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Medical Forum / Diseases and Disorders / Alzheimer's / July 2005Dementia & using a walker
My MIL has vascular dimentia. She started using a walker about a month ago & has had home therapy with a Physical Therapist & also Occupational Therapist. She can walk a few feet, but she is quite unsteady so the walker helps a lot. As is understandable, some days are better than others with remembering to use the walker. When she goes to the restroom, outside on the patio, the kitchen (just walking around the house), I've been reminding her as much as possible about the walker. If she forgets it & I notice, I'll go get it & bring it to her, then she walks with it. Or sometimes I'll ask "Where is your walker?" before I go get it - she sometimes says she forgot it. The OT asked her where it was today (she was walking from her chair to the table) & she just said we were "aggravating" her. So she has days when she doesn't want to use it and doesn't take well even to being reminded to use it. It is right beside her chair. I talked to the PT about it - she just said to keep reminding her. Understandably, since she can walk a little, she just goes through phases when she almost refuses to use it (childlike obstinance attitude). My husband & I moved it about three weeks ago & are her caregivers now, so this month has been an adjustment for all of us. I really have a fear of her falling. Can you offer me some tips on getting her to reach for the walker more frequently? Should I continue to go get it when she forgets & bring it to her or should I just give in & let her walk around without it? Thanks for any suggestions. Octavia, I am a home health physical therapist with some dementia experience. The answer to your question is you will have to bring the walker to her for her to use it. Even if in plain sight, it may not register for her to grab it. (will explain further). Another strategy is to have secure handholds available for her to use, but that usually limits the room available to use the walker. I know that's not what you want to hear and I truly hope I'm wrong. Each person is unique. I am guessing that she is at least at Stage 5(Global Deterioration Scale of Reisberg's-http://www.geriatric-resources.com/html/gds.html) because Stage 5 is where she can no longer survive without some assistance. Real world experience shows that unless someone is comfortable with walker or cane use by Stage 4, it is unusual that they would be reliably safe with their use (enough for it to make a difference in preventing falls). There are always exceptions, but the problem is cognitively "learning" and integrating it's use. When they can't remember that they need it, and it's not part of their self-image---you're not going to alter that. By the same token, having it in sight does not necessarily mean it registers with her. As frustrating as it is, she will react and remember your emotions-so just provide it, guide her into its use without comment, forget the explanations of why, etc. You do the best you can for that moment, and let it go--maybe trying again the next time. If you're fortunate, she may get used to it enough not to resist using it. But you have to alter your expectations because she is not going to consistently comprehend the need or maybe even the how. Sorry, but that's the usual outcome. Along those lines--you may want to consider using hip protectors with her. They're a panty-girdle with hip bone protection. The source I used with my MIL is http://hipsavers.com/index.html. If you've only been with her 3 weeks, you might not feel ready to tackle that. Maybe ask the therapists if they've had any experience. I would be happy to spew further, if I can be of help. Unfortunately, falls eventually are inevitable. If you can delay the falls/injuries quality of life for everyone has to be enhanced. As my MILs MD said, a hip fracture is not a good way to die if it can be prevented. I'm not sure I like the other possibilities either, but feel at least I am doing what I can. Hope that helps. Beth, PT in Maryland A hip fracture is not a good way to die, but neither is the last stages of Alzheimers! I'm not advicating pushing her down to break a hip <bg>, just making a statement. Gwen > Octavia, I am a home health physical therapist with some dementia > experience. The answer to your question is you will have to bring the [quoted text clipped - 36 lines] > Hope that helps. > Beth, PT in Maryland Wow, I'm so happily bowled over by all these wonderful responses:) Beth, thanks so much for your very informative comments. My SIL has taken care of my MIL for years, but things really went from bad to worse back in May when my MIL had a like a ministroke. I don't know what the doctor's diagnosis was, but that is basically what happened. My computer has been back up for a few days - in fact, we set it up downstairs so I could be around her to "watch". Anyway, I've looked up dementia & learned there are different causes. Something about her heart was involved, which affected the brain so without getting specifics from my SIL yet, I'm guessing what she has is "vascular dementia". At any rate, it pushed her situation from bad to worse. I don't know what Stage she is (I'm going to ask my SIL what all the doctor has specifically diagnosed) but simply from what you have said about it, yes, that is where she is. After this last thing happened, the doctor said she must have someone with her 24/7. Between what my SIL had told me about & from what I've seen & experienced in just 3 weeks, I can fully understand why continuous care is mandatory. With the aid of the therapists, I can see she can still do things. But the key seems to be having someone right there beside her, continuously cueing her. Like here is a soapy washcloth - then she can wash her own face. Or, here is your toothbrush, and she can brush her on teeth. However, she has days when I suppose long old habits might or might not kick in & she'll do somehting like make her bed. LOL - I don't make my own bed so that is the very least of my worries. But if that is what she used to do, I'm happy to see the days when she has done it, as I think at least for that moment in time, she must have been feeling ok. It really makes sense what you stated about emotions & expectations. I can see from your response & others, something that will be key for me, like in the case of the walker is to just put it where she can get it or take it to her when I see she walked off without it. I can see you are right - talking reminders at this point are probably not going to do much more than anger her. Easier to just put it in front of her. The hipsaver sounds like a great "tool". Thanks for the suggestion!... I know I have much to learn and a long road to travel. Thanks again so much for your most helpful input:) > Octavia, I am a home health physical therapist with some dementia > experience. The answer to your question is you will have to bring the [quoted text clipped - 36 lines] > Hope that helps. > Beth, PT in Maryland Octavia, Just a note on the staging. Don't count on an internist or primary MD to be able to stage her beyond early, middle, and late. Heck, I have neurologists who won't do it; I suspect because they're not really interested in dementia compared to other "treatable" diagnoses. Patients don't fit neatly into the categories of any particular scale... there's overlap and skipping ---but by going through the progression you can judge about where her behaviors are falling. Different scales have been developed, mostly in conjunction with research studies. It doesn't change the behaviors you see, but can alert you as to what you might expect. For the general public early, middle, and late is more than enough. But when it's your relative, some caregivers tend to want it broken down more. I can tell you Stage 6 seems to last a long time-and early and late in that stage tends to be determined by continence. Dr. Rabin of The 36-Hour Day-fame notes there is roughly 3 years of forgetting, 3 years of praxis problems-losing abilities in everyday activities, altered perception where the brain can't put together memory with what is seen, can't distinguish relative importance of stimuli, aphasias, etc., and 3 years of physical decline. That's a gross generalization of course, and stroke and other medical issues can alter it. Some linger at any one stage longer than other folks. A scoring tool which breaks things down is the FAST (Functional Assessment Staging) at: http://www.geriatric-resources.com/html/fast.html I just want you to know that after beoming familiar with staging, you'll probably be able to manage it for your MIL. I know I am getting pretty good at spotting early dementia in my clients or their spouses. Once you're exposed, it becomes very obvious and you wonder why you haven't noticed before. At least that's been my experience. BTW, I did not comprehend the progression from memory deficits to full-blown dementia until after I'd had direct day-to-day experience. And I have a Rehabilitation background. So welcome to the "club". Beth >I am guessing that she is at least at Stage 5(Global Deterioration Scale >of Reisberg's-http://www.geriatric-resources.com/html/gds.html) because [quoted text clipped - 3 lines] >safe with their use (enough for it to make a difference in preventing >falls). Does that mean that if I practice walking with a walker/cane prior to that stage, I could prolong the period during which I might walk? - Mind control is being able to make all the voices in your head take turns. Mod as a hooter! >>Does that mean that if I practice walking with a walker/cane prior to that stage, I could prolong the period during which I might walk?<< I think it depends on how your brain integrates it and when, thus maybe, but don't count on it. I have a hunch it also could be influenced by your general reaction/acceptance or emotional response to walking aids. Some folks are so adamant that they won't ever need such a thing..... particularly if they have no life experience in them. LThen there's always the application of judgment..... Beth > My MIL has vascular dimentia. She started using a walker about a month ago > & <snip> > really have a fear of her falling. Can you offer me some tips on getting > her to reach for the walker more frequently? Should I continue to go get > it when she forgets & bring it to her or should I just give in & let her > walk around without it? Thanks for any suggestions. Octavia, in the nicest possible way let me point out that I think you are failing to understand something (and I plead guilty to this on past occasions as well ). You cannot 'get her to reach for the walker more frequently' because that implies she will learn. And she cant learn because in order to learn you have to remember. So, you will have to keep a constant watch on her and if she doesnt reach for the walker you'll have to place it there. Especially if she doesnt even use the walker when its right next to her. Probably she has forgotten she needs it. Or maybe she doesnt know what it is? I suppose it doesnt really matter in any event since you cant chnage her reality for more than a few moments. If she is really unstead without it, then I would expect (wouldnt you?) that eventually she will fall if she doesnt use it. So giving in doesnt appear to be an option. So you and hubby will have to watch her like a hawk 24x7.  SignatureTumbleweed email replies not necessary but to contact use; tumbleweednews at hotmail dot com Tumbleweed, thanks so much for your response. It may sound strange, but nicely pointing out the fact that she just doesn't *remember* about the walker was very helpful to me!! As I'm still new to all this, I can see I'm going to have to start reminding myself that there really isn't much point in trying to "remind" her about the walker as she obviously can't retain that memory that she needs to use it. A hawk I shall be:) Thanks! >> My MIL has vascular dimentia. She started using a walker about a month >> ago & [quoted text clipped - 24 lines] > appear to be an option. So you and hubby will have to watch her like a > hawk 24x7. > My MIL has vascular dimentia. She started using a walker about a month ago > & has had home therapy with a Physical Therapist & also Occupational [quoted text clipped - 18 lines] > should I just give in & let her walk around without it? Thanks for any > suggestions. Dear Octavia, I know how difficult it is for you to try and impress on her that she needs to use that walker to get around, but you are asking her to remember something (the walker) when her memory is exactly the thing that is not working any longer. Others have explained it here very well for you, and I hope you find a way of working with your MIL in this difficult issue. I can sympathize because I cared for my MIL for three and a half years before we finally were forced to put her in a nursing home due to her inability to walk anymore without falling. But she continued to TRY to walk on her own many, many times, even after she was placed in the nursing home. We got several phone calls telling us of falls she had, even after she was placed there. At first they tried something called a "Merrie Walker," which is a wheeled framework with a small seat in it.... in essence a walker that they cannot get out of by themselves, also without avail. She just didn't do well in it, because a person with alzheimers doesn't find it easy to learn any new thing. Then they tried a wheelchair with a foam cushion between the arms called a "Lap Buddy" which did prevent falls, but also limited her mobility severely. They had alarms on the bed to warn that she was getting up out of bed, and she still managed to fall. So that is just some of what the nursing home did, in the case of my MIL's inability to navigate on her own anymore. The reason your MIL sees your reminders as "aggravating" her, is because she cannot even remember the fact she needs assistance in the first place, and still remembers being mobile, and independent, and able to walk OK on her own. It is just as though someone told you to use a walker (who presumably walks just fine on your own) in her mind. It is just part of the illness, not to understand ones own limitations. A very frustrating part for the caregiver, I might add. SignatureBest Regards, Evelyn (to reply to me personally, remove 'sox') Evelyn, thanks so much for expressing your experience about walkers. I'm so new to this, I had no idea there were so many different types. I'd only visited a nursing home a couple of times, I do recall them calling one type of wheelchair a Jerrychair (something like that). Anyway, the Merrie Walker & Lap Buddy sound like items to keep in mind. I will definitely mention those to my SIL. Perhaps at some point they will be necessary. I can see from your response & the other great replies that my biggest mistake is thinking I can "remind" her. More & more I can see that attempting to remind is probably just not sinking in. I'm resolved now to just do everything I can to keep it in front of her or by her or just take it to her in those times I see she hasn't grabbed it. Really love your statement that she can't remember the fact she needs assistance to begin with. Your comment & the other similar ones truly help to point out what I need to be drilling into my own head:) >> My MIL has vascular dimentia. She started using a walker about a month >> ago & has had home therapy with a Physical Therapist & also Occupational [quoted text clipped - 57 lines] > the illness, not to understand ones own limitations. A very frustrating > part for the caregiver, I might add. > Evelyn, thanks so much for expressing your experience about walkers. I'm > so new to this, I had no idea there were so many different types. I'd only [quoted text clipped - 12 lines] > assistance to begin with. Your comment & the other similar ones truly help > to point out what I need to be drilling into my own head:) Hi Octavia, The old adage "A word, to the wise, is sufficent" comes to mind here. You realized right away, as soon as you heard it, that reminders and corrections are a waste of breath with this illness, because they can't remember that they can't remember. What is most often amazing is the fact that we, who have perfectly good functioning memories, so often also can't remember that THEY can't remember :-) I have an Aunt who continued correcting her husband throughout the entire illness till the day he died. Of course it was all in vain. He was long past the point where he could remember any instruction even for a half a second. It is so good when someone "gets it" right away that alzheimers is a disease where the short term memory is the first thing to go. I was not so quick to realize it myself. But ultimately when I saw that it was true, I did get it. SignatureBest Regards, Evelyn (to reply to me personally, remove 'sox') "What is most often amazing is the fact that we, who have perfectly good functioning memories, so often also can't remember that THEY can't remember :-)" LOL - Prescisely:)) The last few days have been a bit better because I've been remembering ok. But I'm sure I'll hit another snag or two before I have it so ingrained within me that it is automatic. Still too many times when it dawns on me that I just see her as my MIL, not someone who can't remember the same thing over & over, even if only 3 minutes have passed. And on the good days when she remembers something, I catch myself, wanting to literally cheer:) >> Evelyn, thanks so much for expressing your experience about walkers. I'm >> so new to this, I had no idea there were so many different types. I'd [quoted text clipped - 34 lines] > I was not so quick to realize it myself. But ultimately when I saw that > it was true, I did get it. > Really love your statement that she can't remember the fact she needs > assistance to begin with. Your comment & the other similar ones truly help > to point out what I need to be drilling into my own head:) It's really difficult for family, because the person doesn't look any different, even if their brain is not functioning properly. >At first they tried something called a "Merrie Walker," which is a wheeled >framework with a small seat in it.... in essence a walker that they cannot >get out of by themselves, also without avail. She just didn't do well in >it, because a person with alzheimers doesn't find it easy to learn any new >thing. Is there any evidence that training an early onset patient to use something like a merrie walker at an earlier stage so that they can use it later when required? - Mind control is being able to make all the voices in your head take turns. Mod as a hooter! >>At first they tried something called a "Merrie Walker," which is a wheeled >>framework with a small seat in it.... in essence a walker that they cannot [quoted text clipped - 6 lines] > a merrie walker at an earlier stage so that they can use it later when > required? Possibly. I don't know if anyone has tried it, Anthony. But there were people who seemed to do well with it anyway. We didn't place Ida in the nursing home until she was really far into the illness, and that may have affected her ability to use it. If it were me I would honestly and truly WANT to go there sooner than that, on hindsight. SignatureBest Regards, Evelyn (to reply to me personally, remove 'sox') > - > Mind control is being able to make all the voices in your head take turns. > > Mod as a hooter! >>At first they tried something called a "Merrie Walker," which is a wheeled >>framework with a small seat in it.... in essence a walker that they cannot [quoted text clipped - 6 lines] > a merrie walker at an earlier stage so that they can use it later when > required? Unlikely Anthony, because the things learned latest are the things soonest forgotten. Thats why my Dad can recall the name of his schoolteacher 70 years ago, but not what he had for dinner (or if he had dinner) 5 minutes ago. SignatureTumbleweed email replies not necessary but to contact use; tumbleweednews at hotmail dot com >..because the things learned latest are the things soonest forgotten.< I have to agree with Tumbleweed. I actually tried to get my MIL to handle a cane and a walker when she was in the early stages-but it was too threatening to her and she refused "to cooperate". She could not fathom that she would ever be any different than she was then. Also I think, she did not see assistive devices as helpers at all. I've noticed that folks who have never experienced aspects of disability with others tend to be very resistant to changes even when things need to be changed for them to allow function. One of those basic human traits, I suppose. Beth >"Anthony Shipley" <astech@iinet.net.au> wrote in message >> Is there any evidence that training an early onset patient to use >> something like [quoted text clipped - 5 lines] >years ago, but not what he had for dinner (or if he had dinner) 5 minutes >ago. But what if the learning was sustained by using it regularly--albeit initially unnecessary? In your example above, it would be like having the same thing for dinner every day __and__ that commenced before new memories were a thing of the past? - Mind control is being able to make all the voices in your head take turns. Mod as a hooter! >>"Anthony Shipley" <astech@iinet.net.au> wrote in message > [quoted text clipped - 15 lines] > every > day __and__ that commenced before new memories were a thing of the past? Well, then we'd all have to start using "Merry Walkers" (or whatever) at the age of 10 :-) SignatureTumbleweed email replies not necessary but to contact use; tumbleweednews at hotmail dot com >> In your example above, it would be like having the same thing for dinner >> every >> day __and__ that commenced before new memories were a thing of the past? > >Well, then we'd all have to start using "Merry Walkers" (or whatever) at the >age of 10 :-) Once again, I'd urge contributors to hesitate before posting assertions that are not backed up by demonstrable facts. Unrelated to the above comment, I was surprised during the last few days when I was able to carry out some computer operations that I hadn't done for a very long time. The two sentences above suggests we, with dementia, should be optimistic and those without should be careful with their utterences. - Mind control is being able to make all the voices in your head take turns. Mod as a hooter! >>> In your example above, it would be like having the same thing for dinner >>> every [quoted text clipped - 18 lines] > and > those without should be careful with their utterences. anthony, please note what you said; 'some computer operations you hadnt done for **a very long time**'. This is in complete agreement with what I said, that earlier memories persist for the longest. I think this is pretty comon experience, I believe most people here would agree that those with most forms of dementia may but not recall what they had for dinner yesterday or 5 minutes ago even though they can remember what happened some years ago. I believe this is also why thsoe with Az may not recall children but will recall a spouse, or not a spouse, but a sibling, and so on. Of course, memory is a funny thing and disconnected blocks may remain, nothing is certain. SignatureTumbleweed email replies not necessary but to contact use; tumbleweednews at hotmail dot com >>"Anthony Shipley" <astech@iinet.net.au> wrote in message > [quoted text clipped - 15 lines] > every > day __and__ that commenced before new memories were a thing of the past? Hello Anthony, There was a man who posted here very briefly, and his wife was the one with alzheimers. He was determined to drill her daily with flash cards and daily, constant "memory stimulating" exercises to prevent the loss of her memory. I shudder to think how that poor woman fared. Anthony, if I were you I would read books as long as you can, and when that doesn't work anymore, read magazines where the articles are shorter. Stay active as long as you can, don't vegetate in front of the TV. But also don't torture yourself. The most important thing you can do is TRUST those you have put in a position to make decisions for you. They are going to see deficits when you aren't going to be able to see them. From reading here you can see how difficult it can be for caregivers to find that delicate balance between preserving their loved ones dignity and keeping them safe. The most powerful thing you can do to help yourself and your loved ones who care for you, is to keep your mind active in the meanwhile, and TRUST your loved ones, not try to second guess them when it comes to your needs as this illness goes on. SignatureBest Regards, Evelyn (to reply to me personally, remove 'sox') >Anthony, if I were you I would read books as long as you can, and when that >doesn't work anymore, read magazines where the articles are shorter. Stay >active as long as you can, don't vegetate in front of the TV. But also >don't torture yourself. Does vegetating in front of the computer fit in the same category? I'm relatively immune to the TV these days 'cos I can't follow the story lines enough to make it enjoyable. Sadly, reading is pretty poor too -- I don't recall what I read on the previous page. On the _very_ bright side, I can write nearly as well as ever (Well, I hope that's true :-). >The most important thing you can do is TRUST those you have put in a >position to make decisions for you. They are going to see deficits when >you aren't going to be able to see them. >From reading here you can see how difficult it can be for caregivers to find >that delicate balance between preserving their loved ones dignity and >keeping them safe. "Dignity" is a very important word/concept for me at the moment. I actually believe that dignity is more important than safety in the long run. We pretty know the outcome of AD and, at out ages, longevity is pretty much like just another repeat. Right now, dignity is much more important than longevity!! >The most powerful thing you can do to help yourself and your loved ones who >care for you, is to keep your mind active in the meanwhile, and TRUST your >loved ones, not try to second guess them when it comes to your needs as this >illness goes on. I don't quite agree. The timing of my death is immaterial to me. A long lingering death is not in the interests of my loved ones. That sentence makes me feel young again; I have always been rebellious :-) - Mind control is being able to make all the voices in your head take turns. Mod as a hooter! Octavia, I work at an Assisted Living for persons with dementia and I also lost my mom, my two uncles and my grandfather to Alzheimer's. At work we are all on walker patrol. Daily we have some residents who forget their walkers and just take off without them. Yesterday I found one in our public restroom, which apparently had been left there overnight. Hipsavers are an excellent idea. Beth gave you some wonderful options. We have everyone's name on their walkers, and when I give them back to them, I tell them that I'm gonna velcro them to their walkers (with a smile of course). They laugh along with me, but they can't help it. The disease makes them forget safety, so it's up to all of us to be there to make sure they are as safe as possible. Bed alarms, merry walkers, wheelchair alarms, we have them all. People still fall though, we have mats by their beds and beds so low they are almost on the ground, and they still fall. It's frustrating, but it still happens. Keep bringing the walker to her. She's not doing it to annoy you, she just doesn't remember that it's hers. All the best, Patty Pattycake, thanks so much for your helpful comments about your experience with the residents & walkers. As you & others have pointed out, I can see my error in thinking reminders about the walker will help her when in actuality, they aren't helpful because the majority of the time she isn't going to remember. So I'm doing as you & the others suggested - I'm simply going to take her the walker when I can see she has gotten up & walked off without it. > Octavia, > [quoted text clipped - 27 lines] > All the best, > Patty > So she has days when > she doesn't want to use it and doesn't take well even to being reminded to > use it. She may be forgetting how to use it. Reminding often doesn't do much good for folks with dementias. It's better to not remind when all it does is annoy the patient, since all it does it get them upset, and they still won't remember because they can't. They simply can't, and you need to get used to that idea. > They simply can't, and you need to get used to that idea You are certainly right, Dennis. I've worked hard to drill it into my head the last couple of days that she *can't* remember. Eventually I'm hoping it is going to be second nature - remembering she can't remember. >> So she has days when >> she doesn't want to use it and doesn't take well even to being reminded [quoted text clipped - 6 lines] > them upset, and they still won't remember because they can't. > They simply can't, and you need to get used to that idea. |
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