My Grandmother has dementia and limited mobility from a hip replacement last summer. She does not seem to understand that she requires a walker to get around and consequently she has fallen twice recently and had a few near-misses as well. Has anybody faced this problem before? What can be done short of 24x7 supervision?

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Sadly sometimes even 24/7 supervision isn't enough if they are determined to get up and go. But whether it is now or in a few months the time will come where she can not be left alone any more, you need to have a plan in place regardless.
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Many elders don't like using walkers, even the fancy rolling walkers, as they don't want to appear like they need help.   Then throw in dementia, and that makes it more of a challenge.

In order for my Dad to use his rolling walker, his Caregivers would find Dad almost standing and quickly put the walker in front of him, and wouldn't let him go anywhere unless he put his hands on the walker's handles.   Eventually Dad got the point, as he didn't want to see his Caregiver with her hands on her hips shaking her finger at him :)

But once Dad was starting to have memory issues, he would forget the walker and try to walk using the wall and furniture to help balance him.   Sometimes that didn't always work.

In the middle of the night Dad would get up to use the bathroom and not use his walker.   Before he knew it, he was up close and personal with the carpet... [sigh].

Elder are going to fall, that is what they do.
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