Expert: Mary Gordon - 12/30/2005

Question
hi Mary
my mum has AD. she has just got out of hospital following a fall (more of a crumple actually) & is now home under 24 hour care of my brother. she has severe osteoporosis so an alarm goes off if she tries to get out of bed (only about 17 times each night), & she is very agitated in the daytime too.

my brother is trying to replicate the endless meandering she did before the fall by 'walking' her round & round while taking most of her weight himself.

it is very cruel that her urge for constant motion is so at odds with her fragile frame.

have you come across anything along the lines of this conflict before? & would you have any ideas we could practically implement?
many thanks.
mel x  

Answer
Hi Mel,

A couple of thoughts - a really great product to consider is the Merry Walker line. Have a look at two specific items that can be very helpful for people with AD - the Merry Motivator or the Merry Walker Ambulation Device.  
http://www.merrywalker.com/products.html
Not sure if anyone else makes something similar - but since people with AD rarely can consistently learn to use a regular walker, these things are really terrific - I've seen them in both home use and institutional use. Essentially, the person is contained in the walking device, so they can't not be supported (i.e. it means when you are out of the room for a minute, they can't just get up and endanger themselves. They can still move around, walk, shuffle their feet, whatever they are capable of so they can burn off their extra energy of, but can't have a big fall as easily. Certainly better than the constant use of a geri-chair or other choice (although those can be helpful - there was a woman on my mother in laws AD ward who had to be put in one specific hours a day, because her pacing was so excessive she burned off more calories than they could get into her, and was also damaging her feet from the constant walking, even in custom made sandals! Just in case you don't know what a geri-chair looks like, here are some samples - basically a recliner with a tray that keeps the person from getting up unsupervised.
http://www.lift-chairs.com/Geri-Chairs.htm


Another gadget that might be helpful if you already have a wheelchair at home for her -the  Hugger Wheelchair Positioner or similar product. Here's a picture.  
http://www.allegromedical.com/wheelchair_accessories/wheelchair_trays/posey/the_...
The real purpose of these soft notched cushions is to keep a person sitting in the right position in a wheelchair, but what they often get used for is to gently keep the person in the chair so they don't try to get up and walk when no one is there to watch them/help them and prevent a fall. If you fold up or remove the foot supports on the wheelchair, they can stay in the chair, but sort of pad around while still sitting.  

As a back up, I'd urge looking into a pair of hip guards for her. They DO make a huge difference in terms of fracture protection - a study published in the New England Journal of Medicine a few years back found they reduced hip breaks by 84% in the frail elderly. As I know you know, you really don't want her to break a hip, because that will likely mean the permanent end to walking - it was for my mother in law. Post surgical repair, in theory she should have been able to get back on her feet, but people with AD can't cooperate with therapy,so despite a lot of trying, it was a lost cause, and she never walked again. Here are some samples of what I'm talking about (see link)- and there are also ones you can wear OVER clothing, but I don't know if your mother would tolerate them (i.e. if she is like my mother in law was, she would be picking and pulling at them).
http://www.hiprotector.com/works.html

Finally, if you haven't tried it yet, you might want to give anti-agitation medication a try. It doesn't always help with wandering and pacing but it is worth a shot, to see if it could reduce her need to pace.

Hope this helps. Your mother is so lucky to have such caring children.

Mary G.
Toronto