She won't do the exercises

Almost never because she is being difficult. Refusal is usually specific and reasonable, and the reason is rarely the one written on the exercise sheet. It hurts. She cannot remember being shown. She does not see the point. It makes her feel old. Nobody is there and she is frightened of falling alone.

Each of those has a different answer, which is why “just encourage her” does not work.

Work out which refusal it is

• “I already did it.” With memory loss, this is usually true as far as she knows. Arguing about it costs you the next twenty minutes and gains nothing.
• “It hurts.” Take this literally and tell the physiotherapist. An exercise that hurts is the wrong exercise, or the right one loaded wrongly.
• “What’s the point at my age?”This is about the goal, not the exercise. Nobody is motivated by “maintaining function”. Getting to the letterbox, or to church, or down to see the grandchildren, is a different matter.
• “Not now.” Often fatigue or time of day. Most older adults are steadier and more willing mid-morning than late afternoon.
• Silence, or changing the subject. Frequently fear. Doing them alone after a fall is genuinely frightening.

What tends to work

Attach it to something that already happens. A routine she already has is worth more than a reminder. Sit-to-stands before the kettle boils. Heel raises at the sink. Walking to the letterbox after lunch. With memory loss especially, the trigger has to live in the day rather than on a list.

Make it shorter than you think. Three minutes done daily beats twenty minutes refused. The program can grow once it exists.

Do it with her.Not supervising — doing. This is the single most effective change most families make, and it works partly because it stops the exercises being a thing that is done to her.

Name a goal she actually wants.Not the physio’s goal. Hers. If she wants to get back to the club on Thursdays, the program should visibly be about Thursdays.

Stop calling them exercises if the word is the problem. For plenty of people it carries a gym and a failure attached to it.

When memory loss is in the picture

Dementia changes the approach rather than the goal. Familiar settings, the same time each day, the same person where possible, and demonstration rather than instruction — showing beats telling once verbal memory is affected.

Expect the good days and bad days to be genuinely different, and judge the program on the month rather than on today. Dementia Australia and the Better Health Channel both have good material on activity with dementia, and they are worth reading before the next appointment.

When to stop pushing

If it is causing distress every time, the program is wrong and it needs changing rather than enforcing. A physiotherapist who hears “she hates it” and does not change anything is not doing the job. The program is meant to move when the person does.

It is also worth saying plainly: you are her daughter or son, not her therapist. If the exercises are becoming the whole relationship, that is a reason to hand the pushing to someone else.

Why the days between visits matter so much is covered in muscle loss after 70, and our aged care page explains what a home visit involves.