19 Jul 2009
Dear Mary,
I take exception to the advice you gave in a recent column to use bribery for Alzheimer’s patients as a mean to the end. In my opinion this is treating them like children. They deserve to be respected as adults and not infantilized.
Dear Reader,
I suspected I’d get some flack over that comment. Yes, I agree, they should not be treated like children. However, the progression of the disease causes child-like behaviors and limits their reasoning ability to the age equivalence of twelve to zero. Their recent memory is impaired, so their responses are hinged on old memories and routines. And, because they live in the moment, it is important to reward for “appropriate” behavior immediately.
I’m sorry I offended you, but this system of reward is proven to work very well.
Dear Mary,
Mom says I should put her in a nursing home. She is in her nineties and suffers with poor vision and hearing. She keeps falling and this last fall scared her to the point that she feels unsafe going up and down the stairs. She is also fearful of putting on her shoes because she says they caused her most recent fall. She wears athletic type shoes for stability, but they seem to catch on the carpet and cause her to stumble.
I live with her and I’m concerned about safety issues like scatter rugs that she refuses to take up and of course stairs to the bedroom. She is also forgetting to use her walker. When she does use it, she leans over it instead of holding onto the handles. Every day she goes out to get the mail. One day I arrived home to find her sitting on the ground after falling. Her hygiene is suffering because she’s afraid of falling when getting into the tub for a shower. I try to do all that I can, but it doesn’t seem to be enough.
On another note, I happened to mentioned that I would like to go away for a few days; you would have thought I said I was leaving and never coming back. Whenever I go away I call on friends and relatives to stay with her. However, she only wants me. I welcome any advice you can give me.
Dear Reader,
Safety is the bottom line, so start by getting rid of the scatter rugs. The next thing I recommend is that she wears leather soled shoes that slide rather than grip on carpet. She will probably fuss, but these changes are in her best interest.
There’s not much you can do about the stairs except avoid them. I suggest you put her bed on the first floor. About her leaning over the walker and forgetting to use it: she needs instruction and reminders to use it properly. It also may be too short for her. Take her and the walker to a medical equipment store for adjustment.
A sliding-board tub bench that extends over the tub wall can help her with showering. She sits on the outer bench, swings one leg at a time over the side of the tub, and then scoot her bottom onto the inner bench in the tub. She will still need assistance for safety with this maneuver.
Because she is at high risk for injury, I don’t believe she should be left alone. You should hire someone to be with her or have her attend an adult day center. If alternative housing is the solution, call the Department of Aging and Disabilities for a level of care assessment to be sure she will be appropriately placed.
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