemaker services
• home health or personal care aides
• friendly visitors
• rehabilitative services
• counseling services
• recreational services
• financial and legal counseling
• home meal services
• day care and senior center support groups
• phone and actual "house calls" by your doctor or nurse

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.