Mom refuses to even try to sit up much less resume walking again. Anyone ever hear of anything like this?

My daughter is one of "these folk" and they r aware of what is going on. She has had all types of patients and is able to deal with them all. Especially the harder ones. She claims her GF helped her learn how to handle them. They undertand that the elderly aren't happy with their lives. They have lost everything. Facilities are not allowed to make a resident do what they don't want to. My daughter tries to make them think they r making the decision. Like...Mr. R don't u think you'd be more comfortable sitting in the chair for a while.

The psychiatrist is going to try a milder anti-anxiety medication along with an anti-depressant, so I guess we'll see. On the plus side her appetite is great, she's more engaged in talking and watching her shows, she's getting along very well with the staff and she's letting us put the bed in an upright position without freaking out. On the downside, she still hasn't gotten into the chair and the panic reactions when PT tries are still way out of hand. You can just see the dread when she knows PT is coming (and she likes the therapists, BTW) and the relief when she knows it's done for the day. Before PT she can't remember things, everything hurts, she's evasive and contradictory. After, she's lucid, enthusiastic about things, even jealous of the more mobile residents.

Today I tried to have a nice calm happy sort of talk about her physical pain. Where it specifically hurts when she tries to do a specific thing, what hurts all the time, what makes it feel better and so on. But she's always very vague and evasive about it. I mean maybe she pulled something or tore something and it really hurts, but she's not pinpointing anything so it's tough to tell. And when I prod re: her fear of falling she's even more evasive. Right now I think she has no confidence at all in her ability to not fall down and injure herself and it's become so overwhelming she's locked up with fear even when she's in a position where it's totally impossible to fall at all.

It's good she's getting a psychological consult. Maybe, they can determine what's going on.

My aunt fractured her pelvis in two places and although she does not have Alzheimer's or Dementia at 97 yrs old, she tells me how painful it is. She tells me it hurts to sit up, but once standing to do PT in rehab, it takes the pressure off. Could this be true for your mom??? May God Bless and enjoy your time with mom. My mom just passed away at 76, and I would give anything to hear her scream at me right now.

Has she been checked for non-pressure hydrocephalus?

Unless she's got a broken bone, does it really matter WHY she can't walk unaided? The answer is PT and possibly a walker.

Cinderella, can you get your mother into PT? One of her doctors can script for it. If you can get her to an outpatient facility, she'll have a better array of exercises, and she'll also be able to interact with more therapists. It's been my experience that most have staff who really know how to handle older people, bring them out of their shells, and get them moving as well as inspired to outdo the other old folks there.

my mother has gradually been unable to walk well. now she holds on to everything, has no balance and unless I force the issue, refuses to use her walker. She is a fall waiting to happen! She is under the care of many doctors, none of whom can offer a reason as to why she can't walk well. It really has been a frustrating puzzle. When I ask her why she doesn't walk well (ie, does something hurt?) to try to get to the bottom of it, she shrugs and says she walks just fine or simply says she likes staying put and if given her druthers, would stay in bed forever. hmmmm

Thanks to everyone for their helpful and thoughtful replies, it really does help a lot. They've made some progress in just four days. She's sitting upright to eat which seems like nothing but for her is real progress. The problem is the panic attacks during therapy. As soon as she gets upright to the edge of the bed she starts with the "let me lie down" which she repeats endlessly. Her BP and heart rate skyrocket. Then they have no choice but to stop. She is convinced that a) her legs "don't work" (they're undeniably weak but she has full feeling and can move them when she tries) and b) she will fall. On Saturday they gave her a .25 xanax and she was totally out all day to the point where she had no idea I was even there. It's as light a dose as there is and even that lays her out.

They've done a good job at recognizing this as being her central problem. She's supposed to see a mental health professional tomorrow who might try to prescribe something that might alleviate the panic. When I try to discuss it with her she's VERY evasive and tries to either change the subject or tells me "tomorrow". Today I intentionally left her and the therapists alone (they're very good and very patient BTW) thinking that maybe I was somehow holding her back, but when i arrived they told me it was same old, same old.

IMO if we can break through the wall in her head we can at least get her to a point where she could use her wheelchair and gain some functionality. She's made definite progress physically and mentally, but this issue is still the main sticking point hindering her recovery.

Sandwich, I was thinking of the effect and methods by which PTSD is addressed through therapy dogs. I watched an interesting program on PBS on this issue.

Having been through several kinds of therapy for an extreme fear & anxiety/PTSD type of situation, I can say that you can not successfully reason fear away. There is no proof or statistic or anecdotal evidence that will work. I tried that without success numerous times.

It takes a different approach to re-program the emotional and physical response to certain thoughts and triggers - after the triggers are identified! I don't know if that would even be remotely possible with a dementia patient, as it requires learning and remembering. There are thought and breathing exercises that have to be done on a fairly consistent basis to work.
The suffering patient has to put in a lot of effort to improve.

Based on what I've seen with my mom and other peoples' stories here, geriatric psychs don't have a lot of tools to work with. All they can do is try to control symptoms. All you can do is provide in-the-moment reassurance and keep trying what seems like a good idea at the time.

It really is trial & error in these kinds of situations and learning how to appeal to the emotional part of the brain, which is not as easy as one would hope. Rewards, praise, more attention for complying than not complying are definitely good tools to use. Give no attention whatsoever to undesirable behaviors unless it's a safety matter.

Nobody is probably ever going to stop that inner monolog going on that reinforces the mistaken thoughts of "I'm going to fall & die if I move". If mom has a history of allowing herself to indulge in catastrophic thinking, it probably won't change now.

As long as you know she's safe may be the win possible here.

Dmanbro, I've just skimmed the earlier posts but see that there are still some issues with getting everyone together on helping your mother, but that she did respond well when you were there to provide emotional support.

I do understand now the frustration you expressed on your other post.

I think the fear that she may also die because she saw her mother die after a fall is a legitimate one, especially if she was a child at that time. Those ingrained memories can sometimes become distorted or more intense over the years. The circumstances are different, but that's not always how the brain stores them. For her, it's a legitimate fear, so I would treat it as such and deal with it on that level.

It seems she's calmer in your presence, and you are very devoted to being there with her. I recall that when the therapists come is a questionable issue rather than a set time, but I'm wondering if you could get perhaps one day's schedule from them ahead of time, come early and spend time with your mother listening to her favorite music, or doing other things that relax her.

Petting animals is soothing but if there's no animal therapy, you could buy a nice stuffed animal (with no buttons or things that could be pulled off) and leave it with her. I've found that artificial fur can provide a substitute for real fur. (There's a reason children like cuddly, soft, stuffed animals.)

That way she might not be as tense and fearful when therapy starts.

I'm also wondering if they're forcing her to stand; if so that's probably part of the problem, if not the terror. My mother experienced that; one of the male therapists decided she wouldn't cooperate and advised that therapy be discontinued.

My sister, father and I got together, asked for a family consult, and came prepared to politely and diplomatically challenge that conclusion, which we did. Before that though, we took her for an appointment with her orthopedic surgeon who was angry that the therapists had been forcing her to walk on her broken leg.

He advised that she should be on a non weight bearing status for 6 weeks. With that statement from him, we then met with several of the staff and politely backed them down with their accusations of Mom's noncompliance.

End result: the therapist who said Mom wouldn't cooperate was moved to another facility; a very personable young woman with a lot of patience became mom's therapy, and we moved forward.

For your mother, the therapists can easily give her strengthening exercises either while seated or on one of the very large therapy mattresses that can be raised and lowered.

If she's afraid to stand from her wheelchair, she can be transferred by slide board directly onto the raised platform. That might allay some of her fears.

What kind of treat can you provide her after a successful therapy session? More music, a favorite tv program, tour around the facility, a stroll outside to the garden....what would she enjoy doing that's relaxing? I used to take my mother and then my father to the music room and play for them, either before or after therapy.

What's the progress on psychiatric involvement? Without challenging anyone else's suggestions, which are good, I think that the fear of falling she faces is the kind of trauma that anyone can face after traumatic events. I've always thought that even civilians, especially elders, have their own kinds of PTSD episodes. Perhaps you might even be able to find a geriatric psychiatrist who addresses this issue.

You could also tell her that falling doesn't necessarily result in death. My father fell at age 94 and broke one hip, fell the next year at age 95 and broke the other hip. After that he decided he wasn't going to break any more hips because (a) he only had two hips and both had been broken, and (2) he intended to live to be 100. He's very determined though; not everyone has that mental fortitude. But perhaps just sharing his story may encourage your mother that life after fall can be relatively normal and doesn't have to result in death.

I am aware though of all the dire post fall statistics; they were presented to us as a kind of horror story.

DM, if by "sedated" you mean thwy gave her antianxirty meds, i would assume that would be a good time for her to go to activities, when she's calm. If the antianxiety meds are causing sedation, ie, sleepineas, then perhaps the dose is too large

She also would scream, holler, and swear when anyone tried to move her on purpose for any reason. She is on an anit-psychotic and Prozac, but these are not magical pills that put her in a state of euphoria. If only.

My mom started being physically helpless several months ago. There was no physical reason for it, so it has been attributed to her pre-existing mental illness in her chart. She started refusing to walk, literally over night. PT was able to see that she could still do it, but just wouldn't.

That turned into refusing to stand. PT again, got her to stand, but she continued refusing.

Then it became refusing to sit up, which degenerated into refusing to transfer or assist with her own transfers or scooting herself up in bed. She would sit there and pretend she couldn't cough to clear her lungs because she had slumped down. It was unreal. I can't get my head around somebody who would sit there and obviously need to cough but won't because of the need to put on a show.

Now, over the period of about 6-8 months mom is completely immobile. She won't even try to hold a cup if you offer it. I caught her reaching for and holding onto a full cup of ice water and sipping from the straw when she didn't think anybody was looking.

She is 100% max assist on everything, which includes using a lift to get her out of bed.

I think it started out as part of her bipolar/borderline/narcissistic mental illness and has progressed really fast due to the dementia. The dementia really will take these abilities away in time, but the mental illness got it started way too early. By becoming totally helpless on her own, she has lost muscle tone and control that won't come back because of the dementia. It was a very slippery slope and nobody could stop it.

Having a loved one with mental illness and dementia is doubly painful and difficult.

Everything has a reason the problem is finding it? Meds ar much stronger and longer acting in the elderly so it is often a good idea to start with a tiny dose then go up. Even use half a tablet to begin.

vstefans: Thanks, I just want to help, not tell someone how to do their job. But sometimes it's like everyone's on a different page. Like the activities director who was badgering her about getting out and about an hour after she'd been sedated.

dmanbro, you are doing great! sometimes helth care providers are just mean and impatient and don't like it one bit if you challenge their hasty, judgmental conclusions. I had one therapist assume my mom wasn't capable of understanding anything when she was simply could not hear then got scared at being yelled at right to her face. Therapist threatened to have me thrown out when I pointed out that was the case and got Mom to do one of the exercises while demonstrating how to actually speak to someone who is hearing impaired.

Shirls1945: her mother died shortly after a fall and she is convinced it'll happen to her too. We're trying to alleviate that concern a little to give her some peace of mind, but it's pretty ingrained in her head at this point. In her mind, old people fall, break their hips and die.

Yes it can be terrifying to be afraid of falling. I hate to think what people think of me when they are behind me on stairs because I've taken more than one nose dive and broken bones! I hang on to the rail like grim death and take them really slowly. Joints don't bend so easily as one gets older and it is also a lack of confidence that the body just won't do what the brain tells it to. I do hope that the therapists gentle her along until she believes in her own power of movement again which I'm sure she will eventually.

Shirls1945: yes, it took a little work but they're giving her the correct meds. She's only on three regular meds, not bad for 82 IMO. It seems that much of her cloudy mental state was due to being anemic, as she is showing definite signs of improvement mentally. Her current central issue is panic attacks when she's made to move around, as soon as she feels pushed out of her comfort zone she thinks she's going to fall and injure herself. Now that the staff knows this they're helping to work on the problem slowly but surely.

dmanbro is there an overseeing physician who is aware of exactly what drugs your mom is getting. I was convinced my husband had lost his mind until he was transferred to his last hospital where his new doctor discovered he was being given 19 different drugs prescribed by the half a dozen previous doctors who were all treating different issues he had and they were making him delirious Three days after stopping the drugs he was back to normal, in mind if not in body. At one stage they had to actually put him in restraints which was heartbreaking. .

Is there a t.v. in her room that she watches? Take that out, tell her she can ambulate or wheelchair to the community room to watch t.v.
From what you posted, she may be cooperating more, a sign she is getting better, I am hoping this is the case, for both you and your mother. Stay strong, a day at a time.

Ignore how you think you're being treated. I find that the minute I start caring about what the staff thinks about ME, I'm off track. This is not about who's right, it's about getting your mom's treatment on track.

This would be sad if this could be what is happening:
Often, a patient with some type of cognitive dysfunction or dementia will focus on an issue, for example she is being attacked, people are stealing from her, etc.
Later, they pick a person who they identify as their attacker, etc. This can be an innocent family member, just saying their name in error. If she is more combative with you or someone else, change the person trying to ambulate her. Is she talking? Don't take it as personal if this is what turns out to be happening, you and the staff know it is not true. The geriatric psychiatrist can help with this.

I really wish the staff would simply listen to my advice regarding her condition. Today we did some light therapy (I was present) and I was able to stave off the panic by merely being gentle and taking her mind off of the pain she felt. And she did rather well too. Looked better, felt better, sounded better, ate better, all from one easy session. So far I've accurately predicted everything that's happened yet I'm still being treated like I'm a doting annoyance. Luckily the therapists have been receptive so far, much more so than everyone else. But only when I'm actually there, which sort of defeats the purpose in a way.

I think your diagnosis is correct, she is scared silly, and the trauma she has just been through plus fear of what happens next is immobilizing her. USUALLY, a low dose SSRI is first line for this sort of thing. OTOH...make sure her legs, bowel, and bladder actually do work OK, and that she does not in fact have a vertebral compression fracture that hurts every time she goes to sit. Stranger things have happened in people who can't quite verbalize exactly what and where a problem is. You have to wonder how she let her gastritis or ulcer get bad enough to make her anemic without complaining of reflux or abdominal pain symptoms.

This is a far reaching suggestion, I noticed that my Dad didn't like doing physical therapy, it was a struggle to get him motivated.... until one day a very attractive tall blonde appeared as his PT. Need I say more, Dad was on the road to recovery :)

Same happened with my Mom about 20 years ago.... to this day she still does her exercises on her own and says how Jason [her PT back then] recommended this or that.

Babalou is right. I think it's important to know what is really going on with your mom. Is it regular anxiety, age related decline, dementia, etc. Toughing it out or just getting on with physical recovery isn't that applicable to some medical conditions. She might make it through an episode or seem to improve on her feet, but if she's suffering with a disorder, she will likely decline over time. If treatment is available, I would certainly get it for her. There are other medications for anxiety other than Xanax.

The thing to remember, imho, is that the dementia patient is not reasoning and is reacting "as if" something that we are unaware of. "As if" could mean the patient is back in a war zone, protecting her young, trying to escape a rapist, trying to flee a burning building. The brain is broken and the mind has made up a scenario to which the available adrenalin is applied. We drove my just - released from rehab mom to her lovely new AL residence. She started crying the minute we got in the car and grabbed the steering wheel from my husband on the highway. What was going on in her head? I'll never know. But it was clearly a very real threat she was facing.