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 another fall 
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3125
Location: Vermont
Post Re: another fall
I'm not a dr. or nurse, but I don't think I've seen anything about a person being given Namenda or Aricept and having that or any other med, for that matter, stop our LOs from falling. There are any number of reasons people fall, but I don't know of any med that will stop a person from having frequent falls. Anyone else out there have a different opinion?
I'm sorry you are facing this. My dad's frequent falling and not being able to get up is what ended up sending him to the hospital, a rehab center and then an ALF. He was so disabled after his last fall at home, almost 2 yr. ago, he could not do ANYTHING and had to go to the ER. I was so glad I'd arranged for him to move to an ALF just weeks before, and we were waiting for a room to open up at the ALF when this occurred. I don't know what we would have done if we hadn't been on the ALF waiting list. I guess he would have had to go to a depressing nursing home in the town where he lived. Getting the ALF lined up "somewhat early" (he should have moved there a year before he did) was a Godsend. All the best in your situation, and I hope others will chime in and give you some useful info. Lynn

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Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.


Fri Jul 08, 2011 5:00 pm
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Joined: Fri Dec 31, 2010 3:07 pm
Posts: 1039
Location: Minnesota
Post Re: another fall
In the begining Coy fell down frequently, sometimes several times a day. He had a walker but it did not prevent falls -- it went tumbling down with him. We progressed to a wheelchair, which was much safer. He was DX in June, went to wheelchair in Oct. Used the wheelchair about 6 months. The cause of his falling was determined (guessed) to be narcaleptic type episodes. He is on an antinarcaleptic drug. No more falls. As you know, he bowls once a week. Today he golfed. So we do have experience with a drug that stopped the falls.

I think it depends on the nature/cause of the falls. That is why I asked HappyPuppy if she had ever seen her father fall.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Fri Jul 08, 2011 5:41 pm
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Joined: Sat Jun 18, 2011 9:53 pm
Posts: 17
Location: Costa Mesa, CA
Post Re: another fall
I have only caught dad as he started to tip or witnessed him already on the ground... I've never seen the full dynamics of a fall.

Sorry if I was unclear - my comments about Aricept did not have anything to do with falling but increased awareness (possibly) if I moved him into a memory unit and then started memory medications - then he might improve enough to really be miserable there....

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Jenna - daughter of Dad diagnosed in 2010 with PD and in 2011 with probable LBD. Symptoms were present for a few years prior. Dad is 74.


Fri Jul 08, 2011 10:00 pm
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Joined: Sun Oct 04, 2009 10:18 am
Posts: 276
Location: Washington State
Post Re: another fall
Falls are such an issue with this disease that 45 pages come up with you search under the word "fall". I've been fighting falls by my LO for about 6 years now. I agree that if at all possible, actually witnessing the fall will give you a beginning to the fight.

Early on, my LO's cognition and sight were both affected before we realized how much. While she could never describe why she fell, I finally saw her back up to a couch that was off to the side of where she tried to sit. She sat on air and fell on her bum. She had lost her perspective of where the couch was located. When I got her on exelon we were able to teach her to feel for a seat with her hand or the backs of her legs before sitting and she became more cautious. It took a while though, so we got her a "lifeline" alarm since she was living independently. Within two months she had progressed to where an AL with a dementia unit was necessary. For the past two years she has fallen for a variety of reasons which she always explains as a "person who comes in a rush of wind that knocks me over". I have found (1) occupational therapists and (2) physical therapists to be helpful. The OT can suggest lots of ways to prevent falls or cushion things so that the falls aren't too bad. The PT gives us exercises to keep her muscles strong. At this point, with moderate dementia, she is mobile with a walker in an AL facility and she falls about once every three weeks. The caregivers can't watch her one-on-one all the time but she's pretty good during the day because the exelon is in her bloodstream. At night we hire a private caregiver at $150/night to help her to the bathroom because she would fall otherwise. The ALF has caregivers at night but she doesn't want to bother anybody and won't call for help and the exelon is at a low in her blood. We tried the exelon patch but she couldn't tolerate it. We tried adult diapers at night but she wasn't incontinent and wouldn't "go".

Another reason for some of her falls was a blood pressure drop upon rising from a chair, called orthostatic hypotension. This can be diagnosed fairly easily by the primary care provider. It can be treated by medication but it seems to have gone away with my LO with time.

Robin once told me that the only way to prevent falls is with 24-hour surveillance, but I find that even that isn't enough. She has fallen within reach of me and my husband. Just let go of the walker and fell over backward. From talking to family of other residents, falling is a frequent reason for placement because they can't help them get up anymore. At the AL facility at least they get checked out when they fall and may go to the ER if there's a possibility of a fracture. When researching AL facilities I would ask what their procedure is if someone falls. To me, I don't want her sent to the ER every time. They also may witness the fall or can describe where and how they fell so that everyone can try to prevent the next one. And, at the AL the likelihood of someone helping her to get out of a chair or find her walker prevents some falls. This is a long post but I hope it gives you some ideas. Annie

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Annie, daughter of brave Marie, dx 2007 and in ALF


Fri Jul 08, 2011 10:50 pm
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Joined: Thu Apr 21, 2011 9:07 pm
Posts: 236
Post Re: another fall
This discussion is so timely for me! I wonder if there is something in the air... My dad went out to the dollar store this morning and came home to find my mom sitting on the floor in the kitchen, unable to get up. She had apparently gotten a craving for jello and headed out there without her walker. Bad move. She is fine with the walker, but she lost her footing, slipped and fell, and dropped a large bowl of jello - luckily the glass did not break but there was jello everywhere and she couldn't get up. Even more fortunate, my dad, who has also had an occasional fall, managed not to fall on the jello himself - that would have been a disaster, the two of them sitting in the kitchen surrounded by jello! He couldn't get her up so they called the front desk, and those folks called the paramedics, who came and picked her up, sticky but unhurt.

So now my dad is afraid to leave her alone, and I'm wondering about next steps. We have someone coming in two mornings a week to help and to give my dad a chance to go out. She's physically ok with a walker, but she sometimes just takes off without it. (She remembers she needs to use it but executive function is toast so she doesn't always translate intention into action.) So far neither of them has acquired worse than a bruise or two. My mom was going to balance class for quite a while and I do think that helped - my dad refused to go after one try. We have juggled their meds to minimize orthostatic hypotension while still controlling risk for other cardiovascular events. And falls are infrequent, but still scary.

They live in a retirement community with assisted living apartments, but those are smaller - took us six months to get them pared down to their current apartment. And there is skilled nursing and dementia special care, too, but they just don't seem to me to need anything like that level of support. My dad still drives, they can cook and do self-care, and I go over every day to check up, after work. But I don't want them to wait for help until there is an emergency.

We all seem to be confronting - or to have already confronted - many of the same tough decisions. It's a comfort to read how others have managed and to hear so much support. Thanks!
Laurel

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Laurel - mother (97) diagnosed April, 2011, with LBD


Fri Jul 08, 2011 11:04 pm
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Joined: Fri Dec 31, 2010 3:07 pm
Posts: 1039
Location: Minnesota
Post Re: another fall
Coy has a medic alert device but I don't know how much good it would actually be in an emergency. I'm not sure he'd remember to use it. But we have it.

A serious fall would be a Bad Thing. We all want to do everything we can to prevent them. But we have to acknowledge that we are not 100% in control. Even 24-hour survelience does not prevent falling. I once was walking immediately behind Coy and his walker and I quickly stepped up as he started to fall. I could soften the fall but I could not keep him upright.

Like so many other aspects of this challenging disease the approach to falling involves trade-offs. It is valuable to have some sense of normalcy. It is valuable to prevent falls. Is the reduction in risk of falling by Dad staying home all the time worth the corresponding reduction in the "normal" feeling of going about routines? Who knows? But somebody has to decide.

Even people without dementia can fall down. A week after I turned 65 I fell in the basement. As I lay there trying to decide if I was ready to get up I remember thinking, oh dear, if I have to go to ER for this it will now be counted in the Falls by Elderly statistics! (The musty smelling carpet convinced me I was ready to get up.)

There is no iron-clad guarentee we can prevent all falls by our LOs. We can work at reducing the risks.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Fri Jul 08, 2011 11:37 pm
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Joined: Thu Apr 21, 2011 9:07 pm
Posts: 236
Post Re: another fall
Good point - my mom actually has, and generally wears, a wristband with a call button to front desk. I never thought to ask if she had it on, or if so, whether she thought to use it! My dad, of course, flatly refuses to wear his.
Laurel

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Laurel - mother (97) diagnosed April, 2011, with LBD


Sat Jul 09, 2011 1:14 pm
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Joined: Wed Sep 30, 2009 8:25 am
Posts: 227
Post Re: another fall
Ack! Mom-in-law fell trying to get out of bed this morning. Good thing we were in the kitchen just outside of her room or we would not have known. We heard the crash, but she doesn't make any verbal utterances or call for help to get up. She was just sitting there not knowing what to do. Thankfully nothing appears to be broken. Just some scrapes. She had already forgotten the act of falling so we can't determine if she had a seizure, blood pressure drop, or lost her balance. I fear that one of these days she will break something and end up in a rehab facility. In my heart of hearts I know I can't prevent all falls, but that doesn't stop me from trying.

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Donna (age 56) caregiver for mother-in-law Margaret (age 88).


Fri Jul 22, 2011 1:46 pm
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Joined: Fri May 28, 2010 4:46 pm
Posts: 119
Location: Salem, Oregon
Post Re: another fall
My mom falls all the time. A week ago, Dad vowed never to let her fall again. My reply to him was, "Well, when she DOES fall again, don't be too hard on yourself. The only way to prevent it is to restrain her." Two days ago she fell again. This time she was surrounded by my dad, me, and my aunt, but we still couldn't prevent it or catch her in time. My dad just broke down, feeling like it was his fault. We are interviewing an in-home care nurse next week and have begun touring facilities. My dad "boycotts" any business (store, restaurant, etc.) that he feels he gets poor service from. No second chances. I'm so afraid he's going to be quick to fire a caregiver for not preventing or catching her falls or move her out of a good facility if she falls there. I need to somehow impress upon him how unpreventable her falls are now and to just make sure she's never near stairs unless someone is hanging on to her.


Fri Jul 22, 2011 2:20 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3179
Location: WA
Post Re: another fall
At my husband's SNF, they use pressure monitors, one under the seat in his wheelchair and one in his bed. It alarms when the pressure is released. They work very well. Although he could easily be out of his chair and in the floor by the time someone heard the alarm and came running, the alarm itself has an inhibiting effect. I'm sure you can order them for home use, as well.

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Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Fri Jul 22, 2011 2:48 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: another fall
AliMed is one source of the bed alarm or chair alarm. alimed.com


Fri Jul 22, 2011 4:40 pm
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