Mom starting to have falls - Hate medications - But any truly worked for sleep?

elhijo

Hello ALZ Connected,

Been caring for my mom who has ALZ every since 2018. This April it will be 5 years. Have no idea how I made it except 1) I knew placement was a no-go 2) Took her off all the drugs all the doctors had her on/wanted to have her on.

Over the years my mom got calmer and calmer once I got a new doctor who was on-board with the plan of no-drugs, got rid of all these Home Health Aides who use to come to the house (which left my mom highly agitated as she wasn't sure to strangers), my mom got better and calmer and nicer. So, my mom's aggression is nearly gone. She is calm and quiet and enjoys her newspaper, balcony, and the tele.

Problem is, my mom's legs are starting to get weaker and weaker, and falls are starting to become a problem. She'll be 91 this year and is in overall good health, as there are no chronic conditions except ALZ. She is very lucid and when I do have an HHA come to the house, now and then, they all marvel at how lucid she is, because I don't have her on any drugs.

However, these falls are starting to happen especially when mom first wakes up early in the morning to use the restrooms. She just won't "go" in the adult diaper and will get up. And bed rails are a constant fight as she hates those things and has made it crystal clear how much she hates them. So, I'm thinking about re-visiting the drug route.

So, any medication for sleep that actually worked for someone? Like that didn't make your loved one crazier, more agitated, or use the restroom even more so than if they weren't on any? I'd appreciate input. We have an appointment with the doctor next week so if any prescriptions actually worked for your loved one(s) I'd appreciate input. Please understand that in the past some of these drugs to make sleep happen actually made my mom groggier in the morning and I was so afraid of her falling so that's partially why I took her off them and we went the happy no-drug route.

Thank you,

el_hijo  

​fesk

It is good you are taking you mother to the doctor to be evaluated for the falls. If it happens frequently in the morning or upon standing, it could be a drop in blood pressure is making her dizzy. If at all possible, she would need to sit up slowly and stay sitting for a minute or so before standing. Very difficult for someone with Alzheimer's to remember to do. Probably the best way to prevent a fall is to have someone assist her. Perhaps get a mat on the bed with an alarm in your room, so you know she is getting up. They also have motion sensors that work the same way. I'm not sure how adding a sleeping pill will help this particular situation. If it is at all possible, you could consider an overnight aide who could stay with her and assist her to the restroom or bedside commode. Hope one of these suggestions is helpful. I'm sure others will come along with advice too. Good luck.

M1

Unfortunately falls and choking are part of the disease progression eventually and are common causes of terminal events.   a Bed alarm might help, but it is probably going to take supervision to prevent bad injury, as fesk said.   there are a number of medications that might help sleep, but they can increase fall risk too.  no easy way through, I'm sorry.Hope you find a temporary solution at least....

F&E

Do you think a bed side commode might help?

Cosmic

Curious to know what drugs she was on and how did you discontinue, gradually or just a cold turkey quit. I've been thinking of doing something in that order. She needs pain meds for back and legs but I really wonder about the "brain" meds that were prescribed years ago and if they really are doing anything.

harshedbuzz

el hijo-

I am sorry that you are having this issue as your mom's dementia progresses.

I'm a little confused here, is the problem your mom's sleep deprivation or are you concerned about her attempting to leave the bed in the morning without assistance and suffering a fall?

A medication for sleep would be appropriate for the former but not for the latter situation. That said, as M1 suggested, medication to improve sleep is going to increase her risk of a fall. 

Are the falls caused by her legs being unable to bear her weight or are they caused by a sudden drop in BP as she attempts to stand? If so, supervision is the approach needed. A motion detection mat is best used for a PWD who wanders at night an needs to be redirected to bed.

We had a similar situation with my aunt who broke her hip after a fall and was unable to recall that she wasn't supposed to bear weight without an assist. She was in a SNF at the time, but family was required to supply a sitter in the evenings/nights to keep an eye out for attempts to get out of bed. Because my aunt had no money left, her small (her 84-year-old sister who was guardian for another sister with dementia, her son's widow and her disabled daughter who took most overnights) family took shifts sleeping in a recliner in her room to assist and redirect her. At least the staff could position her in a gerichair near the nurses station during the day so family didn't need to be there 24/7. You may need to hire an overnight HHA in order to keep her safe so you can get the rest you need to be there for her the rest of the time. 

Good luck. I hope you find a solution.

HB

zauberflote

Elhijo, it's wonderful that your mom is so content. My mother took [have completely forgotten which psychoactive drug] in a tiny dose for anxiety/depression, for about 5 years. It didn't affect her lucidity at all, and this was a woman who'd always been extraordinarily lucid so she had a high bar to meet. She also started having the out-of-the-blue falls at about 91, and in fact a broken hip caused one. 

She was a very good sleeper most of her life. When she started staying up and/or waking frequently, we started her on melatonin. Started small, and worked up to one mg, which served better than nothing. Properly given, about 30-60 minutes before a consistent bedtime, it doesn't often cause side effects. Both my kids took it when young, and one still uses it at 32.

Beauchene105

Hi El Hijo, a couple of years ago my mom was attempting to get out of the bed in the night and of course with dementia, couldn't remember to press the call button for help. This sensing pad/ recording device helped greatly. I recorded my voice reminding her to lie back down and press the call button for help. In a month, she had broken the habit of spontaneously getting up (with the help of this device). It cost a little over $100 but was well worth it to avoid nighttime falls. We don't use it anymore because she is older and can't physically get herself up, but at the time this was a great solution. It can also be used in a chair. Look for Smart Caregiver Bed and Exit Alarm Monitor for fall and wandering prevention - dual recordable voice.

elhijo

Hi Cosmic,

It was gradual and I talked to the new doctor about it first. We were on all the pam's they assign to alz patients, Lorazepam, etc. The one I'm most furious about is that the old doctors had her on high blood pressure and would have had her on high blood pressure medicine, forever, had I not intervened when I assumed responsibility for my mom. Thing is, she didn't even have high blood pressure.

The other pills they had her on seemed to have the opposite effect of making her very agitated in general. So, it was a gradual thing. The head meds never helped. So that's how I did it. If medicine is needed it should have an end date for the prescription, like a soon end date, not the forever refills some doctors seem to prescribe. But again, we stay away from medication.

Best of luck to you, you loved one, and your family.

elhijo

Hi,

Thanks to all who replied. The pill-route, if we go that route, would be so mom sleeps throughout the night and doesn't get up to use the facilities to reduce the risk of these falls and doesn't fight the bedrail, as she would be sound asleep. 

In the meantime, as it is so common with this disease, and for me, I've had to come up with a custom solution and get creative. So, I had bought this air bed/pull-out sofa bed combo in case of a hurricane evacuation in case mom doesn't like the bed at the hotel we'd be at/ bed is too for her, etc.

Well, I took it out, inflated it, put it on its side, and given it's an airbed/pull-out sofa combination so it's very big and heavy for an airbed. I put it with its back on the floor, facing up, and it's about mom's height. I turned the hospital bed so that it makes a 35-degree angle between it and the inflatable. This makes a very small nook and cranny so my mom can't wander out of the bedroom and can only go to the restroom where she has lots of places to hold on to. And with the airbed, she can fall into it or use it to hold, so it's a natural, soft barrier. It's actually very sturdy and good quality so it serves as a barrier and really soft cushion in case of a fall. I'll use it until we see the doctor this week. Her blood pressure isn't superbly low or anything. The home health aide who came this week (I use them as needed) took it and it was very normal as it's been for years. It's just old age. All of us are kind of groggy when we first wake up, now image you're 91 years old.

Overnight aides while a good idea, are very expensive and the "government-funded" agencies that employ these workers tend to be terrible with them hiring workers straight out of the welfare-line with zero training and sending them to homes of people with cognitive decline. And in the state where we live Home Health is an unregulated profession. Meaning, anyone can become one, the "training" received isn't overseen by the state, nor does the state keep a record of who is/isn't a Home Health Aide. CNA's on the other hand, are overseen by the state. If you decide to go the home health route, get/ask for a CNA which stands for Certified Nursing Assistant. Those will be better prepared to help with Alzheimer's clients and will have better training. You can also check if the CNA's license is up to date on the state's website as it will be a regulated profession.

As far as the cost, I'm seeing what I can come up with, but it is costly, can easily run up to 20k, if not more, for a couple of days and for only part of the day, per year. 

Meantime, I'm so glad I bought the airbed.

Regards