Falls? by Stewart

toolbeltexpert

My dw is having Falls always in her bedroom by her bed. Last night was her third in a couple months. Last night they heard her cry at 1030. She was so confused, they tried to stand her but she didn't know how to move her legs. They told me they had to stand her like a flat board?

Her mobility has decreased in the last few months and her confusion. They don't believe it's a uti and neither do I.

At what stage do things like this take place?

I had asked about when would she be needing a wheel chair and they just said they keep folks mobile for as long as possible. I was just hoping they could tell me because there are many there in wheel chairs and I would have thought over time they would be able to see that progression.

My wife has big bones but one of these times something is gonna break. They only reported that her hip was sore and her back,which is kinda a normal issue. Today she fell asleep right after breakfast so I came back at noon and they told me she was taking a nap, so I left. I am sure she probably didn't sleep well so I get her tiredness.

I am just worried that there may be a progression phase going on since it's always so slow it's hard to notice.

Stewart

ThisLife

My first thought was an alarm that sounds at night when she is getting up. I don't know if rails are allowed on the bed to prevent her getting out of bed at night. I'm not sure what stage this is but others have mentioned LOs not being able to sit or stand up losing the ability to manipulate their body. IMHO I would think safety (broken bone) over mobility (more work for the staff.)

Ed1937

Stewart, I can't really answer your question because my wife was diagnosed with Meniere's disease more than 30 years ago. Her balance has not been good since she fought that disease. I'd say she started having fairly frequent falls around stage 5, but I think part of it was because of the Meniere's disease. Sorry this is happening. Maybe you could ask if you could put an alarm that would notify the nurse's station when she got out of bed? It won't stop the falls, but at least she won't be lying on the floor half the night, waiting for someone to come in. The facility where my wife was said we could do that.

F&E

Sorry your wife is having troubles.even more sorry that I can’t help you Stewart .but these ideas seem like good ones and I hope other members have more suggestions.what about an overnight sitter? Or lowering her bed

GothicGremlin

Hi there Stewart -

I'm so sorry for where you are now.

I'm kind of in a similar place as you. My sister falls frequently. We never leave her alone anymore - we don't want her getting up and walking alone because she's likely to fall. We're also in the same place with regard to wheelchairs. Keeping Peggy as mobile as she can be is a priority. We only use the transport wheelchair if we're taking her to a doctor appointment or if we take her to an event in assisted living. Memory care is completely separated from assisted living and it's too far for her to walk. In reality, it's not that far at all, but it's too far for her.

She falls at night too, although thankfully that's diminished since we moved her into a hospital bed with partial rails. In California, where we are, memory care facilities aren't allowed to have full rails, but partial rails are okay. Peggy has managed to climb over the rails a couple of times and has hit the floor, so it's not a fail safe. At least she hasn't broken any bones ... I hear you on the confusion aspect, and yeah, she was wiped out the next day. The last time this happened (a few weeks ago) the only thing she could tell the doctors was her name.

In terms of what stage she's at, I'd say Peggy is probably at the very beginning of stage 7.

I don't know if this helps at all ...

Elshack

My DH who soon will be 93 has fallen many many times since he has been in memory care for 9 mo. He is probably stage 7 and is on hospice. Thankfully he hasn't broken any bones but has had steri strips put on his cut forearms after they took him to the ER. They do not use alarms in memory care as people get out of bed several times and roam the halls at night . Some days he is in a wheelchair and others he uses his walker. I know there is no way to totally prevent falls. They do check the rooms every hr or so . I would say he has fallen at least 10 times within 9 mo and has gone to the ER 2x. Other times the hospice nurse or med tech can take care of his injuries. Every case is different but I think these falls are not that unusual for those who are in memory care.

Joe C.

Stewart, My wife has fallen several times as well in the past 9 months. All of her falls have been when she is walking around the common areas of the MC. One fall required a trip to the hospital as she broke her tail bone. The MC will ask her PC for an order for physical therapy to work on her balance. I always agree with the PT request as any one on one attention she gets is a good thing. She is currently doing PT to to a fall about 2 months ago and the therapist is working with me on techniques for getting her into my car as she no longer understands how to step into the car. Falls are definitely scary but I don’t know what can be done to prevent them.

harshedbuzz

I'm sorry @toolbeltexpert . Falls do seem to increase at a certain point. With my dad it seemed to be a combination of visual processing, loss of strength and an inability to coordinate movement. He was rarely more than scraped up as he tended to sort of collapse to the ground as his strength and balance faltered. My aunt, on the other hand, had a hard fall and broke her hip and wrist which was the beginning of the end for her.

You might ask about a PT eval to get her steadier on her feet. We had PT for dad a couple times a week at the MCF. Like Joe C mentioned he seemed to enjoy the attention. And it did seem to help. There are also hip protectors that can be worn to help protect this area in a fall.

@ThisLife said: IMHO I would think safety (broken bone) over mobility (more work for the staff.)

It's more nuanced than that. Generally maintaining mobility is better for the resident. The body is meant to move and will function better with walking-- things like worse sleep, constipation and bed sores can result from being immobile. Plus, a chair could be considered a restraint if it is being used to keep a mobile individual from moving around independently.

HB

Beachfan

Stewart,

My DH reportedly “ fell” out of bed several times during his 17 month residence at a MCF. He was never injured or bruised, never caused a “bang”, rather he was found sitting on the floor during room checks. I think he probably got out of bed for whatever reason, couldn’t figure out how to get back in and ended up sitting on the floor. His bed was lowered for safety and his mattress had slightly raised sides (looked like it was saggy in the middle). Several times when I visited, he was in a wheelchair- - mainly for transport when activities were held in an adjoining building. He was kept mobile until he became bedfast and died within 4 days. DH had 15 cottage mates and caregivers made every effort to encourage mobility, although several had nasty falls while unattended

You may be right about progression. As you indicated, DH’s progression was slow but steady. Hardly noticeable at times, until I look back at the big picture. Hang in there; it’s tough!

toolbeltexpert

Thanks everyone

This life,

I do remember reading some posts about folks not being able to move their body it just is becoming real for me I guess.

I am gonna ask about a silent bed alarm that let the nurses station know she's got up?

I believe bed rails here are considered a restraint in this mcf.

F&E thanks for your idea, her bed is a low as it goes. I am wondering if she is walking into the ac unit it's low and sticks out, standard mcf fare.

GG it's always good to have input, I keep thinking she is getting to the later stage of 6?

I went looking yesterday and did a Google search on falls and Alzheimers, in one place they gave a list of losses that would be late stage and dw has several of those symptoms.

Joe and HB I'll ask about the pt I think any one on one is a good thing, it makes them feel valued!

Beachfan your such a great comforter, you maybe right? The first time she was on her knees and couldn't get up I think she had spilled her sewing supplies mainly just big colored buttons and her knees were red? I appreciate your experiences and so glad your still here with us, wish I could sit in the sand and listen to the waves. The ocean cures everything. We used to go to cape cod several times a week when we lives in MA. I need to make that trip one more time.

I can say that her walking has gotten to just little shuffling feet, I remember about 2 years ago we would go to the store and no matter how slow I went, she was always behind me. So if this is progression it's been a long time in getting to this stage. I am always questioning whether it's meds, and beat myself up because I question if that's what's going on, I am glad I still have those memories about her slowing down, maybe I won't beat myself up so much.

I have been getting down about this, knowing what's coming, but it helps to talk it out.

To everyone in my search yesterday I came across a picture that had a lot of dementia related movies some I had already seen I thought I would share that picture.

I watched still Alice last night and fell asleep watching it so I haven't seen the ending.

MN Chickadee

You say they don't think it's a UTI but do make sure she is checked anyway. UTIs always made my mother fall, it was our first signal she had one. Sometimes it was a fall during walking or transferring, sometimes it was like she just forgot how to be upright and would slither off a chair. For a while treating the UTI took care of it. There does come a point where they just happen no matter what. It's illegal for a home to restrain or confine a person to a wheel chair, so as long as they are trying to get up they won't really stay in a wheelchair. We kept a wheelchair in her room for some things like taking her outside and sometimes staff used it to get her to the dining area but she didn't spend extended time in it then. This is when we had mom evaluated for hospice, because after some of the falls the nurses were obligated to send her to the emergency room for evaluation depending on the severity. Those ER visits were so hard on all of us, and really if she had broken a hip or something we wouldn't have been able to treat it anyway. With hospice on board they didn't have to call the ambulance any more. The hospice nurse would assess her for any pain management or other needs right on site. Since your wife is sleeping more that may also be a sign of progression. I lived on edge during those months, because my phone rang constantly with bad news about falls etc. It's a hard phase.

jfkoc

Is there something by her bed that she can hold onto????

toolbeltexpert

Mn Chickadee no they haven't but all I have to do is ask and they will no problem. The sleep thing is fairly new about a month or so some days the staff noticed she was off and sleeping. So it maybe progression

Jfok no its an open room all the stuff is against the wall leaving a walk way at the end of the beds. She was between the bed and the outside wall by the ac unit. She has the window side which was my choice for her. I thought it would be more cheery.

Today she complained her back was sore so I asked for Tylenol. She also asked about taking a nap around 1pm so I left thinking she might need the rest. Of course today I got how come you haven't been her in so long because yesterday was a blur.

One good thing if they need an xray they do have a mobile service that comes, I don't know how detailed they can get though.

There is a small hospital 3 miles away though I asked them not to send her there for anything major, this was the hospital she did here geripsych at. I wasn't impressed at all. There is a much larger hospital 12 miles away which has much more staff, equipment, ect. I have visited it many times as a pastor with folks who had major problems and they got really good care.

She is a dnr with a limited polst. Dw has one sister and a step brother. The sister is on the dpoa incase something happened to me. I keep her fully informed but it causes her distress as she is 1000 miles away.

I maybe just thinking worse case scenario stuff but lately I have seen how quickly things can turn for the worst quickly.

Denise1847

Maybe this was mentioned. I volunteered in a hospice unit awhile back. When patients were falling alot, they would put the mattresses on the floor. It was strange but it worked. I am not sure how this would help if the person was not strong enough to get up from the mattress, but it may be better than falling and breaking something.

M1

Stewart, I know they had difficult regulating her medications, but I wonder if an antipsychotic could be affecting her gait. Wasn't it Zyprexa that they had trouble with? If she's still on it, it might be worth asking about, though trying to change it could bring up other issues. That said, you are absolutely right that falls--along with swallowing diffculties--are part of disease progression. I feel sure that falls are what are going to get my partner eventually, and we are starting to see more of them.

Jo C.

Hello Stewart, I am sorry this has been happening. Because this is a fairly new dynamic, it is best to have her checked for possible other issues besides dementia that may be causing this. Don't let the nurses minimize looking at all possible causes first before saying the causastive issue is advancing dementia.

First, a UA with culture to rule out a UTI is a good start; then have her dementia specialist check out her medications; meds can often become the culprit even after being taken for awhile without issues, (you can also look up each of her meds for side effects and may find some enlightening information so you can be her advocate in this matter); then also having thorough full labs done to check her body systems to see if something untoward pops up that needs addressing. Sometimes it is something simple such as dehydration or other easily treated matter. Of course having a physician exam would be helpful with all the other items being done.

If after all the other causes are ruled out, then one can begin to determine it may be caused by progression of her dementia.

NOTE: As an RN, I learned very early in my career to rule out other factors first before ascribing all changes to a diagnosis such as cancer, dementia, etc, which is not fair to the patient. Our LOs who have dementia have all the same body systems we do and anything can happen just as it can with us, so always best to err on the side of caution.

For my LOs, I would not permit any diagnosis to be arbitrarily made as definite cause for a new issue unless the physician first ruled out undiagnosed physical issues first. It is an eye opener how many times there was an undiagnosed issue that could be easily treated that caused changes.

J.

toolbeltexpert

M1 yes she is on zyprexa and tremors and weight gain are a side effect she has . As I said her gait had been slow so I attribute that to progression that has been getting worse for at leadt 2 years now.I talked with the charge nurse and we had labs done about a week ago because she started lasix because of weight gain. They were all good. She noticed in the notes from the cna's that dw has been more aggressive and I remember one cna telling me she had cussed recently ,So they are going to do a culture but nothing till Monday I think.

Joe c I agree, I am hoping for a uti, things have been going along very well,which is good as today I picked up the last of my stuff I had at a friend's house from my move. So now everything is at the new house. I was hoping things were going to continue as is, but it seems that is seldom the case as I have seen.

Although they don't think its time to see hospice I started that conversation with the charge nurse today. She likes the extra help they get when hospice is called in. She did agree with me about her walking and her confusion which could be presenting worse if it's a uti. But I wanted to hear what they thought. Anyway. It's a waiting game for now I guess.

Stewart

M1

Lasix is so hard to take, the urinary urgency it causes from the increased urine volume is a problem and a source of falls for a lot of folks as they try to make it to the bathroom or commode. All of these drugs are a double edged sword.

toolbeltexpert

M1 I had asked when does she get it. It's right after breakfast just so she won't be up all night. But that may also be a cause of more uti's?

M1

Lasix is a long-acting drug stewart, so it can have effect at night even when given in the morning. Unfortunately all of us generate more urine when we lie down--gravity effect. Shouldn't have a direct effect on UTi's except that the more she goes, the more chances there are for hygiene issues. I guess she's still continent, is that right?

One thing they could try is limiting the amount of fluids she gets after about lunchtime. Just to try to minimize the difficulties. I'm sorry the struggle is so difficult.

toolbeltexpert

M1 yes she definitely goes more often. I came in one morning a couple weeks ago and she was wet. It was almost breakfast time so I got her changed, but I did notice mornings even b4 breakfast lately she's gotta go,so I take her. So she had had a couple of accidents this year but I chalked up this last one to the lasix. I guess I didn't think about the time of day and went just after 3 today with her favorite shake. I'll pay more attention to the time of day.

She does seems like her confusion is maybe a little worse today. They Are going to do a test and get it cultured on Monday. Sound bad but I am kinda hoping for a uti.

Thanks bud.

Jeff86

My DW was on olanzapine (generic Zyprexa) for a couple of years. When she began to have mobility issues, her neurologist at that time took her off the med, as said neurologist believed decreased mobility was a side effect—cumulative, essentially—and DW’s gait improved somewhat after that.

toolbeltexpert

Thank you Jeff in my conversation with the charge nurse, she is more than willing to try backing down on the olanzapine. That is something I am seriously considering. I use the word zyprexa but she is also taking the generic olanzapine. I truly value your experience, does she take anything now if you don't mind me asking?

Vitruvius

toolbeltexpert, I did want to suggest what they did for my DW. 

At my DW’s MCF they now provide a 2” thick exercise mat that they unfolded and lay next to her bed after her first “fall” out of bed. It was more of her just sort of slithering out of bed according to the aid who was close at the time and heard her then found her on the floor.

As for the other issues you cite about your DW's mobility and confusion, this sounds a lot like my DW's progression. Although with my DW her progression has been very rapid and she is now in early stage 7 on hospice. She no longer falls out of bed, but they still place the pad for naps and nighttime. They also tried to keep her mobile but she is now wheelchair bound except for very short movements from say bed to chair or sofa to dining table (10 feet). I often help with these short walks and it takes two people and great care to facilitate such walks. I'm not saying this is where your DW is headed as she seems not as far along and is not progressing at the same turbo pace my DW is. 

toolbeltexpert

Vitruvius thank you for you experience, I have seen those mats used b4 not sure where though. If it's not a uti then we just kinda zoomed along. It'll be Wed I guess b4 I hear

Jeff86

Stewart —. Happy to share my experience further if it helps you. The olanzapine Rx was prescribed for anxiety. My DW also had a couple of incidents of hallucinations.

After tapering off olanzapine, the neurologist increased the dosage of DW’s anti-depressive (escitalopram—generic Lexapro), which DW continues to take. At one point I thought DW was less anxious and tried—with the knowledge and concurrence of DW’s PCP—to reduce and then eliminate escitalopram but the anxiety returned/increased so, for now, steady as she goes, 30 mg.

your mileage may vary

toolbeltexpert

Thank you so much Jeff I really appreciate you for sharing. My wife is also taking escitalopram 20mg and the same behaviours or symptoms including a few hallucinations, your experience gives me courage If it comes down to getting her off the olanzapine someday that there's hope. Everything I learn here has always helped me from almost a year ago when I was faced with our crisis to the er like ghphotog is going thru. I can't help but to think what would I be doing today if I hadn't found this forum. Thanks to everyone

Stewart

SDianeL

My husband is in early stage but has fallen several times. I found this: "A person with dementia may also have 'visuospatial difficulties', when the brain has problems processing information about 3D objects. This can affect a person's spatial awareness or the ability to judge distances. They may have difficulties using stairs, parking a car or recognizing objects." The Neuro Psyche doctor that initially examined him said he had visuospatial difficulties and that he should no longer drive. The only thing I noticed was that he was driving very slowly. Talk to the caregivers. If she breaks a hip she may need surgery and the outcome is usually not good.

mommyandme (m&m)

I believe when we switched to mainly the wheelchair it was because of my mother’s fear of moving around. When she wouldn’t stand at all, even to pivot, is when she had to be bedridden. Her legs were still strong enough, I think. She was so uncomfortable moving and afraid that having her settled in place was better. She was happier and as a comfort measure, it worked. Definitely hard to accept that new reality though. Obviously that’s not the issue with your LO, just thought I’d share there are different reasons to use wheelchairs etc… immobility is sometimes mental. Mom was still walking with assistance into late stage 6.

toolbeltexpert

Well there has been some more things happening a couple of weeks ago a nurse had taken dw to the bathroom to go, a few minutes later dw was back at the nurses station having to go, taking lasix can cause this I know. The nurse took her back and waited she had to make sure she sat down. Well the last few days she is afraid to sit on the toilet. It took me 5 minutes to get her seated, super afraid she's gonna miss the toilet. I watched a video and tried the two techniques but I need more practice, this is a new thing for dw as well. She also is complaining of a pain in her back as she tries to sit, not any other time.It might be a kidney ?

I will be asking about another blood work. The results from the sample will be Wednesday or Thursday. I hate that it takes so long.

Sdianel my wife's Peripheral is bad, she's easily startled if you approach from her side, a good way to get hurt, one time I was at her side and touched her and she swung to punch me because I startled her.

M&m the late stage thing is how to figure but I think she maybe headed that way if it's not a uti. She struggles to stand up but once up she does ok albeit very slowly. But the sitting maybe because she has fallen several times but it's all new.

toolbeltexpert

I was gonna start a new thread and title it gut punch because the urine sample came back negative, I was really hoping it was gonna be positive. I didn't want to think this latest new thing was progression but it seems like it is? It feels just like a gut punch that makes my breathing stop, I just took a cleansing breath and it took some of that punch away. I have gotten better with helping her sit on the toilet and it has progressed to sitting I'm general. Today is my dw birthday, she is 69. Gonna have pizza later. She didn't remember it was her birthday. She got a card from a resident in al who is 102 and a good friend of dw. She's read it several tomes times already. Gonna be a long day. Hope I don't hear Alan Jackson today or I'll lose it.