My dad is 85 and in early stage alz. For quite some time now, he's had
trouble walking. Part of it is his knees are really bad from arthritis. His
doctor talked to him about knee replacement surgery years ago, but he
rejected that. The other part of the problem is that he has heart trouble
and has what the cardiologist told us is poor ejection fraction. It means
his heart isn't pumping as much oxygenated blood as his body needs. The
result of this is he tires and gets winded easily when walking--I'm talking
sometimes a matter of feet.

He's also a little unsteady on his feet. He's had a few falls in the last
couple of years, and has gotten hurt some of those times. A fall in his
bathroom a couple of years ago caused 3 broken ribs. He has a cane, but he
really doesn't use it. He says it trips him up. Truthfully, it's not really
sufficient anyway, although my sister thinks it would be better than
nothing, that at least it would steady him better. All his doctors have
talked to him about getting a walker and/or companion wheelchair. The
wheelchair would come in handy for outings or to go any kind of distance,
like getting to a doctor appointment in the hospital. He staunchly rejects
those options too. He says he doesn't want to "be a cripple"---probably the
skewed logic of the alz. disease process--as if using a wheelchair or walker
makes one a "cripple", not that his walking impairment necessitates the use
of an aid.

For a short time within the last year, he was a little improved. The
rheumotologist got him on some medication that helped a lot to ease the pain
w/ walking, and the cardiologist got his cardiac medications working
effectively, improving his cardiac output. He wasn't great, but he was
walking a little better, w/ less stress and struggle. Unfortunately, that
was temporary. In recent weeks, he's deteriorated and the same
symptoms--getting winded and tiring easily and the knee pain when
walking--have returned. He likes going out--if he's up to it, which some
days he isn't. My 2 sisters and I are taking turns looking in on him and
helping him with the practical tasks of daily life, like food shopping and
personal shopping. Sometimes we shop for him ourselves, but the problem is,
he won't agree to let us do all his shopping for him. He insists on being in
control of selection of food and clothing--it's important to him. So my 1
sister and I take him grocery shopping every week--which ever one of us is
available, once or twice a week. Believe me, getting him to agree to this
was a huge concession on his part. By his own admission, walking around the
store is easier for him than walking elsewhere because he uses the shopping
cart as a support--the principle behind a walker. He still gets winded
though and we catch him sometimes stopped in the middle of an aisle, leaning
way over the cart, "resting." It's kind of scary. I'm just waiting for the
day he keels over and paramedics must be summoned.

Shopping w/ him is an interesting and slightly comical experience though.
He's funny. He gets the sales ads that come out in the paper every week and
the lady who comes in to help him around the house 3x a week helps him make
up his shopping list based on what's on sale that appeals to him, and of
course on what he needs or really wants, whether it's on sale or not.
Somehow, having those ads to look through really helps his mind organize to
get a list put together. I don't know why, but it works. Then he has her
make a copy and, when we go shopping, he gives the other person (my sister
or me) the copy and he assigns us to get all the things on one half of the
list, and he says he'll do the other half. Of course, inevitably, he ends up
getting things on both sides of the list and then I have to run around
putting the extra items back. Ugh!

Last week when I took him shopping, I was rushing through the aisles
returning all the duplicate items to the shelves and he got into the
check-out line and had the cashier page me because he "couldn't figure out
what happened" to me. LOL! I guess I consider it lucky he didn't forget I
was with him and just leave on his own. One time, he got through the
check-out line while this was going on and he went to the service desk and
asked the asst. manager to call him a cab to go home. Luckily, we always
take him to the same store in the neighborhood where the whole staff know
him and understand the situation. When that happened, the asst. manager
asked him "didn't you come with your daughter? Oh there she is!"

Reading his list is often difficult as it's not always clear what he means,
and often things will show up twice on the list. What I think is happening
is that he insists that the woman helping him write down things the way he
tells her even when she tries to use logic on him. She has the patience of a
saint, I must say. But the surprising thing is I'm amazed at how most of the
time the information on the list, in terms of what's oin sale and the
prices, are accurate. He's so confused about so many other things, it amazes
me that he's able to get the list right as much as it is.

Anyway, I try also to get him out for lunch and sometimes a movie once a
week when ever possible. He loves movies and he loves going out to eat, and
it's an outing and activity he can do that doesn't take walking once we get
there. But the getting there and back is more of a problem all the time.
Even places that have adjoining parking lots and I can get a handicapped
space as near to the entrance as possible, it's still always far enough a
distance to get to and from the car that it's a problem. The most he will
allow is for me to come around and take his arm for support as we go along
slowly. Getting to accept even this much help from me was a big concession
for him. But in the last few weeks, even this has become too big an
obstacle. His walking is so bad now, and so precarious, it's just not
practical to walk even a short distance w/ him. We went to a movie and lunch
afterwards (there's a couple of theaters in the area that offer really early
matinees, and that's all that works for him because he's zonked by 4 pm)
last Fri. and he loved the movie (Thank You For Smoking) and he enjoyed
lunch (by blessed happenstance, there's a nice restaurant next to the movie
theater so it could not have been more convenient), but getting into the
theater and to and from the car parked a short distance away was an ordeal.
As if the walking isn't bad enough, his pants were loose on him and kept
slipping down and he had to keep pulling them up as we went along. My sister
took him out last year and bought him 3 pairs of new pants measured to fit
him properly, and a new belt. I don't believe he's lost any weight since
then, so the pants should still fit him. I asked which pair he was wearing
and he said they're his tightest ones. He also wasn't wearing the belt. I
asked him why and he said he couldn't find it--the lady who cleans must've

his room pretty quickly. It's frustrating.

This is an instance where it would've been really convenient to have a
companion wheelchair. I could've folded it and stashed it in the car, then
pulled it out when I parked the car and wheeled him from the car into the
theater, which is completely accessible. I tried to talk to him about this
as calmly and casually as I could after the movie, over lunch. As always, he
instantly rebelled against the suggestion, refusing even to listen. He
starts singing loudly--a song w/ "dirty words" he remembers from his army
days. Of all things to remember w/ perfect recall! LOL! He does this
deliberately to embarrass me so that I'll shut up. I tried to get him to see
how much simpler and safer it would be for him and for me if we had a
stowable wheelchair for moments like this, but he wouldn't even listen.

That evening, I spoke to both my sisters on the phone and reported the
situation. Both are aware of the problem and have observed it themselves. We
had a long talk about what to do, but could not reach a consensus. Dee Dee,
the older sister--the one who shares the shopping trips w/ me--thinks we
should start w/ a walker and delay the wheelchair idea for the time being.
Delphi, the middle sister, agrees w/ me that he should have the companion
wheelchair for any type of "outing" and says we should just all go in on it
together, buy it for him, present it to him, and "threaten" that we won't
take him out w/ us anywhere if he refuses to let us bring it along and to
use it. She thinks a walker is a good idea too, and suggests we buy that for
him as well.

My reaction is multi-fold. First, I think he would benefit from both a
walker and a wheelchair, but I know darn well he won't accept a walker any
more cheerfully than he will the wheelchair. Second, while the walker offers
advantages the wheelchair doesn't (mainly steadying him when he gets up or
down and allows him to feel more ambulatory), it will do nothing to address
him getting winded and tiring, which results from his heart trouble. Third,
while I in no way object to spending my money on a gift for him, I don't
agree w/ the idea of buiying him these items. He has the money for such
purchases and also has insurance coverage. He would need to make the
purchase himself to get the insurance to pay. Delphi knows that but thinks
it would be worth the money to us to force the issue on him. We can purchase
the walker and wheelchair and simply present it to him, while we can't
"force" him to buy something for himself he doesn't want.

Also, I dislike the idea of using emotional blackmail on him to get him to
comply w/ our dictates. If we say "you do this or else we never take you out
again" all it will succeed in doing, IMO, is getting him very angry and very
hurt, and it's not even practical. If we do it and he still refuses the
wheelchair and walker, will we really not take him anywhere again? We'll
just leave him to fend for himself? Not very practical or realistic.

Delphi wants us to get together w/ him at the same time and use the
"intervention" approach. Dee Dee refuses to be any part of that and says she
thinks we should just keep talking to him about it individually and maybe
we'll get through to him at some point. But we've been doing that for years
now, and his doctors have been telling him the same thing repeatedly too for
just as long, and it's not making a dent.

My husband, who went through this w/ his own dad for years up until his
dad's death last year (and it really stinks that we have to go through this
all over again), doesn't like the "intervention" approach either, but
suggests this: next time I take him out anywhere, get a folding wheelchair
to rent for the day ($5/day) from our local pharmacy, stick it in the car
and "surprise" him w/ it when we park and get out. He thinks if the chair
"appears" when it's most needed, my dad will see the benefit of it and will
allow me to push him in the chair to our destination. He thinks I should
then begin doing this each time, which he believes will get my dad gradually
introduced to the idea of using the wheelchair for such occasions, and that
he'll then see the wisdom in buying one to have on hand instead of us
renting one each time.

I see his point, and it could be a great solution...it's just that I also
see the distinct possibility that I do this and dad will go ballistic when I
pull out the wheelchair the first time and be totally insulted and furious.
He'll refuse to use it and make a terrible scene. He's capable of that.

So the options as I see them are as follows:

1. Delphi and I go to dad's together and essentially "confront" him on the
issue, insisting that he agree to either a walker, companion chair or both.
We play "tough love"  and give him an ultimatum, or we don't...if we do, he
very well may take it badly and we'll accomplish nothing. If we don't, it's
quite possible that he'll say as he's always said before that he won't
consider it and we need to mind our own business;

2. We go in on a wheelchair and/or walker together and present it/them to
him, along w/ a bill to reimburse us that he may or may not pay. If he
refuses to reimburse us (which I know he would insist on doing if he accepts
the purchases), we leave the walker and chair w/ him anyway and write it off
as an expedient way of solving our problem. He may or may not agree to keep
it/them or use it/them;

3. We take the soft ball approach and keep bringing the issue up
individually when a convenient moment arises and hope that maybe,
eventually, the "wearing down" approach will produce results. So far, that
approach has not worked;

4. My husband's suggestion that I rent a wheelchair from my local pharmacy
next time I take him out somewhere, and any time after that, hoping it will
appeal to him more when there's an immediate need in front of him and that
this may gradually get him comfortable with the idea of buying one to have
on hand when he needs it. The down side: dad may pitch a fit on the scene if
I "surprise" him like this. A modification of that plan would be to talk to
him on the phone about renting the chair before I come by so as not to take
him by surprise and limit his possible outrage to a private discussion on
the phone, not a public scene. Down side of that: he'll probably say :"No
way!", and then what?;

5. Some other option none of us have thought of yet.

<sigh> In some ways, we're in the worst possible stage of this disease. He's
just feeble-minded enough to exacerbate every other problem he has and make
finding solutions a lot more complicated, but still copis mentis enough that
we can't force our will on him and make decisions for him whether he likes
it or not. That's not just an assumption either...we've talked to a couple
of attornies about this. He's given POA to my 2 sisters IF he becomes
incapacitated, but he's not yet incompetent enough to enforce POA. So, at
this stage, it is a careful, difficult dance around all these heavily loaded
issues. In short, it's a tough spot.

I'm sorry this has run on so long. I didn't mean it to starting out. I
wanted to give everyone reading a comprehensive picture of the situation.
It's frustrating and worrisome and stressful. Maybe that's why I ran on a
bit. I hope no one here will hold it against me.

So, how about it? Anyone have any thoughts? (thanks in advance)

~katelyn~