Falls in a secure unit

[Lavender45]

My mum is in a secure unit at the moment. She will have been in this present unit 5 weeks tomorrow. Mum is a pacer, she paces for long periods of time, sometimes alone, but the staff say she mostly walks with another patient.

Mum has had a number of falls, most likely to be through sheer exhaustion. I have asked that the staff remind her to use her delta walking frame and I have asked them to try to distract mum from pacing so much that she gets exhausted. They aren't trying too hard with the walker and told me that she has to be allowed to walk if she wants to and that they cannot stop her.

Am I being unreasonable asking them to step in and deflect mum? They are having to call a doctor into the ward to check her over when she falls as each time she has hit her head? I know there are other patients to care for, but shouldn't they be looking to prevent problems rather than accepting that mum will walk until she falls at times?

 

[Jessbow]

They cannot physically stop her walking about . Is there an activity that will occupy her? have you suggested it?

its very frustrating but I do think there hands are somewhat tied. Any attempt to restrain her in a chair would be frowned on

 

[Lavender45]

No don't mean for them to restrain her, but I do feel frustrated that they do not atempt to distract her with a cup of tea, a chat or anything. It seems like they let her walk until she falls then call a doctor to check for injuries and then phone me to come in. I am there every other day usually, but go in regardless of there is a problem. My worry is that one of these bags to her head will be serious, or that she will break a hip or something similar.

 

[Jessbow]

No don't mean for them to restrain her, but I do feel frustrated that they do not atempt to distract her with a cup of tea, a chat or anything. It seems like they let her walk until she falls then call a doctor to check for injuries and then phone me to come in. I am there every other day usually, but go in regardless of there is a problem. My worry is that one of these bags to her head will be serious, or that she will break a hip or something similar.

frustrating isn't it. What Is the staff ratio like? Are folk there generaly calm, or do they all take a fair bit of management?

I suppose part of the problem is, they are assessing her, she needs to behave a she ordinarily would ( whatever that is!) and from that point they can assess her needs better.

At the moment she will be being recorded as pacing to exhaustion and falls.

How long is her assessment, do you know?

 

[love.dad.but..]

My dad was a pacer day night and day continued in his dementia nursing home and I know from my experience living with dad it is a compulsion some have and never lose until immobile. One morning at breakfast a few years ago when dad had come to me 30 times in the night I asked him apart from getting up for the toilet what makes you want to get up and dressed...and his reply summed it up...I don't know I just need to walk. So even trying to distract etc he would soon be back in the loop of doing his well trodden circuit and we just had to let him satisfy that need. As he became less mobile falls were increasing because of his age, he was no doubt tired and the dementia muddled things and probably what he saw as well.

 

[Shedrech]

hi Lavender45
I appreciate that your mum's pacing is a worry for you
dad has times when he won't go to bed and times when he walks the corridors - the staff monitor him; at night especially they make him toast and coffee and try to get him into a comfortable chair - but there's little anyone can do to stop him or 'make' him sit down or sleep
there are a number of wanderers in his care home and none can be stopped - it's a compulsion - the staff do encourage these residents to have a sit down for a chat and a cuppa; it can work for a short rest, sometimes even for 40 winks, then they are up again and walking - I've sat in the lounge and encouraged some to come sit with dad and me and share some fruit, chat or whatever - they stop for a bit or say how lovely I am, and then continue on
the home has handrails along all sides of all corridors and cameras directed along the corridors - the staff do watch out and notice which residents are OK walking and which are tired - but cannot ease the compulsion
I know dad has had some falls and I just don't see how every one can be prevented - at least there are staff on hand to help him - I've just had to come to some acceptance of the situation - even if I went in all day every day, he could still fall when I went to the loo ...
sorry not to be more reassuring - talk with the staff and the manager, maybe the GP too, so they know your concerns and can explain the strategies they have in place
best wishes

 

[oilovlam]

What they need is something like an adult 'baby-walker'...I don't think there is such a thing. Letting someone walk knowing they will eventually fall sounds a little crazy but there isn't much alternative. In hospital they put an alarm on their chair and a trolley in front of them...but these are people recovering from broken hips. It still doesn't stop falls.

I wonder if the constant walking is due to anxiety and could that be treated? Something that would NOT make them drowsy, increasing the risk of fall.

Exercise is good but the problem is that they don't know when to stop...indeed the more tired they get, the more their obsessive behaviour increases, almost to the point of destruction.

My mum is going onto Memantine (instead of Aricept) and Mirtazapine soon, I'm hoping that her behaviour will improve but it could make things worse.

 

[Witzend]

Is she easily distracted? I say this because some people just aren't, and even if a habitaual 'pacer' was distracted briefly with a cup of tea, he/she would very likely be on the move again right afterwards.

My mother was a 'pacer' in a secure unit - often wandering around for half the day or night. Luckily the place was designed with wandering in mind, since it's normal for dementia. She did fall now and then - at least once a week for a while - but I didn't honestly see how the staff could prevent it since they could not possibly watch her non stop (she could never remember to use her frame) and in any case, trying to thwart her in anything only made her very stroppy.
She evidently had a 'need' to walk, and short of tying her to a chair or drugging her into a stupor, I don't honestly see how they could have stopped her.

 

[Tin]

hi Lavender45
I appreciate that your mum's pacing is a worry for you
dad has times when he won't go to bed and times when he walks the corridors - the staff monitor him; at night especially they make him toast and coffee and try to get him into a comfortable chair - but there's little anyone can do to stop him or 'make' him sit down or sleep
there are a number of wanderers in his care home and none can be stopped - it's a compulsion - the staff do encourage these residents to have a sit down for a chat and a cuppa; it can work for a short rest, sometimes even for 40 winks, then they are up again and walking - I've sat in the lounge and encouraged some to come sit with dad and me and share some fruit, chat or whatever - they stop for a bit or say how lovely I am, and then continue on
the home has handrails along all sides of all corridors and cameras directed along the corridors - the staff do watch out and notice which residents are OK walking and which are tired - but cannot ease the compulsion
I know dad has had some falls and I just don't see how every one can be prevented - at least there are staff on hand to help him - I've just had to come to some acceptance of the situation - even if I went in all day every day, he could still fall when I went to the loo ...
sorry not to be more reassuring - talk with the staff and the manager, maybe the GP too, so they know your concerns and can explain the strategies they have in place
best wishes

Almost impossible to stop it Lavender, as you know my mum lives with me and she paces/wanders around house and garden - cannot stop her and can only distract her for a few minutes, so I have to let it happen. Awful thing is that when she got up this morning I noticed a bruise on face, she was wandering around and moving furniture in her bed room last night, did eventually get her to go back to bed around 4.30, but at some point she must have fallen or bumped face on a piece of furniture. We have had over a week of peaceful nights too, so last nights activity was a bit of a surprise to me.

 

[Fullticket]

Falls

Just a thought - I know she has only been in the unit for 5 weeks but I've found that any 'new' environment increases risks of falls. At home there is the familiar chair, table, sideboard they cling on to (even with a frame) but in a new environment it takes a while to establish a familiar routine and know their way around. So what I am saying is it may improve, given time, and hope no serious problems before then.

 

[Lavender45]

Thanks everyone.

The doctor and the physiotherapist saw mum this afternoon. Mum is now leaning to one side as she walks, further increasing her risk of falls. The doctor thought it might be due to consitpation??? I had no idea that consipation would make someone lean, but the doctor checked her stomach is soft and she has told them she "goes" every day. Mum would normally be pretty regular with her BMs so she's probably right. They have decided to 1 to 1 her for now because of the increased falls risk. Hopefully the can decide what the cause of the leaning is before too long as pacing and leaning is never going to be a good combination.

 

[SEASHELL]

My mother had another 'fall' a few weeks ago in the assessment centre (where she's been held for over 3 years). She must have fallen very hard as she broke her hip. I also witnessed another patient pushing her over right in front of me and the nurses's so whether that happened again where she broke her hip I don't know. It's disgraceful that my mother's been put in with dangerous patients and a place that has hard floors everywhere. I also suspect she's been beaten up in there a while back too because her entire face was purple with cuts.

Also check any medication your mum is on because with my experience it made my mother hyperactive and pacing round and round the place. Some of these doctors are idiots and won't admit the medication is causing problems.