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My parent is 91 yr old, frail, uses a walker, with bad hip-replacement. He has dementia and constantly wants to get up and walk around. He has fallen 2 times recently and fractured his clavicle bone. He gets angry and won't follow directions from the staff at the nursing home. Facility doesn't allow restraining him, so what can we do? We want to keep him from falling and fracturing his hip, and be more cooperative.

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My husband 70 years old was doing exactly like this and was injured several times. I did a lot of research and foung Rivastagmine which is used for dementia is also preventing falls. His doctor should have given it long time back. He is being given this med for three months when I asked for it and it was like magic he stopped getting up frequently.
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If the nursing home refuses to restrain him for his own safety, then keep him in a bed with the bars up - I know of no other way. In cases like this, I say the hell with the rules - restrain him and keep him from harm. Otherwise, he will fall and worse.
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dsschuessler Mar 2019
Nursing homes in Kansas feel that bed rails are restraints and do not allow that. I don't know about other states.
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Dad chose on his own to use the transport wheelchair instead of walker as he felt more secure. We left foot pads off and he used to get around pretty well in it because of it's small size. He only stood up to move to the power chair or bed or use the toilet. They checked on him hourly to see if he needed assistance because he never thought to use the call button. But you can't anticipate your needs with dementia and he would often just try on his own. Putting the wheelchair across the room just caused him to try to limp over to it (without the walker).
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They have alarm mats that they can place on the bed, on a chair, in a wheelchair. Then when the resident stands up to walk, get out to the bed/chair, etc. the alarm will go off and alert staff that the resident has gotten up.
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In a perfect world - which sadly we do not live in - the perfect nursing home staff would accompany him and give him physical support to prevent his falling. Mobilisation is a good thing for people, it improves muscle tone and blood circulation. Sitting still all the time is bad for the health.

But. No nursing home is able to provide one-to-one care round the clock; and your father is a serious falls risk so he cannot be allowed to mobilise on his own.

Why is your father getting up? It is important to check that he is not in pain or otherwise uncomfortable. He should be helped to change his position frequently; and ideally he should be assisted to mobilise as often as practical.

There is no point in explaining falls risks to a person with advanced dementia, and directions that antagonise him are counterproductive. For example: if you ask him to sit down again when he wants to get up, he will resist. So, what about letting him get up, leading him to another chair, and asking him to sit there to rest "for a moment"?

Obviously this kind of thing is a tall order for staff anywhere; but on that point are you happy that this NH does have enough specialist expertise in handling dementia?
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Invisible Mar 2019
Totally agree with your assessment. You want him to be accompanied. It's good for him to move around and use his body. He might be uncomfortable. Restlessness is also a signal that he might be going through a change in his dementia. Staff should be checking in on him on a regular basis. It is very hard for people with dementia to remember/follow directions. Read "36 Hour Day" and know the signs/get suggestions for coping.
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Perhaps an alarm could be sounded when he's on the move. A psych eval may also be helpful and necessary if he's not able to follow the rules/directions of the fadility.
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My mother had dementia . The doctor she had gave her something as she got angry and agigitated so it helped to calm her. Your poor dad doesn't know why he can't do the things he did before due to his dementia bless him. You should talk to your dads doctor and explain your concerns. As the home can only do so much it has to come from the family. Unfortunately my mum got to the stage that she would neither drink or eat. I asked one of the nurses could mum not be put on a drip. They said i'd have to contact the doctor as they couldnt do it. I did then my mum was on a drip for 72 hours. Unfortunately my mum went down hill in less than 2 wees. My mum wont be a year dead till June she was 89 . Good luck i hope they do something to help your dad and give you all peace of mind x
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Invisible Mar 2019
Long term nursing home care is custodial. Transitional care in nursing homes is rehab care (PT/OT/ST). Hospitals are acute care. You have to go to a hospital to get an IV/Drip. Hospitals also have alarms/monitors for people trying to get up but nursing homes don't want to do that and - thankfully - they don't want to use restraints. Just went through all this to make choices on my father's care. Hospice gave me a wonderful book called "Hard Choices for Loving People" that finally explains the processes your parent is going through at end stage dementia and why the hospitals don't explain the consequences of some medical procedures they will perform on your aging parent which can actually be harmful and painful to them. If you do not have a DNR order and/or POLST, they are mandated to try to save lives. And you want to do what is right for your loved one even if you personally are having trouble letting go. There is a lot of denial in recognizing end stage dementia.
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Have you ever looked up a wheelchair with a seat belt. I found it on computer. I also found a wheel chair with a toilet under the seat.
Its true I did. So I brought them both. the one with the commode was great when I took dad out. rolled him into a room, hallway or whatever and he was able to go . mom was the same. just pop the top off of seat and that's it. the seat belt one I brought to the nursing home . dad was doing the same as your dad. wanting to walk around and falling down. he did stay in it for a long time until he learned how to undo it. mom was totally different that dad. she laid in bed for three months and had every one do every thing for her.

As they get older they mentally get younger. there is no way to make them understand something . Their brains are being taken over with the diseases they have.
I had the nursing home put dads to the floor with cushions all around it so if he climbed out or fell he didn't have far to go.
but than they told me he would crawl like a baby around the halls till someone found him......cant win......
good luck......
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there are time when there Should be psychiatric intervention. Sometimes dementia causes anxiety, restlessness and confusion. As a registered nurse I don’t advocate to prescribe medication for all dementia patients but if it’s a safety issue there may be something that is available for him.
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I learned with my mother, that along with aging and Dementia come agitation, both mental and physical. An anti-depressant at the right dose can make a big difference. Allowing them to feel calmer and less frustrated.
We want them to be more engaged and active so WE feel better, but usually they’re content not be busy. You need to tell his Dr. all his symptoms. At this point in his life just knowing he’s safe and comfortable is the best gift of love you can give. It may also be time for the Dr. to ask Comfort Care to evaluate him. They understand what is going on in his body that makes him restless.
They were just what both my mother and I needed to make the best choices
for the last part of her life.
God bless and guide you. You’re not alone.
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The Broda chair works great for my mom. During her 5 months in assisted living, she fell 7 times, even twice in one day, trying to reach for something on the floor while in her wheelchair or trying to get out of bed. We put a fall mat next to her bed and she has a curved foam mattress pad that slows her down if she attempts to get up, which she no longer is able to do). The Broda chair leans back like a recliner. She is in an advanced stage of vascular dementia now in a nursing home, and non-ambulatory, so falling is less of a concern, but it certainly was worrisome for several months. Also certain medications keep her calm as she was sundowning pretty bad, feeling anxious, restless, agitated.
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Grandma1954 Mar 2019
I/we had a Broda Chair it is great and makes repositioning much easier as all you have to do is shift the chair a bit and the body moves.
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I would purchase shin and arm guards, to cushion any falls. I like the the ideas of a chair alarm and also being near nurse's station.
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Make a wheelchair or better yet a motorized scooter seem like FUN to them! IF they can self transfer-and if they can stand they can transfer. That way they are not feeling trapped. As another person mentioned here, a mild sedative but beware the anti depressants as they can make dementia SO MUCH WORSE! Do your google homework.

Melatonin does not work well with dementia and does not work with sundowning. Sequel is handed out like candy and can lead them having worse hallucinations so keep that in mind.
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cak2135 Mar 2019
I will be 66 years old in September and I would love to have a motorized scooter! I love to have fun, too.
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My mom is 96, has dementia and a knee that buckles if she tries to walk unassisted. She's fallen a few times because she forgot about the call button (or even that she's now in a nursing home). It's helped to place her wheelchair well out of reach and lower her bed as much as possible so that she physically cannot get up, but some aides forget these things. BUT... now they have a sensor that beeps loudly (and different from the call button) if she tries to rise. When she's in bed, the sensor pad, about 8x10", goes under her butt. When she's in the wheelchair, the sensor is on the seat. There's a cable that goes to the alarm box, and we put the alarm box OUT OF REACH because she figured out how to shut it off. I make sure this setup is in place whenever I visit. I hope this helps keep my parent -- and yours -- safer!
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”When there is no ’good’ solution to a problem, it becomes your responsibility as his caregiver to make the best choice among all the ‘bad’ choices”.

You have realized that there are NO good solutions to Dad’s desire to walk because he has become a serious fall risk.

SO- for better or worse, it’s time to try a less than good choice.

My LO was anxious and in constant, unfocused motion, and hostile to her caregivers, until she was assessed by a kind, quiet psychiatric PA., who recommended a trial of the LOWEST POSSIBLE DOSE of an anti depressant with tranquilizing properties.

I DID NOT want her “doped up”, and the therapist agreed. The effect of her medication was enough to give her a more peaceful outlook without depriving her of her sense of humor. She now uses a walker, and has still fallen occasionally, but with far less serious results, although ironically one of HER previous falls had resulted in a fractured clavicle too.

In the last two weeks, her comfort level has regressed a bit, but we will adjust her medication level up (or down) as circumstances warrant.

I’d give anything if there were another kinder, more compassionate, more fair way of dealing with my LO’s current problem, but if there is, I haven’t come up with it.
LO doesn’t warm readily to “strangers”, and dementia or not, she’d know the minute some smiling faced “helper” came up to her and asked her if she wanted to take a walk. The answer would be a polite, professional “No”.

Keep loving him and choosing the best of all the solutions, even when there aren’t any good ones........
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A toileting schedule with someone walking him with walker to the bathroom every two hours, and about 1/2 hour after meals. This is a tough one to follow because of staffing, but oftentimes residents stand up because they want to go to the bathroom.

Having someone walk and/or exercise with him with walker throughout the day as sitting gets old.

A seat/bed alarm with familiar voice that says something like, "Dad, please sit down, someone will be with you soon."

Decorating his walker with relevant stickers (for example: cars, army stickers, his name on the inside facing him), and/or "Washi tape" to personalize it and he can help decorate it. Studies have shown that this works to increase walker recognition and use. Keep it near his bed and where he is sitting.
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That is a tough one. Can you afford to send a one on one aide in to give him attention and support? I had to do that. It is a tough journey. I wish you the best. Is there another facility that can supply more staff oversight?
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Maybe, and I hate to say this but maybe it's time for a sedative. Mild. My father was put on trazodone. Good old sweet dad is back. Still forgets to use Walker now and then but med makes huge Difference.
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I experience this problem (starting several years ago) with my father - same age and scenario. His neurologist ended up treating him with medication for anxiety: first with melatonin for sundowning and then a low dose of Seroquel when it started after breakfast. His facility would only allow him one alarm until hospice supplied the second; he has one on his bed and one on his easy chair. He forgets that he needs a walking aid for balance control and the facility is usually at capacity and sometimes short-staffed. When they aren’t, one of the aids will walk him up and down the hall to help calm him. I visit three times a week in the evenings for dinner and to do the same. We have placed several different things in various areas of his room (within his sight) for him to fidget with: a small box of PVC fittings and kids’ tools (former Mr Fixit!), several small stuffed animals, a couple of kids’ musical instruments, etc. It hasn’t totally eliminated the problem, but has really slowed it down!
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My Mom did the same. We tried a walker and wheelchair but she would either forget the walker or just get up from the wheelchair. We also tried a merry walker. Worked great for a while but she eventually started trying to get out of it. She tilted it and almost injured herself so the staff removed her from it. They literally had to have someone watching her closely. Mom was very hard headed and always argued with staff. I feel your pain, I always dreaded the phone calls from the nursing home for fear she had injured herself. Good luck and god bless.
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Have someone volunteer or paid or nursing student come take him out to walk 1/2 mile each morning and again afternoon to let off energy. That works for my folks . 3 times a week I have someone take my dad fishing . He’s less agitated and can settle the other times. Also look at diet. More fats to calm the brain and remove fruit juice. Read the work of Dale Bredesen on Alzheimers. Lots of these symptoms can be reduced with certain methods.
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Invisible Mar 2019
I always wondered why they gave them so much fruit juice. High in sugar.
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I have the same problem. Would love some ideas. My Dad used to walk 1-2 miles a day and was always on the go. Never relaxed and always doing physical labor. This same pattern / urge has stayed with him even though he has advanced dementia. He is still physically fit although no sense of space and balance is poor. He falls at least once a week at NH. Can’t reason with him or use signs as he cannot remember or understand what the signs mean. Since he did not use an Ambulatory aide before advanced dementia he has been unable to learn how to use one now or even have cognition to know what one is even for. He can’t sit still for activities and have yet to find something to occupy his attention. Walks / paces continually. Provider has tried multiple different medications to try and relax him and quiet his agitation. They have just made him sleepy and the additional side effects made him at greater fall risk as the urge to walk did not cease. Staff has been great but can’t be with him all the time and he is always on the move day / night. Facility is set up in a circle and room doors are 1/2 doors for optimal sight lines but he still falls. If someone has a magic solution would love to hear it. I am resigned to the fact that one of these times a fall is going to result in a more serious injury. Breaks my heart but cannot physically Or chemically restrain him. For now try to find a medication regimen that balances his agitation with sedation to keep as safe as possible.
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Have you or they tried a wheelchair that reclines? If the chair is tilted back a bit it makes getting up much more difficult. The movement of him trying to get up would set off an alarm (I hope to God they have an alarm on his chair) and get someone to aid him.
The other possibility is that the trying to get up is a sign/symptom of agitation that he could possibly be medicated for. Medication not so much to make him groggy or in a stupor but medication that would relax him and make him less agitated.
Also if he is in a position where it is more difficult to get up, like putting the chair in front of a table. He can be given some sort of activity to do, drawing, puzzles, reading would all give him something to do.
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I should hope the home would not restrain him! They should be qualified in dementia and therefore should know how to deal with his wandering and keeping him safe, should always have a one to one where possible
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Cloudtouch3r Mar 2019
1 to 1. Good luck with that. Better off with home care if you want one to one.
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Give him something to do while he is setting
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It is naturally instinctive to want to walk, especially if they were active most of their life. My mom's Alzheimer's has gotten so bad she quit getting up on her own. However, she can still use a specialized walker that she rests her forearms in called Dolomite Alpha Rollerator and it has been God sent--but it cost me nearly $700 (medicare does not cover these walkers so it's out of pocket). I still manage to walk her a quarter of a mile a day with this walker. I can tell she enjoys these walks in the park. Rest of the day she is much better. Needless to say I must be with her at all times when she walks with it.

During earlier stages of he Alzheimer's I depended on exercise to manage her behavior and she never needed a single narcotic or psychotropic. Exercise actually reduces falls. but there is no way you can completely eliminate them.
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We have the same problem. My father was so use to being so independent. Just getting up and not thinking about it. But, because of his diabetes, he basically can't feel his right leg from the knee down and falls a lot too. What we did was 3 things: We took my father's walker away and now he only has a wheelchair. He did not like it at first but when we told him it gave him the opportunity to really heal his diabetic foot and that it was safest. After a week, he actually learned to like it - thinks it is comfortable and likes wheeling around. Secondly I purchased bright orange neon poster board. I made signs that stated 'Dad - ALWAYS use call button for help' - 'Dad use wheelchair at all times'..., 'Always get help to stand up and walk to bathroom'... and even have a sign on his wheelchair itself... it has helped a lot. Good luck... it's a tough situation. We also asked the NH to come at scheduled times - like at 10:30 and then again at 1:00, etc. to ask if he has to go to the bathroom so this way it is proactive prevention. There is no perfect solution but the above has helped a lot. Good luck.
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cetude Mar 2019
My mom hates wheelchairs. Even with her advanced Alzheimer's she would do two things--lean on one side to the point she is almost at a complete angle and not be able to right herself, and sink. When I reposition her--again she would lean on one side, and sink in the chair to the point slid to the floor. Once on the floor she cannot get up and one has to use either "911" or a Hoyer lift. If your dad is in a nursing home this has probably happened and you were never told. As for seat belts, this is a physical restraint. Wheel chair belts are only are they awful--but I think cruel because they cause discomfort and they cannot tell you. Even with the best cushions they can create buttock sores. Even if I allowed my mom on a wheelchair all the time--which a hospice nurse practitioner actually suggested I do that, but she obviously does not understand how it's like-- she will lose her ability to get up and it's probably better to keep her in bed until she's dead and gone; wheelchair bound will require several people to get them up. This is not an option when one is the SOLE caregiver as I am. Immobility has complications of skin breakdown, sores, ulcerations, urinary tract infection due to sitting on stool, blood clots and pneumonia. And yes they can fall on a wheel chair due to sliding to the FLOOR.

So I keep her off a wheelchair and only use it for transport purposes such as taking her to the mall and just wheel her around. AT home she sits on an easy chair with a hydrolic lift (cost me $800), and I use a walker to get her around the house, bathroom, teeth brushing, and so on.
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There are a number of things you and the facility can try, but, often the resident will still continue to fall, get fractures and then become wheelchair bound to the point that they are not able to get up or even try to up. I have a friend who's father was similar to yours. The Nursing home put his wheelchair near the nurse's station so they could supervise him most of the time. You can also discuss the issue with the staff and see what ideas they have. They deal with this all the time. While there are normally laws on restraints, I would explore what your state allows in the form of geri chairs. And, if you think he's getting up due to being agitated, I'd discuss the agitation with his doctor and see if medication could help treat that.
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Tell him the truth. If he keeps getting up, he'll keep falling so tell him he needs to STOP. If he starts to argue, walk away. Then repeat. Every time he gets angry is the time you walk away. He'll learn quickly that if he starts up, that's when he'll be on his own, falling and hurting not only himself but those who love and care about him.
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worriedinCali Mar 2019
this is unrealistic for a dementia patient in a nursing home. You can’t reason with him, he is NOT going to learn and the OP cant be there all the time.
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Fidget Quilts! They can help keep folks distracted. You can find them On Amazon and Etsy.
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