Why the ability to stand, dress, or walk in dementia depends on pain, fatigue, the room, and how much help shows up, not just strength.
A woman at an adult day program had the hardest time getting out of a chair. Staff would walk her through it step by step. Scoot forward. Feet back. Lean forward. Push. Stand. And the more instructions she got, the more stuck she became.
But if you simply held out a hand and said, "come with me," she had a much better chance of standing up on her own.
Not every time. It was not a magic phrase. But it happened often enough that you had to wonder. Same woman. Same chair. Same legs. She did not get stronger the moment someone said "come with me" instead of "stand up." So what changed?
I tell caregivers this story because physical function in dementia gets reduced to one question constantly: is this person strong enough. That question misses almost everything that actually decides whether someone can get out of a chair, get dressed, or walk to the bathroom on a given day.
What the Physical Spoke Actually Means
The Wheel of Function Framework™ looks at five spokes that all connect to a person's ability to function day to day: sensory, emotional, physical, cognitive, and environment. The physical spoke covers strength, joints, balance, coordination, endurance, and pain, everything involved in the body's ability to carry out a movement.
But movement is never purely physical. Your brain has to organize a movement before your body can carry it out, deciding what to do first, what comes next, and how to string it all together. When that organizing step breaks down, it is called apraxia, and it belongs to the cognitive spoke, not the physical one, even though it shows up as a physical struggle. The woman in the chair had the physical capacity to stand. We knew that because she did it, more easily, when she was not given a six-step instruction to organize first. Her legs were not the problem. Her brain's ability to plan the sequence was.
That distinction matters, because it means physical struggles in dementia are rarely just about the muscles. This post stays with what is genuinely physical, strength, pain, fatigue, and the physical demand of a task, since that is plenty on its own.
Why "He Did It This Morning" Doesn't Mean "He Can Do It Tonight"
One of the most frustrating patterns for caregivers is watching someone do something in the morning and then seem unable to do it by evening. Mom got out of her chair just fine at nine. By four in the afternoon, she needs help.
It is tempting to think, "you did this a few hours ago." But function is not something a person either has or does not have. It fluctuates, the same way it does in any of us. Think about getting out of a chair after a great night's sleep compared to after three restless nights in a row, or when your back is acting up. You are still you. Your legs did not disappear. But what is available to your body in that moment is different.
Watch for what changed. Is she tired. Is something hurting. Is this a different chair. Is there more happening in the room than there was this morning. The goal is not to catch a consistent answer every time. It is to stop expecting consistency dementia cannot reliably give.
Why the Chair Matters as Much as the Diagnosis
Furniture changes the physical demand of a task more than most caregivers realize. A soft, low couch puts the hips down near the knees, feet out in front, nothing firm to push against. A firm dining chair with sturdy armrests asks for something completely different from the same body.
So when someone can get up from the table but not off the couch, that is not necessarily decline. It may simply be that one chair is a harder physical task than the other, for the same person, with the same strength, on the same day. Research on caregiving approaches backs this up directly: when nursing home residents with dementia were given more supportive setups and more opportunities for independent movement during morning care, excess disability, difficulty beyond what the underlying impairment actually required, measurably decreased.
Before assuming a physical task has become impossible, it is worth asking what the setup is actually demanding, and whether a different chair, a different height, or a sturdier surface to push from would change the answer.
When the Clue Is Pain, Not Defiance
A person living with dementia may not be able to say, "my hip hurts when I put weight on it." They may not be able to locate the pain, name it, or connect what they feel to the question you are asking. But their body often tells you anyway.
Maybe someone suddenly refuses to walk. Maybe an arm going into a sleeve triggers anger every time. Watch instead of assuming. Does the face change during a specific movement. Is one side being protected. Does it happen at the same point in the motion every time. Is this new compared to yesterday.
A sudden change in physical function, new weakness, real pain, a new pattern of falls, deserves medical attention, not an automatic explanation of "it's the dementia." The framework is meant to sharpen the questions you ask, not replace a doctor's visit when something changes quickly.
How Much Help Is Actually Helpful
It is natural to want to finish a task the moment someone struggles. Mom gets one arm into a sweater and stops. You finish the rest.
Some mornings, that is exactly the right call. If there is an appointment in fifteen minutes, this is not the day for patience. But if help arrives at the first pause every single time, opportunities to use the ability that is still there start to disappear.
On a morning with more room to move slowly, waiting, bringing the sleeve into view, or helping find the opening and then stopping can let someone get partway there on their own. That is not failure to finish independently. That is participation, and it matters on its own terms. Can she dress herself completely. Yes or no is not the only useful question. There is an enormous amount of function living between yes and no, and the goal is not proving independence, it is preserving participation in a person's own life for as long as possible.
Reading the Body Before You Read the Behavior
Physical function in dementia is never a fixed number. It moves with pain, fatigue, the setup of a room, and how much help is offered in a given moment. Before deciding someone "can't do this anymore," the more useful question is what is different about right now.
I talk more about this, including the full story of the woman and the chair, in the newest episode of Navigating Dementia. Episode link
If you want somewhere to start tonight, pick one physical task the person you care for does every day, getting up, dressing, walking to the bathroom, and just watch. Not to test. Just to notice where they get stuck, what they can still do, and whether more time, fewer words, or a different setup changes the outcome.
Notes
Park, J. E. (2017). Apraxia: Review and update. Journal of Clinical Neurology, 13(4), 317-324. https://doi.org/10.3988/jcn.2017.13.4.317
Rogers, J. C., Holm, M. B., Burgio, L. D., Hsu, C., Hardin, J. M., & McDowell, B. J. (2000). Excess disability during morning care in nursing home residents with dementia. International Psychogeriatrics, 12(2), 267-282. https://doi.org/10.1017/S1041610200006372
Want to keep figuring this out together?
Subscribe to Finding Our Way in Dementia Care and get honest stories, helpful tips, and gentle support delivered to your inbox every week. Just real talk, grounded care, and space to breathe.
Subscribe to Finding Our Way in Dementia Care and get honest stories, helpful tips, and gentle support delivered to your inbox every week. Just real talk, grounded care, and space to breathe.
Kind truth. Clear steps. Warm guide.
ABOUT THE AUTHOR
Carlyn Lenfestey, PT, MPT, CDP, CADDCT, is a licensed physical therapist with 25 years of clinical experience and 15 years specializing in dementia care. She is the founder of A Better Way: Dementia Care Solutions, LLC, the creator of the Wheel of Function Framework™, and the host of the podcast, Navigating Dementia.
DISCLAIMER
The information provided in this blog is for educational purposes only and should not be considered medical advice. Always consult with a doctor or a licensed physical therapist before starting any new exercise routine, using assistive devices, or following the recommendations mentioned. Every individual's needs are different, and professional guidance is essential to ensure safety and appropriateness of care.
0 Comments