Mom’s a “walker”, has fallen, and it’s scaring me.

Mom was diagnosed with dementia about a year and a half ago but still lives at home. Someone is always with her, but she walks…A LOT. Not to the mailbox or the kitchen, just aimlessly. I’ll ask her what she needs, and she’ll say “nothing.” If I ask where she’s going, she doesn’t know. What scares me is that she’s fallen 4 times in 2 months, and one of them broke her wrist. I got her a walker, and I got her Hipsters, but the thought that I have to watch her 24×7 to make sure she doesn’t break bones is freaking me out.

Elder-proofing the house

The urge to constantly get up or walk, walking aimlessly without knowing where, and the tendency to fall while doing it are all, unfortunately, signs and side effects of dementia. My mom used to walk a lot. She’d shuffle through the kitchen lightly propping herself up with one hand on the counter, and eventually fell and broke her “good” arm (the other one had been injured 20 years before in a fall down an embankment in her back yard), so after taking her to physical rehab to get her well enough to use her arms, I got her a walker. I’d cringe every time she used it, because she never held onto it that tightly.

At least you already know your mom HAS dementia and have someone watching her; but it sounds like it’s getting to the point where she actually needs some kind of medical supervision or assistance. From your description, she’s getting enough basic care that it doesn’t sound like she needs to be moved yet to a dementia home, but there ARE some things you can do.

Since some dementia behaviors seem to occur on a “schedule” (sundown, 4 hours after meds, etc.), one thing you might consider is hiring a nurse to check in on her when she’s most at risk of making a dangerous “excursion” through the house.

And I’m sure you’ve already looked at “elder-proofing” your house with guardrails and handholds in the bathroom, raised toilet seats, etc. Similarly, it may help to scan the house for fall risks: throw rugs, clutter, or bric-a-brac that might hurt her if she fell on it.

Improve the lighting in the house so she can see what she might trip over.

You can also look at getting her a wheelchair, bed rails, or even moving her bed to the floor. Whatever reduces injury.

Deciding whether and when to move Mom to dementia care

If Mom can’t be trusted not to hurt herself accidentally, get lost, keep herself clean (even with help), or if continuing to live in her own house is frightening her, then it’s time to do something. Take a look at both her assets and the level of care she’s likely to need and start early looking for a dementia home that can provide the best care for the longest duration at the most reasonable price.

Start looking early, talk to Mom’s doctors—including a geriatric psychiatrist—about her level of remaining mental fitness, and if you don’t already have guardianship or power of attorney, talk to Mom’s attorney about how to ensure her continued safety. If there aren’t any conflicts of interest, it should be a fairly straightforward thing. If not, don’t be afraid to ask for advice on how to best take care of Mom.

If Mom’s still mentally fit enough to do so, have her sign papers allowing you to manage her finances to ensure she’s taken care of.

Have your plan ready for the moment when the universe seems to be telling you it’s time to move Mom. Because that time is coming.

Why does Mom keep falling?

Chances are, though, she’s going to get up when you’re not watching, and she’s going to try to walk, and she’s going to fall anyway.

But why do elderly people, especially those with dementia, fall so much? There are a handful of common reasons:

• Sarcopenia: That’s a fancy Latin word that means loss of muscle strength. If this is a major factor, you can try getting Mom some physical therapy, which might help with this.

• Loss of executive function: It’s a gross oversimplification, but one reason Mom may fall is that the parts of her brain that used to control walking are “shorting out.”

• Loss of familiarity: Imagine you’re visiting a neighbor whose house is FULL of strange stuff. What are the chances you can walk rapidly through their living room without stepping on a dog toy, legos, or tripping over a doll their daughter has left on the living room floor? Now imagine Mom lost in her own house, without the same level of attention a fully-functioning adult would have in that situation.

• She doesn’t remember the walker or wheelchair is important…or how to use it.

• Mini-strokes: Especially with vascular dementia, it’s not uncommon for parts of Mom’s brain to just “go dark.” Sometimes that’s memory, but sometimes it’s the parts that control gait, posture, and other parts of the walking experience.

Dealing with the urge to walk

The difficulty many people with dementia have with wanting to walk and not being able to do it well sem from a combination of physical and mental decline, restlessness, and the need for routine.

For physical decline, you can look at a walker. If Mom’s not going to use it properly, you can also look at something called a “merry walker”, which is a bit like a normal walker, but with better ability to catch and support Mom if she starts to fall. You may remember those little plastic buggy things with hanging seats in them that toddlers use when they’re in that “exploring” phase and are transitioning from crawling to walking. A merry walker is a bit like that, but for grown-ups.

Part of mental decline can be agitation and habitual behavior. Mom doesn’t want to sit still, but when she tries to get up, she no longer remembers why. Perhaps she wants to be doing something. My mother-in-law used to putter about the house every time we visited, and my father-in-law would always tell her to come sit down. Well before she experienced memory problems, she felt she needed to be getting ready for our next meal, cleaning house, or something else. Those perfectly normal behaviors get so entrenched in our subconscious memory that when much of the rest of us is gone, only the behavior remains.

Sometimes agitation can be a side effect of a urinary tract infection. Guide Mom to the restroom and make sure she actually uses it, have a home-visit doctor (yes, those DO exist!) check her out, and see if she needs to be on antibiotics.

You’re probably not going to entirely squelch the urge to walk and the inability to safely do it, but if Mom appears agitated or frustrated, talk to her gerontologist about anti-anxiety medications and other ways to calm her down.

Accepting reality with grace, dignity…and even joy

Once you’ve dealt with the obvious and made Mom as comfortable as possible, you’ve done 90 percent of what CAN be done. If Mom’s not agitated, there’s also a good chance she won’t get up and try to move around. Or you can walk WITH her to the point where she’s physically tired enough to sit down.

The point is that while you cannot fix the situation, you and Mom can deal with it together in ways that improve the quality of her remaining life.

You can do fun and interesting things together that require Mom to sit in one place. My mom and I used to do jigsaw puzzles together, play board games, or just sort beads while eating ice cream and cookies or a milkshake I’d bought for her at Sonic. Nothing really mattered except the fact that we were doing it together and it kept her occupied.

She enjoyed our time together. And despite the stress of it all, so did I. Now that it’s all a memory, I am grateful for those odd, weird little moments when we could both just be two little girls together, without a care in the world.