Renyx2014 Asked September 2014
Nursing home, assisted living, my home. When and how to broach the subject?
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Mom is 78 years old. My dad died a few months ago. They were married for 59 years. She is coping much better than I thought she would. Physically, she is healthy. She has balance issues (inner ear-not fixable) and mild dementia. She falls frequently but rarely hurts herself. She wants to remain as independent as possible and to stay in the same home she has lived in for the past 48 years. We have in home health care, Lifeline and the family checks on her daily. This week she fell and broke a toe. Not a huge deal, but do we wait until she really hurts herself before doing anything or should we act now?
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"“The 30-day mortality rate after hip fracture is about 9 percent. It rises to 17 percent if the patient already has an acute medical problem. If a patient has heart failure while being treated for a hip fracture, the 30-day mortality increases to 65 percent."
The overall mortality rate in seniors after a hip fracture is 25% in the first year.
Mom fell and broke her hip last March. She's 87. She spent almost 3 months in between the hospital and rehab....pneumonia, exacerbated heart failure. Now, back living with me again, she has lost maybe 50% of her mobility. Where she could walk with a walker...now she can't walk unassisted. She needs her walker, a gait belt and me. She can no longer get up out of a chair without help.
Address that issue pronto. Google all her meds to see if any of the side effects (even rare ones) is dizziness. If so, switch it out just in case.
As her dementia increases, and, believe me, it will, her personality may change for the worse...where she's been compliant, she may become a stubborn little mule. She'll stop taking her medications properly, she'll stop bathing, stop eating right, she'll become even more of a fall risk. She may wander. Eventually, sooner than later, she'll become unsafe to live alone.
If she's falling "frequently," it's not "Is she going to hurt herself?" It's, "How SOON is she going to hurt herself?" How soon will your concerns go from moderately concerned to "Lord in heaven! What are we going to do?"
What people should realize is that moving to assisted living, a nursing home, or in with you doesn't prevent falls. Those moves may make it somewhat more unlikely, but it's no guarantee. Mom broke her hip with me 10 feet away from her where I couldn't see her try to get up without her walker. Two steps...boom! Broken hip.
Until you decide what to do, make sure she has grab bars in the shower. Get her a walker. Make sure throw rugs are removed. Seam down carpet edges with duct tape to eliminate the transition from bare floor to carpeting. If her laundry's in the basement, start doing it yourself. Put a lock on the basement door so she can't go down there and have one of her frequent falls at the top of the stairs.
She's going to get nothing but worse, Renyx. Move in with you? To assisted living? A nursing home? I'd say one of those choices will either happen in a controlled way or as a 911 emergency. And when it's a 911 emergency, your problems will be much greater than they are right now.
I say move her before she hurts herself. Kicking one's self in the butt after the fact is very awkward. ;)
A broken hip requires surgery. Anesthesia for an elderly person is like poison but they won't not do the surgery. While your mom may have slight dementia now she could come out of surgery much worse cognitively and be unable to participate in conversations about her care.
That's the down side. The up side is she may not injure herself when she falls. My dad didn't have cognitive issues when he kept falling and I swear that man bounced because he never injured himself. He sat on an ottoman once while I was in the room and I swear he did bounce right off that thing and onto the floor. He was unhurt.
However, my dad did fall one day while I was at work. He couldn't get up by himself. When I came home he had been there all day, was dehydrated and mentally altered. He went into the hospital and never came back home again because laying on the floor as he did and becoming so dehydrated made him very ill. From the hospital he was transferred to a rehab and he never really bounced back (no pun intended). He died in a nursing home 6 months later.
So the gist I guess is that you still have a choice. You still have options right now. You can roll the dice and hope that your mom never has an injury and she may not. Is she alone at any point during the day or night? You said you had in-home help....?
Just from my own experience and having some perspective, my dad was bound to have an emergency related to a fall. It was coming, I just didn't realize it.