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Old 05-02-2011, 03:38 PM   #1
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when to start the wheelchair?

My FIL with late Alzheimer's has trouble to sit down or get up from a chair by himself although he still walks with a cane. He cannot stand up for too long and gets tired easily. Although he may be mobile with a cane, it seems dangerous for him to hang around without a wheelchair. Today he fell but not hurt. So the home gave him a temporary wheelchair. The home wants him to be as mobile as possible. But maybe he is worse than they thought. They said he could go to the toilet himself. Well today he fell in the bathroom. I just saw him yesterday and we went to a concert outside. In the concert hall, he is slow to walk by and has trouble to stand for long. Once he sat down, he prefered to stay there until the end. He is a tall guy so it is not easy to hold him up.

Don't you think he should start using the wheelchair although he could get up and walk a little sometimes?

Nina

Last edited by ninamarc; 05-02-2011 at 03:43 PM.

 
Old 05-02-2011, 08:43 PM   #2
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Re: when to start the wheelchair?

I don't think it is an all or nothing question. I used a wheel chair for Dad when I took him to the doctor or other places he had to stand or walk a long way years before he was in a wheel chair full time. Then there were days he would use the wheel chair and days he would walk by himself. In the end he was using the wheel chair almost full time but still got up and went for a "walk" from time to time. If your Dad does become a fall risk you can use a bed/chair alarm to alert the staff he is trying to get up. Then they can either push him or let him walk with assistance. These can be used on a wheel chair, a bed, or another other chair he might want to sit in. I would suggest that you let him walk as much as he can and will. But having a wheel chair available for those down days is also a good idea.

Mom is still walking but having some trouble getting up and sitting down. She did fall (we think) just the other day. Just as a proactive step I took the wheel chair Dad used back to the facility and stuck it in her closet. Now it is there just in case.

Love, deb

 
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Old 05-03-2011, 07:43 PM   #3
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Re: when to start the wheelchair?

My biggest fear after my mom fell and broke her hip was that it would happen again. It was a terrible, painful experience for her. She was walking on her own before it happened and after much time and pain and rehab time...which caused a steep decline in the disease, she did walk again. Within a few more months she began getting more unsteady on her feet...so...we got the wheel chair. Like Deb's dad she didn't use it all the time but within 5 months of leaving rehab she stopped walking all together. My advice would be to get it and use it but keep him walking as much as possible...and with aid. If we took long walks with her, we used the wheel chair...or if we took her out shopping, we brought the wheel chair. Have physical therapy work with him. For awhile mom pushed the wheel chair herself as she walked behind it. It doesn't have to be an all or nothing thing.

Eek, Deb...sorry to hear about you mom falling.
Love, Meg

 
Old 05-03-2011, 08:09 PM   #4
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Re: when to start the wheelchair?

Meg... I received "that call" and the care staff said Mom was "sitting in the grass". I am sure she didn't just sit down on the ground but she was occupying herself with picking leaves out of the pine straw and seemed happy. It did spur me to at least give PT a try to see if they could do anything about her strength, balance, and leaning. It also spurred me to take the wheel chair back and tuck it in the closet in her room. I hope we don't need it anytime soon but would rather it be there if needed.

Falls do happen. It is hard to tell unless somebody sees the fall what causes it. There are trip and falls caused by anything. A slight hole in the grass can cause a tumble even though a loved one might be stable on their feet. Even in a wheel chair they can try to get up and fall. So try to assess the ability to walk rather than looking at the falls unless you do know what causes them. Dad's falls resulted from his inability to get up. He would get off balance and fall before he was standing. Once standing he could walk. That is why a chair alarm worked well for him to alert staff to help him stand up. So don't just assume because he fell he needs a wheel chair full time

Love, deb

 
Old 05-04-2011, 04:43 AM   #5
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Re: when to start the wheelchair?

I started talking to the aides about the same question for DH, and it doesn't appear that there are any clear guidelines. DH is also having trouble sitting and getting out of chairs (he's now in mid-60s) due to the Alzheimers. It isn't clear whether he doesn't understand what a chair is for, or if his sense of balance is completely off. He prefers to stand or pace, which is heartbreaking since he has that "Alzheimer's shuffle." He's been caught literally sleeping on his feet. DH has managed to lower himself to sit on the floor a few times, which is obviously not acceptable to the NH especially since he isn't always able to get up off the floor by himself.

The aides are concerned that if they start to put him in a wheel chair, that they can't guarantee he'll stay in it. They said even if they lock the wheels, it's still more dangerous for him to try to get out of a wheelchair than a fixed chair.

Walking to not-walking appears to be one of those transitional stages that raises a huge set of concerns.

Last year DH had a psychiatric admission to have his medications adjusted. The geriatric psychiatrist said that mobility is a quality of life issue for patients who still want to move around. Balancing the need for medications against the risk of falling is very challenging. The psychiatrist told us that NHs don't want fall-risk patients, since they don't want to be blamed if a patient falls and breaks a leg or a hip. On the other hand, he acknowledged that a patient who is bedridden is actually much easier for the NH to care for (and also has a shorter life expectancy -- we were speaking frankly, and he said that's not necessarily a bad thing).

In the 1-1/2 year that DH has been on his Alzheimers ward (everyone at least stage 6), we've only seen one patient go through the transition to a wheelchair instead of walking. That patient is helped to stand and walk to a wheelchair, only for purposes of taking him to the common room where he's moved to a fixed chair in case he still tries to stand. I think DH is next.

We have seen a 2-3 patients who walked one day, and just didn't get out of bed the next day. Those patients appear to go downhill rapidly, one dying within a week.

 
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