Helping Aging Parents Cope with Knee Pain

"I can't…my knee hurts," says your parent, uttering a seemingly simple statement that in fact implies so much more.

Your parent may also have thoughts like, "Oh, no, is my hip going to go out next?  How will I get up the stairs? What's going to happen to me?"

As a loving adult child, you feel responsible for helping them get the support they need. But how do you help aging parents cope with knee pain?

Today, 30 million adult children are providing care for a parent or loved one over the age of 50—and that number is expected to double over the next 25 years.

According to the Center for Retirement Research at Boston College, 6% of adult children currently serve as caregivers, including 10% of adults ages 60 to 69, and 12% of adults age 70 and older. All are serving as caregivers in some capacity for their aging parents. 

There are many reasons adult care is required, but one of the most common is the elderly person's inability to get around due to knee or hip pain. Each year, millions of people are diagnosed with osteoarthritis (OA), a progressive condition associated with aging that often eventually leads to highly invasive joint replacement surgery. 

According to Joseph Bosco, M.D., an orthopedic surgeon who specializes in sports medicine and knee care at the NYU Langone Medical Center's Hospital for Joint Diseases, approximately 95% of knee pain caused by arthritis is osteoarthritis, which is wear and tear on the joints. Other types, like rheumatoid arthritis, are much less common causes of knee pain.

So, how can you help mom or dad get the right osteoarthritis (OA) knee treatment?

The first step is to ensure they are receiving appropriate medical care. And, if you are helping with your parent's care, it is important that you be involved in the conversations about your mom or dad's health and treatment plan.

Here are some other considerations for helping your aging parent cope with OA knee pain: 

Physical therapy

Only people with severe cases of knee OA typically have knee replacement surgery.  If your parent's doctor thinks it is too soon for surgery, he or she may prescribe physical therapy (PT) to help your parent strengthen the muscles around the knee. 

Staying physically active is important, particularly for people with mild- to moderate knee OA.  Depending on your parent's level of independence, you may need to help them get to their PT sessions.  If home visits are provided, you might still need to oversee the exercises mom or dad must do at home. If you are caring for your loved one from a distance, you can check in via phone or video chat.        

One important job? You get to be their cheerleader, regularly encouraging them to keep up with their exercises. 

"The earlier they can begin building strength in their knees through a structured PT program, the better chance they have of avoiding surgery," says Robert Agosto, DPT, director of physical therapy at the Sports and Spine Rehab Clinic in Rockville, MD.

Bracing 

Most people with knee OA have issues with their body alignment. If the spine, hips, knees and feet are not aligned properly to work together, the result can be increased pain as well as potential additional damage to affected joints.

To help your parent maintain mobility and ease their knee pain, their doctor might recommend a biomechanical evaluation and prescribe an "unloader" brace that has been specifically developed for knee OA. One of the leading options is the Unloader One® knee brace made by Össur. The Unloader One® features a lightweight, low-profile design and has been clinically proven to reduce pain in people with unicompartmental osteoarthritis of the knee.       

According to the Arthritis Foundation, a recent review of 25 studies of different biomechanical devices worn by people with knee OA found that knee braces and foot orthotics helped decrease their pain, joint stiffness and the amount of pain medication needed.

Medications

Many doctors prescribe medications to help with OA knee pain. There is a whole pharmacy of potential options, from aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDS) to heavier-duty opioid painkillers. But care needs to be taken so you are clear on how much, and when your parent should be taking their meds. 

Many people with OA also have other health conditions, including some which may also require medications.  Because some drugs can affect how other drugs work, talk with your parent's physician and pharmacist about the various medications they are already taking to make sure there is no risk of these adverse interactions. This should include any prescription medications as well as vitamins or supplements as these can all have drug interactions.  

You might want to keep a written list of all current medication names, dosages, and quantities, or use your phone to take photos of the medication labels. 

Finally, if your parent is experiencing memory issues as well as physical pain, there are steps you can do to help encourage them to take their medications correctly and consistently, including: 

• Use pill boxes that are labeled with the days of the week and divided into morning, daytime and night compartments. Keep these pill boxes in the same location all of the time.
• Set up a daily alarm when medications need to be taken.
• Set your own reminder alarms, and phone your mom or dad when it is time for them to take their medication.
• Post a calendar specifically dedicated to tracking medications.  Have your mom or dad check off each day and time they took their medication.
  

Weight Management and Exercise

Many OA patients also struggle with obesity, which wreaks havoc on the joints. Every pound counts when dealing with knee pain. Unfortunately, because of OA knee pain, most people tend to become less and less active over time. The result is a domino effect: exercising less leads to weight gain, which increases the pain and pressure on the knees, leading to exercising less... it can be an endless cycle.  

"When you gain ten pounds, it's like forty pounds across the knee, which is why the knees are so susceptible to weight problems," says Dr. Patience White, a rheumatologist, vice president of public health for the Arthritis Foundation, and a professor at George Washington University School of Medicine. 

Luckily, regular exercise can help to get rid of the extra pounds. You don't want to add pressure to an already-stressed knee, so first make sure mom or dad have been medically cleared by their doctor for exercise. If they get the green light, you can encourage them to wear their Unloader® knee brace and find activities that they enjoy. 

The good news is: they don't have to run a marathon – even regular walking, whether it's around the block or around an indoor mall, can help.

Some people with OA also find practicing yoga or Tai chi can help their condition. Clinical studies have shown that yoga can be therapeutic for people with knee pain caused by OA. The slow, flowing movements of Tai chi have also proven beneficial, improving pain, stiffness and physical function.  

"It's a mind-body exercise and arthritis is a mind-body disease," says Dr. Timothy McAlindon, MD, chief of the division of Rheumatology at Tufts Medical Center in Boston. According to Dr. McAlinson, Tai chi also lowers stress, which can influence people's experience of pain. "It also improves lower-body strength, which is important forpeople with knee OA."

Living Environment

You will also want to consider your parents' living environment. Although they may feel safe in their own home, take an objective look at the layout of each room. 

Make sure to clear any obstacles that could lead to trips and falling, such as furniture, loose rugs or piles of magazines that may spill over into walking areas. Arrange the living area to minimize the need to bend or walk upstairs. Move frequently-used household items at waist height as much as possible, and make sure all rooms are brightly lit so mom or dad can see potential obstacles. 

Mental Health

It is no surprise that living with chronic pain and declining mobility is enough to make someone feel depressed. One study found that most people with knee pain also have other sources of pain, and together, these can combine to limit function even more.  It can also increase feelings of depression and anxiety.  So, it's important to stay in tuned to how your elderly parent is coping emotionally with their reduced mobility. 

The good news is that today, people with OA knee pain have a lot of choices. They can explore therapeutic options to reduce their pain and other symptoms. 

And what about you, the loving adult child who's now providing care to their aging parent? Be sure you also take care of yourself physically, get adequate rest, and make time for the things you enjoy. 

To read more about unloader bracing, please click here.