New to caregiving(1)

Sactolady

I am now the caregiver for my 87-year-old aunt who has dementia/Alzheimers diagnosis for about 4 years. On March 30 she fell and broke her right hip and right wrist. Hip replacement worked great and the wrist was only fractured so no surgery. After one week in hospital and 3 weeks in a good-for-nothing rest home, she was discharged to me without any medical equipment nor in-home care. Had to take things into my own hands. I now have adquate in home caregiving three days a week.

Here's my problem. Prior to my aunt's fall, we were planning a move to Oregon where her sister (my Mom) and my sister live. Both my Mom and my sister have medical issues and will need help. Now that my aunt is no longer able to care for herself, I still want to move up to Oregon with her and work something out.

My aunt will not cooperate with any physical therapist when trying to get her to sit up on the edge of the bed and then transfer to a wheelchair. She begins shaking and crying with fear that she will fall again. No amount of reassuring helps. She will fight if we try to get her to her feet. Any mention of getting out of bed creates a huge problem.

How do you get through to someone whose brain is telling them that they will fall again?

Thanks for listening.

Debra

zauberflote

Hi Debra and welcome!

I think fear of falling is a dementia "thing". Are you sure she's remembering falling? Or could it be plain "fear of falling"? Both my MIL and my mom had this fear, around the toilet, getting into the car (back when that was possible), and transferring. The solution that worked for me was the "dancing hug" transfer whenever possible. It's not easy on the caregiver's back though, especially because the PWD may become a dead weight halfway through the maneuver. But if there's fear even when contemplating it, that's much more difficult!

You cannot really reason with her; as we say here "her reasoner is broken". I am hoping some others come along with better ideas for you!

mommyandme (m&m)

I just try to reassure my mom that I’m here to help her and I won’t let her fall.  I’m constantly saying “you’re safe, I won’t let you fall”.  I also say, “I’m here to help you, but you need to help me help you”, no clue if she understands. She even thinks she’s going to crash and burn when I’m just rolling her back from her side while safely on her bed. That’s probably when she feels the most vulnerable and gets quite annoyed with me.  At least she doesn’t remember it for long, until the next diaper change.  Definitely Ground Hog day over here. 

Sorry for your challenges. 

towhee

I went thru a similar situation with my LO who had a leg injury and a broken wrist. Your situation sounds more difficult but I hope something I suggest might help. This is based on my experience and the advice I had from the better PTs. I am not a PT or medical person so check my suggestions with the appropriate experts.

Fear of falling and fear of even just moving does happen. Older people can get vertigo or feel dizzy for vario0us reasons. Peripheral vision and depth perception can deteriorate, and they can lose a sense of where their body is and where you are. Bed rest causes muscle loss and they can feel that their legs are weak. 

In addition I suspect your aunt has had multiple occasions where she has felt like she was falling and as you said, this fear is now engraved in her memory. When you have a broken wrist as well as a leg injury your balance is off, and it is hard to compensate even without dementia.

What I am going to suggest is going to take time and patience from you and the aides. You will need to give the PT a lot of backup. The idea is to try to let the fear fade and replace bad emotional memories with better ones. If you slow down and and try to get her comfortable with one movement before you move on to the next it might help. Her fighting you is dangerous for everyone and reinforces the fear.

There are medications you could try but they can occasionally cause dizziness and constipation so if you do that you want to start with the lowest dose and monitor closely. 

Some general tips-- Use music. Playing music and singing lessens anxiety and rhythm makes movement easier. Laughter eases tension and reduces pain. Show her what to do as well as telling her and do the movements with her if possible. Let her move on her own as much as possible, coach her but don't try to physically move her. If the PT is using a gait belt a wide one is more comfortable for her. If you need to adjust chair height or use something like a sit to stand lift to make it easier for her that is fine. Trying to insist that she do everything normally is setting her up to fail. Try to tap into automatic/natural movement (muscle memory), so that she moves without thinking. 

Movement-Any movement increases the ability to move. Even if it is not your target movement it is likely to increase her physical function. I don't know how much your LO is doing right now, but if necessary you can start out with her in the bed, doing anything that will increase leg and core strength such as adjusting herself in the bed, range of motion exercises, balloon toss games, etc. for short periods of time, 2-3 times a day. The physical  therapist can set up a routine for you. Any personal care that she can do is good.

When you can get her to sit on the side of the bed let her just sit. Sitting with only partial back support will strengthen her core muscles. Have her do things while sitting, brush hair, teeth , wash face, eat meals, treats. games, exercise to music (make sure she does not overbalance). If she needs back support someone can sit by her side. Don't leave her sitting on the bed alone and try not to overtire her. If you can get into a routine that is good. 

If you can get her calmly sitting, you can try getting her to put partial weight on her feet. Not getting up, just taking a little weight off her posterior (a small bounce). Then after several days to standing a few seconds and sitting again. If you have a hospital bed you can raise it a couple inches above her knee height to make it easier for her to stand. If you get lucky, then work on transferring to wheelchair, make sure seat is not too low she needs to be able to get back up.

Standing was where my LO fell apart. With the broken wrist she was off balance, the mattress was not firm enough to push against with her good hand, there was nothing to pull on and her legs were too weak to do all the work. They ended up using the hoyer lift to put her in the wheelchair and let her use the bar in the hall to pull up with along with a gait belt assist. With something in front of her to hold onto and the wheelchair behind her she was not so off balance and scared.

If you have access to the right kind of sit to stand lift, one with a bar and a seat or one that has a harness that lets you stand upright, that might help. A walker is no good to pull up with, although it may give support while standing.

I hope you have sucess. Being able to transfer, even if you use a sit to stand lift, will give you more care options.