Is it true that a fall can start "the beginning of the end?" Is my Mother heading toward that so quickly?

Amy, your mother's experiences are similar to those of FreqFlyer. Hopefully she'll come along and answer your questions. FF's mother had an intra or intercranial (not sure which) brain bleed, that seemed to precipitate the kinds of behavior you're seeing in your mother.

She could have had minor strokes which are causing balance problems or the original fall itself. She could have had a minor concussion or a closed head injury.

From your description of her behavior, you may want to have a discussion with her doctor about having her evaluated for hospice.

It's hard...

Wouldn't that show up in the CT scan they did of her head, twice?

So the CT scans showed nothing? I wonder if she has orthostatic blood pressure, which means when she stands, her blood pressure drops, causing fainting. Have they checked her for that? At 100, just about anything could be going on...and when older folks are hospitalized, it can cause a kind of delirium from the change in their schedule and environment. I assume they've also checked her urine for a UTI?

At her age, medication can be over prescribed, too many milligrams. Talk to her doctor. Then try to find a way to strengthen her over time.
It may be towards the end, but she is living with these challenges, a better way to think of it instead of dying from the challenges. Imop, hoping that did not offend anyone.
Best to you and your Mom.

AmyGrace, the first time my Mom had fallen and 911 was called, she bounced back pretty quick. Then a week later, Mom fell again, and she spent a few days in the hospital having terrible delirium.... her arms were reaching for the sky and her feet were pedaling a mile a minute and that lasted over an hour, I thought for sure we were going to lose her then. The CT scan showed a current and previous brain bleed. Her mind was very befuddled.

Everything your Mom is experiencing now is what my Mom went through for a month. Then Mom got a UTI which made everything worse. The hospital doctor recommended Hospice so we set that up.

Now into the end of our second month and we are seeing changes that really are surprising us. Mom is now feeding herself and eating solid foods. That's all she can do for herself, but that's impressive on its own.

This evening when I went to visit Mom she asked if I was at work today [my gosh first time in 2 months she had remembered], and smiled saying her hair needs to be cut [which it does], and she asked if it had rained today. Even the nurses/aides were remarking about how Mom has improved.

Then she was having some type of delirium, tugging at her clothes, flinging her arms, then fell to sleep. So we quietly left her, and like with your Mom, she won't remember I was even there :(

Can you bring her home with hospice care?
So sorry this happened so sudden, and that you will be going through this worry.

Ff, we have heard about urinary tract infections over and over, they are responsible for these symptoms so often!

Same thing with my Mom. She took a fall one day when I had accompanied her to her doctor's appt. Sad thing is I had gone with her to prevent this from happening but it happened so quickly I'm still not sure how it happened at all.

But things really seemed to escalate with her after that. I think when they start falling thats usually an indication of something. In my Mom's case CT scans did not show any signs of stroke or brain bleeds. Just normal brain decline for someone in their nineties.

Can someone explain the difference between hospice and nursing home? If she went to hospice it would have to be to a facility. My sister can't take her - she just went through a year of hell with her husband dying of a brain tumor. I can't bring her here as my home is not good for any disability. (In fact we are trying to find a home as it is too much for us, too many stairs and levels, etc)

Sendme, I know with my Mom being 98 now, returning to home wouldn't be a good option as I don't think my Dad could emotionally deal with seeing my Mom in that condition 24 hours a day.... right now his Caregiver takes Dad to see Mom for a hour or so.

Dad would like to bring Mom home, but he's thinking he could help her walk upstairs to their bedroom. He's in denial of how serious this is. Oh he thinks he can get Mom to stand up. He doesn't understand that Mom's brain isn't relaying the right signals for her to stand up and walk.

Dad would need to hire a whole new set of caregivers as the caregiver he has now is a "companion" as Dad doesn't need a lot of help but he is a major fall risk. So the caregiver can leave the room to prepare a meal, or do laundry, clean the house, and not need to worry that much about Dad. With Mom, she would need a license nurse 24 hours a day, as Mom is a climber which results in falls. Told Dad he would need a medical transport so Mom could see a doctor, he thinks we can just put her in the car and go.

AmyGrace, hospice can be preformed anywhere.... at home or at a facility. Hospice is usually independent from the facility and are allowed with open arms to work hand in hand with the facility.

My Mom went to rehab after her 2nd fall where Medicare paid for the first 20 days, but since she wasn't responding to any type of therapy, after the 20 days she was put in as self-pay which my parents could afford.

I am the same as you are, my home isn't elder friendly, in fact there are days the house doesn't like me :P Plus my age and my physical health as I am in my own age decline. Heck, if I fall, is Mom going to pick me up???

FF is correct Amy. Most hospice is done in hospitals and care facilities. In a nursing home, once a person is placed in hospice care, the hospice medical team takes over care of the patient, usually even bathing. The nursing home staff still tend to basic needs and meals. Hospice is a blessing for patients and their families when the end of life is near.

All good advice, thanks for that FF.
Thanks for bringing in the experts, GardenArtist, FregFlyer, Windy, and everyone else.

Every week we all learn something new. Thank goodness for the Aging Care forum, I learned so much about falls and dementia before the fact, how parents can be so darn stubborn, learned about boundaries that I am trying to use now, that when I saw Mom lying on the floor with Dad trying to pick her up, I kept my wits about it as I dialed 911. Yes, my hands were shaking, at least the EMT's thought it wasn't my first rodeo when in fact it was.

At the nursing home when Mom was talking saying things that didn't happen, or thinking she was in a hotel in another State, I just agreed with her instead of trying to correct her.... so much easier that way.

I believe the Staff noticed how I was dealing with Mom and me not freaking out over the little things, that has made it easier talking with the Staff. Whenever the Staff calls about Mom yet again falling out of bed, I take it in stride, I know there isn't much any of us can do, this is just part of dementia process... maybe up Mom's meds a bit to calm her down.

Falls may come near the end. It is hard to say whether the increased weakness toward the end causes the falls or whether the falls trigger the decline (especially if they include blows to the head.)

But not every fall starts the beginning of the end. My husband fell repeatedly in the BEGINNING of his journey with dementia -- and lived another nine years.

My mother fell and broke her hip (or more likely her hip broke and she fell) in the nh. In the hospital she was delirious and they recommended hospice care. She returned to the nh on hospice care. She improved and after about 3 months she "graduated" from hospice and is doing fairly well, 18 months later. Her dementia is worsening slowly, but physically she is doing well.

I don't think it is possible to generalize about falls and the end of life.

Getting hospice care in the nh was very helpful as I see it. A huge benefit is that all red tape is cut. They thought she needed a special mattress ... she got it the same day. When she could be transferred out of bed they got a special geri chair for her right now. They wanted to try a different pain med? It didn't have to wait for the nh doctor to approve it and insurance to approve it and someone to deliver it. She had it within an hour. This alone was worth signing up for hospice! Then she got extra attention. The nh staff still cared for her, but there was an extra check by the hospice nurse and there were volunteers who painted her nails and sat with her. Mom's nh is a very caring place, but short-staffed like nearly every facility. Extra attention was worthwhile!

My husband was on hospice at home, for 5 weeks before he died. That was a very comforting addition to his care, too.

It depends on the reason for the fall "whether it is the beginning of the end". Per your comment, she has fallen three times so far. Something is causing the falls and it sounds like the brain bleeds. Sometimes, they are so tiny they are missed the first time around but get her checked again. Your doctor should have said something when she fell the third time. It also sounds like her personality is changing as well. Not eating and getting irritated. It sounds like the medications she's on is what's making her sleepy rather than the dementia. Does she also have Alzheimer's? What does the doctor say about her falls and her personality changes? It's possible that it's time for hospice to step in and take over if she has really stopped eating completely. Does she have an advanced directive? Does she want life-saving techniques to be activated? Hospice doesn't usually do that. They are there for the palliative care towards the end. It sounds like you need some answers from the doctor. Good luck; you have some serious decisions to make soon.

Terry, pretty much we know the main reasons for her falls: 1) she is 101 next month 2) she doesn't eat (she has anorexia and is emaciated so she is weak from lack of food and is dehydrated because she doesn't drink either) 3) She refused to use a walker for years when told she needs one 4) she has a hump on her back so she is unbalanced 4) she refuses help on any sort and even before the dementia got a good grip on her, she would never cooperate with the doctor. She fell in the hospital and the nursing home because she won't stay in bed and keeps getting up every five minutes. Despite her age, she is pretty fast and even though they use alarms, she got far enough out of bed to fall (she has dementia) before they got there. She is so agitated and combative they have to give her something to calm her down.
That's a good idea to talk to her doctor. We now have to use the NH doctor and I haven't met him yet.

AmyGrace, my Mom is also quick to fall artist. One day the nursing home had her in a wheelchair and placed it in the nursing station so they could keep an eye on her. And in a flash she fell out of the chair, probably trying to pick some imaginary object up off the floor. The staff couldn't get to her quick enough. Eventually Mom was placed in a Geri recliner and still was trying to climb out but the way that chair is, even you or I would have a hard time getting out of it.

Mom frequently falls out of bed, and her room-mate is able to buzz the nurse. The bed has been lowered as low as it can go, as Mom is on an air mattress... and there are fall mats on both sides of the bed. There are rails up near her head/shoulders. So far Mom hasn't hurt herself, never has had a broken bone, so maybe all that calcium she was taking paid off.

Any time Dad hears that Mom has fallen, he wants to bring her home.... like she's not going to fall at home??? Falling at home and getting a head trauma is the reason she is at the nursing home. But I can understand he misses her.

Same here, if only Mom would have used a walker. The caregivers have Dad's pretty much trained to used his walker. Guess coming from them he will take notice, but not take notice if I said the same thing :P

I think the problem is when we fall and must be bedridden, we accumulate fluid in our lungs because we are not moving around etc. Then other thing set in.

Now a days many facilities use a special type of air mattress that is motorized... it's mainly to help slow down bed sores from non-movement. My Mom's nurse/Aide said they come in and re-position Mom every two hours. And they do place her in her Geri recliner so that she is semi-sitting up.

Thank goodness my Mom was always real big on getting her annual flu shot and making sure her pneumonia shots were up to date.

Its been a challenge, trying to help Mom, who doesn't want help. I feel for the nurses. I think the recliners they have in front of the nurse station are the ones people can't get out of easily. Mom's days and nights are mixed up. She tries to get up every five minutes all night long and then sleeps in the recliner most of the day. She would be horrified to see what she has become. I'm glad the dementia and confusion is keep her from being fully aware.

AmyGrace, does your Mom know where she is residing?

We live in Virginia but my Mom thinks she is staying at a hotel in Connecticut [she grew up in that State] and she thinks I am staying in a room down the hall. Then she will ask me to call her sisters to which I reply "I will call tomorrow" [all her siblings has passed on]. One day she asked me what city in Connecticut is this hotel, then she quickly rattled off a list of cities and I quickly had to pick one. Just amazing how the mind works, she knew a lot of cities in Connecticut, but didn't know she was in a nursing home.

Mom thinks she is in a hospital. Last time I was there she mumbled something about having to get better so she can "get out of here". Because she is almost deaf (and last week lost one of her new hearing aids, and takes out the other one) it is hard to have even a short conversation with her. We end up writing on the whiteboard. The nurse told me the night before she was hallucinating and talking about having whooping cough. (so she is remembering when I was 2 years old and had it - I guess that goes to prove memories are all in there somewhere. Its the retrieval of the memories that fails.)

AmyGrace, did you get an answer to you question about the difference between Hospice centers and nursing homes? I looked back, but didn't find it. I'm sure others have much more info on that than I do, but I did have a friend who was at a hospice center. The patient stays there under hospice care and the entire facility is for that purpose. Many have names like Transitions. The nursing home provides skilled nursing care and yet you can have a hospice team come into the nursing home to provide care to the patient and support to the family while in the nursing home. That's my understanding of it.

My cousin is in a Memory Care assisted living and I observe hospice teams there providing support to the patients. They are not employed by the facility.

Maybe others who have had direct experience with an actual Hospice facility will chime in.

We had a family friend show fell a couple of weeks ago and fractured his hip. He hasn't really been communicative since. He won't eat, drink, etc. I'm not sure which route they will go with him. He was having dementia like symptoms right before his fall.

It just seems to me that they should be able to give your mom some medication to help relieve her anxiety and discontent. I can't imagine them not being able to do that.

"Is this the way it progresses at the end?" In my personal experience, yes. Just keep her as comfortable as possible and let her know she is loved alot. Showing and saying the love is very important. She is trying to let go. This is hard to do. Let her know it is OK to go. When I told my mom, "Sis and I are set up and can take care of ourselves" Mom finally knew she could let go.

My father fell a few months ago due to medicine. The doctor sent him to physical therapy which has helped some. He has not fell again so we have our fingers crossed. I agree with Sendme that her meds should be checked - low bp can also make you weak and sleepy. Dehydration can cause falls also.
My father is too proud to use his walker in public, so we are on pins and needles every time he goes anyplace - figuring that it's just a matter of time...

I can tell you that my aunt fell in the nursing home several times, and she still lived about two more years.

http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

This source will provide the stats for falling.

My son in law in Palm Beach lost his business partner to a fall in the kitchen,He was 55.
I always caution anyone walking on stairs to use the banister (quoting some of the stats) as they continue on.

I had the maintenance folks install shower grab bars in my new apartment. Falls lead to other serious outcomes.

The hidden cause could be depression, which is under diagnosed in the senior population. Late-life depression can be a subtle cause along with other life changes. Tests are available to determine status GDS , MMD have your doctor order the tests

AmyGrace. It is hard to say as sometimes they bounce back after falling.The first thing I would check into is medication and whether there is a UTI.
My Mom first fell and broke her hip 19 years ago...they did surgery and she lived on her own for 17 yrs.,and drove her car for 11 years after that Then she fell 4 years ago, broke her wrist but was able to return to her home after that and used a walker. Then a year and a half ago at age 91 she fell again this time breaking her arm and she could hardly stand or walk after that. It progressed within 3 months that she lost all ability to walk or stand on her own. Even with a transfer she would begin to go down and a lift machine had to be used. She has been bedridden in my home for a little over a year now and on hospice for 6 months, so falling can just drive the situation down or they can recover. Check the meds and for a UTI first.

I think that falls really depend on the type of fall and the person. Sometimes a fall can indeed start the beginning of the end and I'll explain why:

Years ago a friend of mine who owns his own house had an attic that he only visited once in a while. There was this handrail that was not properly installed, and he used this handrail to pull himself up the rest of the way into the attic for about 25 years before it suddenly detached, sending him right back down the ladder, and hitting the floor below. Of course he was hurt in the fall, and yes he was a little up in age. I used to visit visit him at night, and we used to visit for about an hour. However, right after that nasty fall, he was only able to visit for about 30 minutes because he started going to bed earlier. One time I went to visit him and he was surprisingly on a walker. Something inside told me that he was going to die, but I kept fighting it off because I thought it was just in my head. Lo and behold, I went to visit him one night and the door was locked but all the lights were on. The car was in the garage and the garage light was on. I called him and left a message on the answering machine because there was no answer. I waited for quite a while before finally having to go home for the night. I made a few calls inside while waiting because I figured he may have gone out with friends or family. Little did I know, he really did die just as something inside told me was going to happen. It wasn't until I finally saw his obituary in our local paper that everything clicked, it was God telling me that my friend was going to die and it was not in my head after all. I then went on to pray to God about lucid dreams that people have about their loved ones after they died. At first I didn't believe in lucid dreams because I thought it was all a big wives tale. Lo and behold, one night I had such a dream where I was visiting my friend at his house, it's possible I may have very well been in the spirit. My friend was as he always was and he said that he was allowed to come back for two weeks until he had to go back. We had our usual half-hour visit before we closed. In closing of our visit, he did his usual habit habit of going to the kitchen and he was by the fridge. I was starting to leave before I came out of the experience. Upon awaking I had a piece about me that the world just cannot give, this was God's peace. I don't recall what my friend said during this encounter, but whatever he said let me know he's OK. I did confess to him that I took him for granted because I didn't want him dying without Jesus, this was during that encounter after he died. For quite a while after his death I found myself riding my bicycle past his house when I felt the strongest emotion to go past there. I would ride up and turn around right by his house and coast back down the main street. What bothers me most is he's in the ground while all of his stuff is now in the process of being dispensed. It bothered me that he's in the ground with nothing, and I forgot that his spirit which is what really matters is actually in heaven with God forever.