Expert: Mary Gordon - 1/7/2010

Question
Hello and thanks for the opportunity to ask a questions. My mom was diagnosed just 2 years ago and inspite of us doing everything we've been asked to do.. medication, home care , home nurse etc.. it been steadily downhill. Which is okay... as long as she's comfortable... In the last week I noticed a the area around her hips and knees turning slightly pink--not red.. but pink. after reading about bedsores i'm terrified.. my mom is not bedridden.. we take her for 3-4 half hour walks everyday.. she's slow but she holds our hand(my brother and I) and walks.. I live in India where care and information on alzheimer's is rather limited.  I'm terrified of her developing any kind of bedsore and the other thing in terrified of is that she will fall and break her hip or leg or something.. that would be the worst thing that can happen...I'm terribly sorry about the long, long question.. but could you please help me by telling me what mattress I should buy for her prevent sores.. what kind of soft sheets and every way in which i can prevent a fall.. even if it means babysitting her round the clock... thanks very much in advance...Nimi

Answer
Hi Nimi,

Your poor mother has a progressive and incurable dementia - which means that she will continue to deteriorate no matter how well you look after her. Her brain is being dismantled by this terrible disease - which means not just a mental decline, but a gradual loss of her depth perception, her sense of balance, her coordination and muscular control, and her reaction time. She will be more and more wobbly on her feet as time goes on. You are quite correct, she will be more and more prone to falls. Eventually, she will lose the ability to walk entirely.

Things you can do to help her avoid falling include
- Continue to make sure she gets exercise to maintain her strength. The weaker she is, the more prone to falling.
- Making sure someone is with her as much as possible. I think you are wise to make sure she is holding someone's hand or arm when she is walking.  
- Try introducing a walker to assist her. She may or may not be able to learn to use one.
- Look around your home and remove anything she can trip over, electrical cords across the floor, shoes, papers, books, toys.
- Arrange the furniture so she won't trip - keep small furniture like low tables out of the way
- Remove small rugs or use double sided tape to make sure they won't slide.
- A consistent flooring in the house will help. People with Alzheimer's often trip when there is a change in flooring - for example, going from a hall where there is a tiled floor to a carpeted floor.
- Make sure there is good lighting in the home
- Install handrails on any staircases, or in hallways
- In the bathroom, install non-slip mats in the bath or shower and grab bars
- Make sure she is wearing shoes that give good support and have thin non-slip soles. Avoid letting her wear slippers or athletic shoes with deep treads.

Keep in mind, no matter how careful you are, you cannot guarantee she will not fall. My mother in law broke a hip midway through the illness. She stood up from a chair, and went straight down before anyone could grab her. She did not take a single step. She was in a room full of people sitting right next to her, and the floor was carpeted. To this day, we have no idea what made her fall like that. I think a healthy person would not have hurt themselves at all - but she was very thin and frail, so her bones were not strong.

I know you are very worried about bedsores. These become an issue when the person becomes less and less mobile. For example, by the time she is unable to walk, she may sit or lie in one position without shifting her weight. This causes loss of circulation where her body touches the chair or mattress, and sores develop. Here are some good basic tips for preventing them. http://www.merck.com/mmhe/sec18/ch205/ch205a.html
The most important item is making sure she is repositioned every two hours as a minimum to keep circulation going.

At this point, if she able to walk as much as you describe, she is able to move around enough that she should not need special pads or linens. My mother in law did not require a special mattress until very late in the illness - she reached a point where she had to be propped in the wheelchair or she would fall over, and moved very little on her own. For example, when she went to sleep, she would not move around in the bed at all. Obviously at that point, she was very thin, and we had to take care she was frequently repositioned, kept clean and dry, and had no folds of clothing or bed linen under her.  She had a gel pad, and that was adequate with frequent repositioning. Although I doubt you need this now, you might want to visit a local medical supply place and see what they have available that might be suitable for your situation.

There are many different mattresses and overlay products to prevent bedsores. Here is a sample of the kinds of mattresses there are out there http://www.rehabmart.com/bedsores.asp

Hope this helps. She is very lucky to have you thinking of her comfort and safety.

Mary G.
Toronto