Fell... start of UTI?

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I know I tend to stress over everything these days (related to elderly grandparent) ~ I know I shouldn’t but it’s hard not to... Anyway, it’s been a pretty good year ~ fall wise.. until yesterday (12/31). First and only fall of 2017. I was upstairs sleeping but heard a loud ‘bang’ (...we do have a cat, but she was sleeping with me. Also have a kitten, who is in the upstairs bathroom if no one is home/or we are sleeping. The kitten has really taken a liking to grandmom when she’s up, loves sitting on the table next to her watching her work on her word searches.) At first I thought it was the kitten (many times she’s knocked over food/water dishes, even plays with her toys in the bathtub) but then I head the dreaded words ... “help, I fell.” Came down stairs and she was on the floor in the powder room. Luckily I was able to get her up. I looked her over, no bruises or cuts. Did not hit her head. Wouldn’t let me take her to the ER. Said the only thing bothering her is her right arm/shoulder (nothing new - I’ve seen the xrays. There is no hope for that shoulder other than a total joint replacement - which I won’t consent to. 96 years old and major surgery ~ nope, not happening). So I ended up sleeping on the floor next to her hospital bed in the dining room (so she wouldn’t get up without me knowing it). My question (concern?): What can I do (if anything) to make sure she’s safe at night? I already have a light in the kitchen that stays on, illuminating the walkway in the dining room...so she can see if she needs the powder room. In the powder room, I have a raised commode (not sure if it’s the correct terminology) that fits over the toilet. I have the rugs taped down with masking tape (so there’s no tripping hazard). Is there anything that I’m missing? Is it worth getting grab bars put in the powder room? For the time being, I’ll be sleeping next to her bed...I’ll admit it, I’m a worry wart, it’s who I am/what I do. Right now Gran is ok. She’s saying ‘she’s ok’. Only thing that bothers her is her right arm/shoulder. I did buy one of the Azo urinary tract infection kits though ~ on the off chance the fall was from the start of a UTI (got the kit today, but since I’ve been back from the store, hasn’t urinated). Been sitting here working on paperwork for my job, grandmom has been doing her word search (...in other words, typical day). I wish I didn’t feel so stressed but it’s hard not to...

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We have grab bars around the toilet. Also a half bed rail for Father to hold onto when he stands up at night. I request that he use a walker at night when he gets out of bed, because it's more dangerous waking up and walking. Before he needed the walker full time, it was problematic whether he would use it. And don't forget to review the meds list to look for meds that can increase light-headedness. also ensure that she's taking the correct dose of each.
Top Answer
If you're willing to get up during the night when Granny gets up, use a wireless motion detector. I use this with DH because he is so unsteady. It alerts me when he swings his foot off the bed.
For now, sleeping next to her bed as a precaution. Also have the side rail up on the bed too. She makes enough noise when she’s trying to get up.

Medication wise ~ Only new meds she has - as of 05/2017, is metropolol extended release and lisinopril. Everything else med wise is the same. For her age (96), only takes the minimum in prescriptions - 4 doctor prescribed meds; plus a daily baby aspirin; and Tylenol for arm/shoulder pain (tried meloxicam but it caused stomach pain, wound up in the hospital - once it was stopped, stomach pain vanished. Still got arm pain though and Tylenol doesn’t cut it unfortunately. She even gets cortisone injections every six weeks into the shoulder joint.).

She’s supposed to use her walker 24/7 but at times she gets stubborn. Piecing together the events from the other night, I think she started to lose her footing, the attempted to grab the towel rack (which isn’t stable) and ended up on the floor.

Are grab bars easy to install? The downstairs powder room has tiles. Thinking I’d get rid of the towel rack and replace it with a grab bar. What kind of place sells grab bars? Would they also do installations? Granted I’m pretty handy with home improvement projects/making household repairs....I don’t want to take any chances with this ~ I want it done right ~ I want to ensure than gran is safe.
Midnight, ask your GP to refer you to an occupational therapist. This person should be able to recommend the right sort of handrail and may even know of a reliable tradesman locally who can install it for you. I wouldn't do it yourself unless you are a keen, experienced DIY-er, because it's crucial it's secure in the wall and you'd need to know what the wall's made of behind the tiles. Falling little old ladies exert quite a force once they're under way.

If you like, an OT can also visit the home and recommend other equipment and adaptations that would reduce the falls risk. I completely sympathise with the stress of this, it really does turn your hair white.

A commode, strictly speaking, is a potty in a chair that can be used anywhere and is then emptied into the loo. If there's space near your grandmother's bed it might be an idea to put one there at night so that she doesn't have to make her way to the bathroom.

As for supplies and equipment, you will find whole catalogues online of things you would never, ever have thought of - and some of them are extremely ingenious and useful, like slide sheets and no-rinse shampoo caps (you don't need these yet!). But the great thing about OTs is they've seen it all and know what actually works, so I hope you'll be able to find a friendly one very soon.
If she's refusing, I mean forgetting, to use her walker, and falling.....I'd consider that she may not be able to remember safety precautions. And she may not think to use grab bars, secure feet firmly, call you first, etc. when she gets up in the night, no matter how much she may promise. It may be that she's just not able to use all the precautions you would like. I'd consider that she may need an outside person to watch her all night, just to be there to help her if she gets up. Or, use a bed alarm so you can get up with her each time. Trouble is, that is exhausting and not a good long range option, imo. I would not leave it up to her to get up on her own. With a history of falls, physical condition and age.......I wouldn't chance it.
Sounds like you are a very solicitous person and she is lucky to have you. One thing that was suggested to us when my Mom was still living was to put something hard like a table leaf under the couch cushion where Mom sat. She sank in so much that she would have a hard time hoisting herself out of the seat. Also, they suggested no coffee tables or things that she would bang into.
midnight78, for the areas that had tile, my Dad called the plumbing company he had used for years, and they knew what type of bars he needed, and they came out with the bars to install.

As jjariz had mentioned earlier, there are grab bars that one can install on the toilet. I bought the toilet grab bars from a pharmacy that sells a lot of specialty needs, and my Dad's caregiver installed it, no drilling was required as it was sturdy plastic piping that snapped together.

Can your Grandmother take Aleve? I had upper arm pain from a break. None of the other over-the-counter pain relievers would work as well.

Oh you ask if UTI's and falls were related. I really don't think so. There is no harm testing Grandma just in case. My Dad had been falling for a number of years, it wasn't until years later when he had his first UTI, and the way we noticed was when the caregiver said my Dad was seeing ants on the walls and in his food.
I’ve got a clear pathway from the living room thru the dining room (basically where she ‘lives’). Heck, the pathway is even bigger since I’ve been decluttering. She’s capable of doing steps but I don’t push it too often ~ ex: easier for her to go down steps than up steps. Had PT as well as OT earlier last year (s/p c-difficile infection in 02/2017; spent entire month of March in short term rehab; I insisted on home care...so in April we had PT; OT; and an RN). RN was only at the house three times ~ said she couldn’t justify any more than three visits cause Gran is doing so well. PT only came once. She passed PT screening with flying colors. Though he did leave a list of exercises that she can do to keep her strength up. OT was pretty much “last man standing”. Gran passed the OT screening with the exception of the right arm/shoulder issues. OT gave us a list of exercises to do to keep her mobile. And yes, she does them everyday ~ only exception being is if I’m working at she’s at Senior Care.
I did ask OT about a rail for the steps out front (live in a row home, so we have one step then walk a few feet...then go up the four steps to the house) and she thought it was a good idea. She also suggested that I get a grab bar for between the doors, so she could easily get in/out of the house. Was able to get both and it’s been a worthwhile investment.

She knows what’s going on... just told me ‘please don’t hire anyone to come in and watch me’. Luckily I only work part time during the week (my hours are determined by the state of New Jersey ~ but the pay is awesome plus I get reimbursed for bridge tolls as well as mileage to and from work. I’ve done the math, as a private pay client...only need to work two hours each day. Either way, I’ll still have some cash coming in, and for that I’m grateful. The office manager knows I am a caregiver and seems willing to work with me, if needed.)....now my weekend job (only work Saturdays - plus two holidays a year) may be an issue. If her kids can’t help or think it’s too much, then I’ll have to consider outside help. Hoping it won’t come to that though.

Between both jobs I work (maybe) three to four days a week at most. As much as it sucks sleeping on the floor, figure it's the least I can do for her - she raised me when my father wouldn’t. I can suck it up for a few years. Plus I’ve slept on an air mattress before, to me it’s more comfortable than a regular bed. But I’m also realistic and realize there may come a time when I’m going to have to hire someone to come in and stay with her while I’m at work (or at night) - so I’ve been putting aside a few dollars each week as a ‘just in case’. Tentative plan being me sleeping next to her bed for a few days...then sleeping on the couch, with the ultimate end goal of sleeping upstairs.

Gran doesn’t sit on the couch, she’s got one of those lift recliners. She’s used it so much the battery gave out/won’t let me replace it. Claims it’s very comfortable.

When she had her hip replacement back in 1998....was given a ton of stuff from the hospital. Elevated toilet seat (never used); regular commode; and a commode that goes over the toilet (looks like a commode but instead of a closed bucket, it’s open at the bottom - so stuff goes straight into the toilet). My only concern with the commode would be ~~ how would I make sure that she would use it safely? It’s not like it’s a toilet, it’s portable - it can easily move (or is there a way to ‘anchor’ it so it won’t move?).

I don’t want to put her in an assisted living/nursing home if it’s not needed. I want her to be in her own home for as long as possible.

Call your grandmothers gp and ask for a bedside commode. Medicare will pay for it. You can use it without the pail by placing it over the bathroom commode. This will give her an elevated seat easier to get up from and arms to push herself up from. Tell the dr she fell and ask for therapy. Even home health to come out and evaluate
If you want you can call a medical supply and ask them to contact your GM doctor to get a script for the commode. Are you taking your GM bp? If you get the HH they will check her BP, pulse and O2 saturation each week. They can help her with a bath and shampoo.
Metoprolol reduces the pulse. An oximeter is inexpensive, can be bought at the drug store. You can monitor her pulse to make sure it’s not too low. Ask your doctor for a healthy range for her. We hold the metro if my aunts (91) is below 60. She takes lisinopril, meto and amlodipine. If her pulse is too low she takes an extra amlodipine instead of the metro.
A person can fall for seemingly no reason but low pulse might be contributing if she just started taking it you might want to monitor.
Keep a daily log of bp and pulse for a couple of weeks to see how she’s doing. Also the OT will help her shoulder. The muscles in her arm can help support the shoulder. It helped my mom for years.
Metoprolol has a side effect of orthostatic hypotension. When going low to standing, some people feel dizzy because blood pressure drops then stabilizes. If her falls are associated with standing up described above then speak to her doctor who prescribed the med. However she is also using a walker and choosing not to use it which could be related to decline.

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