23 Falls- What's your count ?

Balance problems are often a problem with dementia patients. My cousin's balance was and is so terrible. She fell so many times. Probably at least 20. She sustained multiple fractures, including, wrist, spine, left shoulder, right shoulder, foot, and hand. Most of these occurred when she was using her wheelchair! She would apparently get up, forgetting that she can't walk and fall. She is able to use her feet to propel herself all around the Memory Care unit though and so mobility is not an issue. She loves the wheelchair.

We (Memory Care, her doctor and I) decided to put an alarm on her wheelchair and bed. Your state may require doctor approval. The wheelchair has a belt that she must unfasten to get up. It sets off an alarm and staff can go to her. Now what happens is that she unfastens the belt, hears the alarm and fastens it back. So, so far, it's working . Knock on wood!

She also has an alarm on her bed and it will alert the night staff if she gets out of bed during the night. They can get to her and assist her. She's fully incontinent, so she's not really going to the bathroom at night. So far, it's working. Knock on wood and thank God for this blessing.

Repeated falls are very stressful as it often means long visits in the ER, MRI's, x-rays, casts, slings, etc. It's very stressful and painful for the patient.

Mica, maybe it is time for her to give up walking, I've seen a lot of older folks scooting around in their wheelchairs by propelling with their feet. Would she accept that?

Annnd she fell again. #24 this time off her rollator seat- plop.
my mom is like your aunt Twinflower, gets up from chair or bed and takes off... except she goes to the bathroom herself (wut?)
She hasnt broken anything yet, but i am sure thats next. They take very good care of her at the memory care place and say she's a hoot.

I appreciate everyone's ideas and views. I've been beside myself trying to help prevent falls my aunt takes in the memory care facility where she lives. she will just get up and take off, completely confident and then fall. she has a private room and bathroom and can no longer use a call light. The facility accepts falls as part of the disease and don't think much about it. I have seen thick foam pads around beds in other resident rooms, but they're used for people who fall out of bed. My aunt is wide awake when she travels. My aunt is compliant and prefers to have help to go to the bathroom (one reason she gets up, the other is being in bed awake and bored), but if no one is there, she gets out of bed.. The facility has torpedoed every idea I had from bed alarm to motion detector, to preemptive bathroom breaks. The best I've been able to do is to ask them to keep her up in the recliner until she is sleepy and then put her to bed. some staff do that, some don't..
I guess I have many more trips to the hospital to go. And more pain and broken bones for her. Other than the falls, she gets very good care. there are continual struggles to adapt to her changing care needs, but the admin is very responsive and tries.

Cathberry, do you think your husband would get better treatment and more attentive care at another facility? Are you otherwise pleased with the facility he's in now?

I have just got ANOTHER phone call to tell me that my husband was found lying on the floor--again. His fifth fall, third one this week. Now the nurse tells me that they want to keep him up at the nurses station.

When I asked her how they would do that she said that they would keep him in his wheelchair. I said NO! I told them from his admission that the only time he can be in his wheelchair is when he is going off the unit. I am afraid that if he gets used to the wheelchair that he will never get out if it.

Anyway, what is the point in keeping him in his wheelchair? They cannot strap him in as it that would be deemed a "Restrictive procedure". Also what is the point in having, decorating (and paying for) his own room just to have him sit at the nurses station which, by the way, frequently has no one there.

I told the nurse that I am aware that he has a "high risk for falls" but I am willing to take the responsibility. If he falls, he falls. If he gets injured, he gets injured. Otherwise he would have no quality of life at all, sitting in a hallway, beside the elevator with all the noise and lack of privacy. Even if someone was standing beside him he could still fall. It is what it is.

Now I have been told that I must have "a discussion" with the Occupational Therapist to try to sort this all out.

I thought that having him in long term care would help to relieve some of my stress. No such chance.

GA, it is not a side effect, it is a basic component of the disease -- depending on exactly where the "bodies" appear in the brain.

GardenArtist, yes, orthostatic hypotension is quite common with LBD. And yes, there is a treatment for it. The drug is called MIDODRINE. It is an alpha agonist which constricts the blood vessels to increase blood pressure-- which is the opposite of beta blockers which are given for high blood pressure and which dilates the blood vessels thus decreasing pressure. My husband gets 2.5 mg twice a day.

Of course, he cannot remember to get up slowly from a lying position to give the blood time to get to his brain!

Jeanne, is it a common side effect? Are any measures taken to counteract it, or just be aware of it? It's interesting (and unsettling) that LBD can have that as a component.

GA orthostatic hypotension is common in LBD.

Cathberry, one of my relatives had Lewey Body Dementia, presented primarily with the delusions. I'm not familiar with the falling because of blood pressure change, so I'm not speaking from a background of knowledge on this issue.

However, orthostatic hypotension can also result from blood pressure drop when rising from a sitting position. It can cause lightheadedness and falls if the rise is too sudden and the person doesn't have support.

Mica, my husband went into a long term care facility three weeks ago and I have just received a phone call from the RN telling me that he had fallen this afternoon. This is his FOURTH fall in those three weeks. I think that this is "not bad". When he was at home he could fall four times a day!

The reason he falls, other than forgetting to use his walker, is the difference in his blood pressure from lying and standing. He stands up, he gets dizzy, he falls. It is one of the symptoms that he has as part of his Lewy Bodies Dementia. When I got the phone call about the first fall all I could say was that although it may be his first fall there, it won't be the last. Luckily he has been unhurt each time. (Heck, I fell a few months ago and broke a toe!)

As someone else has said, it would really help if you could determine the cause of the falls so that "fall prevention" techniques could be put in place. Good luck with that.

Just looking for average fall counts of peeps here...
- she is very happy and they LOVE her social butterfly and room shopping ways....
(no alarms allowed there)

Mica
My 93 year old mom hasn't fallen quite that many times but she has a torn tendon in her foot which has been a problem for years - now add arthritis and several compressed vertebrae and she can trip over a thread - I worry constantly at her memory care because of all the mayhem and dang dogs running around on top of the anti-psych drugs which cause dizziness and confusion - I try to get her physical therapy as much as Medicare will allow in a year

I decided against the hipsters since she's a big gal and I knew she'd hate having anything tight on her tummy and I've read mixed reviews on their usefulness - your take on them?

I can tell you that others there fall continuously but they seem to be very different acting than her - that is can't really talk etc Of course one 90 year old woman fell right in front of me and she was using her walker

My other observation is even if they put an alarm on your mom's wheelchair or bed if there's no one around they will still get up and fall - one poor woman fell 2x in a day and knocked out a tooth and the LVN didn't notice the missing tooth despite a head injury

In our state memory care is considered assisted living and they cannot use restraints nor would I want her tied down

GardenArtist raises a good point. Sometimes PT can help prevent falls. But it really depends on the reason for the falls. For my mom, the reason was that she could not remember that she couldn't stand up and support her own weight. She was not a candidate for PT (except for some upper body strengthening.) Other means had to be found to minimize risks for her.

While my husband's falls were caused by a form of narcoleptic episodes no amount of PT would have prevented them. Treating the episodes worked.

Often we don't really know what the cause is, so a certain amount of trial-and-error is called for, all while trying to minimize risks of injury.

Mica I think the falls and the risks associated with them are just part of allowing he to have the freedom to move around and generally be as happy as possible in the facility. Worrisome as the fall risk is they seem to have done all they can short of tying her up or medicating her into a zombie. She uses her rollator and they have protected her hips which are both good things. She is getting plenty of exercise and hopefully interacting with the other residents. Do you really want her strapped in a geri chair asleep all day getting bedsores. There have to be checks and balances

Jeanne's post reminded me of what can be done in an attempt to prevent more falls: physical therapy.

My husband fell often 2 or 3 times a day. There were few days without falls. He was at home with me, and he fell sometimes when I was standing beside him! All I could do was break his fall. I don't remember exactly how long this went on, but it was 3 months that would be about 150+ falls.

It helped a lot when we got a wheelchair. He could scoot around the house using his feet, without fear of falling. This did wonders for his state of mind! But I don't think a geri chair would have been suitable at that point. He was still mobile.

Then his doctors speculated that his falls were the result of narcoleptic episodes and treated him accordingly. No more falls! Amazing. (Balance issues caused some falls later in his disease.)

micalost, you need (in my opinion) to talk to the staff and work with them on the falling issue. Obviously they are aware of the problem and are trying to minimize the risk of injury. She has fallen 23 times, but how do you know that without their careful supervision she wouldn't have fallen 90?

One way of preventing her from falling is to restrain her with physical restraints or with drugs. That is generally considered Not Good practice and is illegal in many situations. A geri chair might be considered restraint.

You need to talk to them about what they are doing, what things they have considered but have decided against, their reasons, and how you can help.

I haven't counted all the falls as back when my 90 something parents lived on their own, they would fall and never tell me but bruises were a sign that there was a mishap..... unless Dad couldn't get himself back up and he needed help. Elderly people fall, that is just something they do.

micalost, when you think about it, your Mom falls on average once every two weeks or so. I would get calls from the facility once every two weeks, too.

Whenever my Dad needs to use the bathroom he would try to get there on his own, using his rolling walker, as he doesn't want to bother the Staff by paging them. And fall on his way to or in the bathroom. He will fall trying to get out of bed at night, even with a bed railing to help keep him steady. He will roll out of his recliner while trying to tie his shoes. We have to understand that their memory isn't as sharp so they won't use common sense when they want to get from point A to point B.

My late Mom [98] was Houdini, she lived in long-term-care and was always trying to climb out of bed, out of her wheelchair, and out of her geri-recliner... the only thing she couldn't stand up any more but she thought she could. The Staff tried all they could as by law in our State they couldn't be tied down. The geri-recliner worked only if my Mom didn't remove the pillows under her knees, and she was placed in the nurses station to be watched. But she was quick !!

Mica, I see your point now. But the number of falls that might or might not be "excessive" is totally dependent on the individual's medical and physical conditions. It sounds like your mother is fairly active and mobile, so I would ask how and why did she fall? Was she trying to move unassisted? Was she in a hurry? Was there no one to help her?

I would factor these issues into the equation, but 23 falls in one year does seem excessive. Again, it depends on the individual.

E.g., I could write that my father who's 98 has fallen once this year, after having falling and broken each femur in the past. But he's living in his own home, has a good neighborhood support network, and is a very determined individual. And those individual characteristics come into play. I sense that your mother might be another of those determined individuals. So in that context, yes, I would be concerned about the number of her falls, but again, it depends on what other medical conditions she has.

excessive? see, thats why i wanted a count here, to see if it was excessive.
They put on "hipsters" which is a padded girdle. She runs around with her rollator all day and is Quite mobile!
It is a years worth and i wondered how others here measure up.

I also wonder what the facility has to say about this, I know that some falls are inevitable but this seems excessive. What falls prevention procedures and strategies have they discussed with you?

Mica, I think that rather than counting the number of falls, I would high tail it to the administration and discuss the issue of falls and what they can do to address it. If you think she needs a geri-chair, don't wonder. ASK.