Expert: Paula Damgaard - 4/11/2009

Question
My mother is 88, and in a nursing facility after a hip fracture in Feb, she shows significant cognitive decline.  She was in assisted living after having some issues with cooking in her apt, also with confusion about time occasionally and general fatigue.    I have done a lot of research and asked questions on this board and others, and she is showing classic AD symptoms (confusion, unaware of where she is, paranoia, disrobing inappropriately, night terrors,)  Most recently she is refusing to eat about every other meal and last night, said almost the whole mass while I wheeled her around.   She also  has difficulty finding words.

The facility is stating they want to stop PT - after 60 days she is unable to respond, they say, to their instructions.   She is wheelchair bound but can walk assisted with a walker.   Our worry is that without activity, her sleep will be even worse.   We know she probably won't get back much more mobility, but don't know if we should fight this decision or not.   She also has an aortic stenosis, and has an appt with a cardiologist that I think should be cancelled.   She is not a candidate for surgry, and from what I read, there is no other treatment option for that.  What do you think?

Answer
Terri, Unfortunately, unless you are willing to pay out of pocket for her PT, they will have to stop because unless someone is progressing no insurance will pay for it, and from what you are saying it would seems that the notes the therapists would be writing on her would show that she is not progressing.  

Having said that, I would say you should have her seen by a geriatric physician who specializes in dementia and really find out what is going on with her.  Either a neurologist who specializes in dementia or a geriatric psychiartist if you live by a University hospital you could see if there is a Memory Disorders Clinic there and have her worked up.  They would be able to give you the advice you need.

I hope this helps.  It is a hard time.  Paula