Expert: Mary Gordon - 2/9/2009

Question
My mom has alzheimer's. She has been in a nursing home since June 2008. She refused to walk at that time. She sits in a recliner chair all day. Sometimes it's reclined, sometimes she sitting with her legs dangling. In bed, her legs are bent at the knees. She never straightens them. I would like to have the nursing home do range of motion exercises on her to straighten her legs or at least try. I am also hestitant because it's a hassle just to get them to do basic care.

When she first came to the nursing home, they tries to get her to walk. After 20 days, they said it was useless and she's been in a chair every since. She can still move her legs.

Is it maybe possible for me to have a private therapist come in to take a look? Thank You for your help.

I want to get a chair mattress and a bed mattress to keep my mom from getting sores. Do I have to purchase these or can the nursing home provide these?

Please forgive me if I seem to be going on and on. But I have to fight for my mom everyday to make sure the nursing home is doing their job.

Answer
Hi Barb

I know its frustrating, but I doubt if a private therapist would accomplish anything. People with Alzheimer's don't just have cognitive and memory problems - they have neurological ones. They lose their ability to coordinate movements and balance, so they lose their ability to walk. There is nothing you can do about it. Your mother will not understand the purpose of the therapy and she won't be able to cooperate with the therapist. She won't understand the instructions, she won't understand why she needs to work at it. She may find it frightening, tiring and painful, and in the end, everyone will be frustrated, and it won't help get her back walking.

My mother in law broke a hip in Stage 6, which was repaired (she stood up from a chair and just went down without taking a step, onto a carpeted floor). We couldn't get her walking again, no matter how much any of us tried. In theory her legs were fine but her coordination and balance was shot. Not only was she weak and wobbly, but she had no idea what we were trying to do. Her depth perception was affected, so that when we stood her up, even if she was being supported on both sides, she was terrified and would scream and clutch at us as if we were at the edge of a cliff.  We tried and tried, but all we were doing was getting her upset. The nurses tried, the therapist tried, family tried - it became clear to us that her walking days were over.

I don't know where you live, but in most locations, the facility MUST prevent bedsores, which are caused by pressure on the bony parts - they lose their layer of fat padding, and if they can't or won't move around themselves, the circulation gets cut off, and sores start to develop. Typical locations are the buttocks, backs of heels, hips, base of the spine,  elbows etc.  Being repositioned and turned frequently helps. If you think for one second she is in danger, speak to the home about what they are going to do to prevent sores. Since sores are generally seen as a sign of neglect when licensing agencies review care at particular locations, most facilities will take them very seriously because they can be subject to lawsuits as well as losing their accreditation.

Here is some information. http://www.elder-abuse-information.com/news/news_082903_bedsores.htm
You will have to discuss the purchase of pads and special mattresses with the facility to discover what they may have available, what might be subsidized under various programs, or what you might have to purchase on your own. If you are in the US, try contacting this organization with your questions about what may be available
http://www.decubitus.org/

Below my signature I've pasted in the most commonly used description of the last two stages.  You will see loss of the ability to walk as part of Stage 7, although many people don't fit perfectly neatly in a particular stage (i.e. they have characteristics of more than one stage at once, because everyone is a little different).

Hope this helps
Mary G.  

Level 6
Severe cognitive decline (Middle Dementia or Moderately Severe AD). May occasionally forget the name of the spouse upon whom they are entirely dependent for survival. Will be largely unaware of all recent events and experiences in their lives. Retain some knowledge of their past lives but this is very sketchy. Generally unaware of their surroundings, the year, the season, etc. May have difficulty counting from 10, both backward and sometimes forward. Will require some assistance with activities of daily living, e.g., may become incontinent, will require travel assistance but occasionally will display ability to familiar locations. Diurnal rhythm frequently disturbed. Almost always recall their own name. Frequently continue to be able to distinguish familiar from unfamiliar persons in their environment. Personality and emotional changes occur. These are quite variable and include
(a) delusional behavior, e.g., patients may accuse their spouse of being an impostor, may talk to imaginary figures in the environment, or to their own reflection in the mirror;
(b) obsessive symptoms, e.g., person may continually repeat simple cleaning activities;
(c) anxiety symptoms, agitation, and even previously nonexistent violent behavior may occur;
(d) cognitive abulla, i.e., loss of willpower because an individual cannot carry a thought long enough to determine a purposeful course of action.

6a - Requires Assistance dressing
6b - Requires Assistance bathing properly
6c - Requires Assistance with mechanics of toileting
6d - Urinary incontinence
6e - Fecal incontinence

Level 7
Very severe cognitive decline (Late Dementia or Severe AD). All verbal abilities are lost. Frequently there is no speech at all - only grunting. Incontinent of urine, requires assistance toileting and feeding. Lose basic psychomotor skills, e.g., ability to walk, sitting and head control. The brain appears to no longer be able to tell the body what to do. Generalized and cortical neurologic signs and symptoms are frequently
present.

7a - Speech ability limited to about a half-dozen intelligible words
7b - Intelligible vocabulary limited to a single word
7c - Ambulatory ability lost
7d - Ability to sit up lost
7e - Ability to smile lost
7f - Ability to hold up head lost