90-yr-old mother with Positional Vertigo fell again resulting in a concussion. How do I get her to stop bending over to do things?
She has a catheter that she must empty several times daily. She bends over the toilet to do so. I put a hospital chair in her tub so she can empty into the drain with hot water running. The night bag works great for this.
The day bag is more challenging, so we added a fold-up stool to the tub. She can put her foot on the stool and empty the bag into a urinal while sitting in the chair, then pour urinal down the drain. She says it’s faster to bend over the toilet. This is how she fell last time.
I tried to explain that it will become faster to empty the bag into urinal/tub the more she does it. She is now very lightheaded from the concussion. She just won’t do whatever is necessary to assure she won’t fall again. I’m at my wits end. She is in independent living. I’m her only caregiver.
21 Answers
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I believe she won't because she can't.
She needs more supervision.
Since having a concussion, I would speak to administrator and/or management wherever she is. She needs an elevated level of care.
At 90, I sense that you are expecting way too much which is (one reason) why you're at your wits end. Perhaps you are in denial (?) (as) when you get the level of care she needs, hopefully your expectations will change and you will feel more compassion for her than frustration, knowing she is doing the best she can.
Since you are the only care giver, I can't decipher if she is at home or in a facility. At a minimum, it sounds like you need to get more care / another care provider. You can't do it all all the time.
Study / go to Teepa Snow's website to gain more of an understanding of how the brain changes as one ages ... of course, the brain changes are different for everyone. The more you are educated = feel / shift to compassion, the more ease you will feel, or at least less stress. She needs more support which might mean moving out of Ind Moving into AI.
Gena / Touch Matters
And, you can not prevent her from falling, unless you are attached at the hip to her 24/7.
If she is stubbornly resistant to Assisted Living, then, unfortunately, it will take another fall, an emergency which will land her in the hospital, if not end her life.
From the hospital ER, you make it clear to the doctor that she is unsafe living on her own, and she should be transferred to an appropriate care facility. At that point, it will likely be a skilled nursing facility, rather than a posh assisted living apartment. Even in Assisted Living, they can not prevent her from falling.
It’s well past time to lay it all out on the table with her but she won’t be able to think clearly with the concussion.
When/if she recuperates, I would type up a sort of contract, print it out and have her sign it in front of a notary. She MAY start taking you more seriously after that!🤭She can do (for example):
A. Start investigating ALs (where she will still be responsible for the catheter). List them in order of preference and then choose one.
B. Hire two nurses/aides, or hire a care agency.
C. Refuse any type of care, including yours, acknowledging that you have discussed/encouraged/begged her to get help and she, of sound mind, chooses to live by her own rules.
Good luck!🤗
My sister and I have worked on my dad for two years just to go to IL. He moves in this Tuesday!🚚
You should have backup in case of your absence.
She should not empty the bag anymore. Find a safe activities to avid falls. Good luck.
I completely understand your Mom wanting to live and die on her own terms, but don't agree. Many resistant elders feel they will just fall one day and die. My Aunt was like that. She kept saying when her time is up, it's up. She was 95. I tried to impress upon her that the end may not be quick or painless. We discussed that if she fell she could have complications that would have her disabled, bed bound, in pain and lingering. It was a no win conversation. It was her 30+ years old trailer being uninhabitable (mold and rotted floors due to hurricane damage) that got her to move to AL.
I wish you luck in getting your Mom to agree to a Plan B.
I would advise that she be in a board and care, run by a nurse where they were comfortable helping with the Foley care.
Otherwise, she would need more formal nursing care for the Foley.
For positional vertigo, resulting in falls, I would not advise using any medication like meclizine that just makes people more confused and sedated, but more supervision to decrease falls.
I went to a physical therapy were they were able to get the so called marbles back in place and no more vertigo.
They had me roll in different directions.
However, particularly as we get older and more small injuries happen to the brain… the vertigo may not be fixed by that treatment and Meclazine, very anticholinergic ( like Benedryl) can cause more confusion.
What score did mom get on the cognitive exam she was given? I assume it was not a good one or a referral to a neurologist would not be necessary.
That said, your mother likely has dementia which is why it won't register with her why she shouldn't be bending over. My mother was about 90 when she developed vertigo. She started falling and wound up falling 95x between then and when she died at 95+. I took her back and forth to the ENT for the Epley Maneuver more times than I can recall. It'd help for awhile, then she'd be back to "dying" with vertigo. Back we'd go.
You can't expect a 90 year old with more issues than Newsweek to take proper care of herself in Independent Living. She belongs in a wheelchair if the vertigo cannot be managed with medication and an ENT. My mother went into a wheelchair at 92 because of the falls and the fact that nothing stopped the vertigo for any length of time. Except the wheelchair. She NEVER experienced another round of vertigo after she went into a wheelchair, btw. Physical and occupational therapy didn't work bc of the dementia. They cannot follow instruction, remember what they're told, or follow up with daily exercises needed to improve their balance.
My mother lived in AL until her dementia and mobility issues got too bad, and then she went into Memory Care Assisted Living.
My father had a catheter and by the grace of God, I was able to find ONE AL that would accept him. But, they wouldn't care for his catheter except to empty the bag once in awhile. I had to take him to the ER every single time he needed a Cath change or had an issue.
If mother tests for dementia and you have POA, you CAN place her against her wishes if the danger becomes too great. Independence is a facade at 90 when all these health issues exist.
Best of luck making good decisions for mom.
You won’t teach them the maneuvers to be safer, they will not remember, but you teach their caregivers.
That is why I require every patient to have a written plan of care from PT/OT so all the caregivers can follow it.
There was no Fairy Godmother, just a nagging daughter that kept on & on about a Plan B, downsizing, a new stage. Whatever title she thought may work. Made like 30 attempts, probably more.
Eventually wore one down.. after another chat of "So if you HAD to go to an AL, would you prefer the one UP the hill, or the one DOWN the hill? One day Mrs Stubborn forgot to say "Neither!" but said "I guess.. down the hill".
From that day on, light little *jokes* were added.. "You'll get used to it when you move down the hill". "Imagine not having to cook? Or do the dishes?"Or "what lovely trees" everytime they passed by.
Chip chip chip.
Forward to 2024, when the chips DID fall. Crises arrived. Mr Calm & Ready Now made a swift decision & a lovely place was chosen on instinct. But as the crises deepened so fast, 'down the hill' was available first.
The end of the tale arrived for one. Skipped the nursing home stage - straight to endless peace.
The other likes their home down the hill! Enjoys the meals, the activities, the view of the trees.
As happy an end as could be.
💙🕊😊
My dad (who had dementia and a lot of other issues) had dizziness and saw flashing lights upon standing up (sometimes but not every time) and it led to falls and injuries. He could not or would not comply with medical advice around that including he could not or would not drink anywhere near enough liquids so he was constantly dehydrated which also made him light headed and contributed to kidney failure. Even with an aide sitting right by his side, falls were inevitable when he was living at home on hospice. The last few days, he was at a hospice facility where they put his air mattress all the way on the floor with alarms on it and bolsters on either side. He could not fall while trying to get out of bed because he could not get to a standing position. All he could do was crawl. They put him in a padded wheel chair / lounge chair kind of thing during the day and he was corralled in with barriers so he could not get out of that either without aide assistance. None of those means were possible at home.
good luck.
At this point..a 90 year old Stubborn person is not going to change. (I kinda know, I'm not 90 but I am stubborn and I wanna do things the way I wanna do them.)
Or you just let her do what she is going to do.
Honestly if it isn't this it will be something else and she WILL fall again.
No other plan means we are left with *Await a crisis* as the plan.
LO's regular Doctor is aware.
ER Doctor said next admission will start the new journey: ER-hospital-rehab-*not home*-some type of care facility.
ER Dr advised speaking up early to Hospital Social Worker. PT & OT will work on building strength & assistive equipment for a safe discharge where possible. If not, Social Worker helps with next steps for an alternative.
Having a location planned would help smooth things. I reasearched locations, care level & costs for another relative. When a temporary stay had to tranisition to permanent (due to crises) it was difficult but not impossible.
With the next one, I lack any authority to make a start. It will take a crises.
TannD, would you Mother be open to the idea of a Plan B.. a Backup plan?
Time for her to be placed in assisted living where someone there will empty her catheter bag for her.
Your mom is 90 and you know the saying that it's hard to teach an old dog a new trick, well this now applies to your mother.
Please don't continue to allow your mother to live by herself, as you are just asking for more trouble.
And on a side note, I sure hope that your mother had an MRI or Cat scan done on her head as she may very well have a brain bleed which can be very serious.
I’ve seen a little of postural blood pressure problems, but only in acute settings. I do not know how it is managed as an ongoing issue,
What I do know is it takes a while to adjust or accept change. You can see the changes in Mother’s health & ability.. what this means for her I don’t know.
Will it improve do you think?
If she’s not seeing a neurologist, she should. She may need to move to Assisted Living.
I am so sorry that this is happening.