Expert: Michalene Peticca - 4/4/2009

Question
QUESTION: My mother, 88, is currently in a long term care facility undergoing rehab after a hip fracture in early Feb.   She is showing signs of dementia (paranoia, unaware of where she is, confusing about time ) probably between stage 5 and 6, and needs physical help with ambulating and toileting.   She currently is in a semi- room, and her last roommate complained about her night terrors, movements (setting off bed alarm) and removing clothes.   she tells us people are coming to get her and taking her clothes away.   We have been offered a private room on a different ward  - mixed long term and rehab, mostly long term   Do you think a move is problematic for her confused state?   She has just gotten used to her current aides and place.   We have moved all her things from assisted living to this setting as it is not looking like she will return there.   So hard to know what is best for her, safety wise and comfort.   Medication is not recommended for the night issues as the doc feels it will just make her dizzy when she does try to ambulate (not doing too badly with walker).   She also has an aortic stenosis, low oxygen level, and high blood presure.   Thank you for your help.   This is such a hard time on her, she was very afraid of getting Alzheimers or dementia as many of her friends had.  My siblings and I just want to make her as comfortable as possible and any suggestions would be appreciated.

ANSWER: Norma,

I am so sorry for this difficult time your mother and your family are going through.

It sounds like your mother was overall cognitively healthy before her hip fracture in Feb.  This is a good sign, because what she is most likely experiencing is a Delirium state induced by her surgery.  You most likely will see her "clearing" up over the next few months.   

However, in the meantime, it sounds like she also really needs a good doctor to make sure her O2 levels are adequate and her high blood pressure is controlled.  These 2 factors can certainly add to increased confusion.  I do agree with the doctor and Not have any medications at night.  They only add to the Delirium.  However, please request routine Tylenol for any pain.  Although i'm sure she is on some pain meds. as well.

If the long term care facility has offered a private room, i would say take it.  I agree that your mom will have to "get used to" another room, but having a roomate upset can be quite irratating for your mother as well.   Make sure staff either put on side of your mom's bed against the wall or a mat on the floor to prevent further harm if she happens to fall.   Most states will not allow siderails any longer.  

Keep visiting your mom and giving her a calm environment.  Feel free to write back and update me on her progress.  I know it will take a bit longer for you to see improvement with her..but i do pray every day will be a day better.  

Best Regards,
Michalene Peticca, MA



---------- FOLLOW-UP ----------

QUESTION: Thank you.  The roommate has been moved as of this day, but we are still probably going to face a move for my mom as she is on a rehab wing and will probably need to move to long term placement. she was showing some signs prior to the hip fracture -- she moved into assisted living as she was no longer able to cook effectively, starting some kitchen fires, and there were a couple incidents of her getting dressed and going out in the middle of the night thinking it was time for the shopping bus.   then assisted living where she was pretty good, and since i have been checking her checkbook and writing a couple bills, before the fall I noticed some missing checks, bad handwriting, etc.   She also had a UTI in the hospital which was treated.

She is not on pain meds, only tylenol upon request.  and her bed and wheelchair is alarmed so if she gets up, the aides are there.   we are all afraid of another fall.  this week when my sister and I were there we walked into her room to see her sitting on the edge of the bed with her pants off.  She said they fell off her, and she needed to sew them tighter.  but then she will go on to recognize one of the nurses as a student she taught in first grade!  How would we know if this were Alzeihmers or dementia?  How does one get over the guilt of placing her in a nursing home, even though I know in my head she needs safety and comfort, and none of us 5 children can do that for her?

Answer
Hello Norma,

Well, you have given me much historical data that does point, unfortunately, to some type of Dementia.  

Dementia is physical deterioration of brain tissue.  Alzheimer's is one such Type of Dementia.  There are many other types.  However, your mother appears to have very classic symptoms of Alzheimer's disease.  This is an incurable disease.  I am truly sorry.

You may ask her Doctor if any use of Aricept may help her at this point.  It won't cure the disease, but may slow it's progression.

I work with a lot of adults that wrestle with guilt daily about their loved one being in a nursing home.  I'm not sure you ever get over the guilt, but you have very good reasoning that it is for her safety and comfort.  People in nursing homes are generally loved and well cared for.  They have 24 hr. care and are never alone.  Your family is strongest at providing her with their love and attention.  Too many families are "burned out" when caring for a loved one at home 24 hrs. a day.  That isn't a healthy relationship for you or your mom.  

Plan to use your visit time as a social time with your mother.  You can bring along pictures and just do some scrap booking...but don't try and "make" her remember who are in the pictures...sometimes just cutting pretty pictures out of magazines is helpful.   

Also, you may want to consider asking staff if you can take her for a walk.  Can you take her outside in nice weather?   Can you bring in a movie to watch together?  (animals and babies are key!)  Can you bring in pictures of schoolhouses and just reminisce about her days teaching?   A great magazine is Reminisce magazine.  You might consider getting a subscription and just reviewing stories or events with her.

But, for yourself, please see if there are any Alzheimer's support groups in your area that you might want to attend.  The Alzheimer's Association has a listing and also your local Office Of Aging can provide you with further information.

My thoughts are with you.

Best Regards,
Michalene Peticca, MA