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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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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Reply to Sunnygirl1

Ask if they have a geri chair where the seat slants backwards. Makes it very hard to get out of. Does your state allow chair alarms?
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Reply to JoAnn29
SARDINK Mar 7, 2019
Restraints and alarms are not allowed:( Slanting seats do not help either.
Fidget Quilts! They can help keep folks distracted. You can find them On Amazon and Etsy.
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Reply to Restlessremedy

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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Reply to kcandersen
cetude Mar 10, 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.
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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Reply to cetude

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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Reply to mmcmahon12000
worriedinCali Mar 8, 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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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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Reply to MaineMac

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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Reply to tazlady

”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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Reply to AnnReid

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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Reply to DSS893
Grandma1954 Mar 11, 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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