Night wandering

skibreak

Registered User
May 8, 2014
2
My Mum has Alzheimers and 3 weeks ago moved into residential care. For some time she has been confused about time, days and whether it is day or night. When living at home we tried special clocks, and repeatedly reinforcing that if dark outside it is night and therefore time to sleep. She has always been an early riser (around 7 am) and more latterly was going to bed around 6pm feeling very tired. She would often wake during the night, go to the loo, make tea and started making phone calls & getting dressed in the early hours.
At the care home she has settled in pretty well during the day, they have tried getting her to stay up a bit later but after 6pm she insists she goes to bed as she is exhausted. She is then very unsettled through the night, getting up and dressed, wanders the corridors and sometimes bangs on other resident's doors & even tried getting into someone's bed (whilst they were in it!). In the morning she does not remember this & says she has slept well. The Manager says they are used to wandering but I am worried her behaviour may result in her not being able to stay there.
Has anyone been through this and any ideas what we could implement to get her to stay in her room (she has her own bathroom). I wondered about making a poster with sun on one side, stars & moon on the other to hang on her door to denote day & night & explain she must stay inside unless the sun shows. I don't know if she would comprehend this though.
Her GP has been called in and prescribed rispiridone a week ago, I am led to believe it may take a while to work.
Any help would be much appreciated, thanks.
 

clareglen

Registered User
Jul 9, 2013
318
Cumbria
I would have thought this was common so the home should be able to cope with it. Maybe they could have a door alarm on her room so they can get to her before she disturbs anyone else.
 

Witzend

Registered User
Aug 29, 2007
4,291
SW London
Unless the care home has voiced concerns, I would try not to worry about it. No matter what you do or try, your mum is unlikely to take any notice, or be capable of remembering instructions. Night wandering is pretty common in dementia and a CH that takes people with dementia should be well used to it.

My mother goes through frequent phases of wandering a lot at night (as well as in the daytime) - the CH has never voiced any concerns - except that of course there are fewer staff around at night and she is a bit wobbly and prone to falling. But in general it is fine - one of the staff will often make her a cup of tea and reassure her if she seems at all anxious - she has been there over 6 years but still gets disoriented. During these phases she will then sleep for much of the day.

It can however be a problem in a CH with non-dementia residents - they will understandably not like being disturbed and both they and relatives may complain.

I don't know about medication - my mother has never been on anything to help her sleep and I gather that GPs may be reluctant to try anything of the sort, since it may make people 'dozier' if they do wake, and more prone to falling. Still, it may work for your mum - I hope so.
 
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Not so Rosy

Registered User
Nov 30, 2013
578
My Dad seems to be up and down most nights in his care home. He likes to go and sit in reception and they make him a hot drink and a piece of toast.
 

Tilly Mint

Registered User
Jun 14, 2011
21
There are gadgets that help with this problem but I'm sure the home must be well used to this as it's quite common. My mum used to be the same. She stopped being able to tell night from day and the darkness never made any difference.

Strangely she no longer has this issue.

The gadget I had in mind is something that gets triggered when a door is opened or someone gets out of bed and it's recordable with a familiar voice so that when it's triggered a recognised voice could say "It's too early to get up, mum, please get back into bed".

Just returned to add the link to what I was thinking of for you..
http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=109
http://www.easylinkuk.co.uk/page87.html
 
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Katrine

Registered User
Jan 20, 2011
2,839
England
I would say that posters, clocks etc. will be ignored. It is too abstract for her to have an instruction from someone who isn't physically present. She wants to get up and walk around, so she will continue to do it. A later bed-time probably won't help either. When she is tired, she is tired. The problem is not that she's going to sleep too early and would sleep more deeply if she was kept up until she was even more tired. Nudging the bed-time by half an hour just means she will be up and wandering a bit later than usual.

MIL is similarly inclined to your mum. Atg her first CH they would scold her and make her go back in her room. This led to toileting and hygiene problems because she was afraid to come out and ask where the toilet was. The CH was not staffed to manage wakeful residents.

At her current CH she is managed more appropriately, and it helps a great deal that she has an ensuite toilet, although at night when she is more confused she often comes out to ask the night carers to show her where the toilet is. She often has not a clue as to where she is - sleep seems to press the reset button and she could be in a cabin on the Starship Enterprise - her surroundings are alien and she cannot make sense of the fixtures and fittings.

For the first few weeks there she was confused and distressed at night and often became angry at attempts to get her back to bed. She was dressed and determined to go home so they just let her walk until she got tired. Every hour or so they would encourage her back to her unit and get her back to her room. Some nights she slept pretty well, perhaps only getting up once, but every few days there would be another disrupted night, followed by a sleepy day. She now sleeps much better, but still has some wakeful nights.

Often MIL is wakeful because she is hungry. She eats well but there's a long gap between tea at 5pm and breakfast at 8am. She is constantly taking food from the kitchen, or other residents' rooms, and hiding it in her bedroom drawers. Often she has tea and toast in the early hours. We suspect that this is a long-standing pattern but when someone lives alone you don't know what they get up to at night.

The staff encourage her to stay in her nightwear as a prompt to understanding that it is night-time, but often she puts her clothes and shoes on and gets back under the covers. I think there are times when she feels vulnerable and she feels safer with her clothes on.

IMO, most elderly people do not need the solid 6-8 hour nightly block of sleep that suited them years ago. Their body clocks and hormones change, their bladders and kidneys don't function as well, they feel the cold, they experience stiffness, aches and pains from long periods of immobility. I think old people are designed to potter about and nap when it suits them, conserving energy and mental processing power, topping up their energy needs by snacking rather than digesting large meals, and so on.

Obviously you don't want your mum to be disturbing other residents, so staying in her room is to be encouraged. The carers tell me that MIL often settles after she's had a snack, or a little escorted walk around the home. They are providing her with physical comfort, and company, so that she can relax enough to get more sleep.

A low level of anxiety often makes night-time sleep difficult. It is the time when we feel most vulnerable. It helps to know that someone younger and stronger is keeping watch at the cave mouth to ward off the wolves and bears!
 
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skibreak

Registered User
May 8, 2014
2
Thank you all so much for the helpful comments & suggestions. I guess I am probably over worrying & that the care home will cope admirably, I have every confidence in them. It helps to know others have had relatives with similar issues. This is a new journey for me and the speed of your responses is impressive!!
 

Lady Phoenix

Account Closed
Feb 8, 2014
135
Various
In my experience as an Ex Care Home worker this is quite normal. Most people wander for a variety of reasons, the most common being that its a strange place. It can take weeks or longer to get used to a place.

Care home are used to this and if someone is found wandering they will deal with it in an appropriate manner.

I used to have a lady that would wander. The reason she wandered was that in her mind she was at home and looking for the outside loo. She couldnt comprehend that she had an en-suite. So, we would take her to the loo, then make her a cup of tea and she would sleep for the rest of the night.

I dont know your Mum and Ive never seen her but it sounds to me that she just isnt fully used to the new surroundings. Remember that your brain isnt the same when you have just woken up. The care staff will already be keeping a closer eye on her as she is fairly new, trying to pick up on her habits and looking for ways to settle her in, even if it takes months.
 

LYN T

Registered User
Aug 30, 2012
6,962
Brixham Devon
Hi Skibreak

As night time wandering appears to be quite common with Dementia sufferers I would imagine the CH are well equipped to deal with it, so try not to worry too much (easier said than done)

Pete was a bit of an 'adventurer' at night, but his CH used to take him downstairs give him a drink and a snack and let him nod off sitting in a chair.Then he'd be off again pacing.

The main thing here is that the CH does not consider your Mum to be a menace:eek:Pete was in a CH for respite once and they couldn't cope with his constant wandering.

Take care

Lyn T
 

emmdee

Registered User
Oct 3, 2010
2
Bristol
I would say that posters, clocks etc. will be ignored. It is too abstract for her to have an instruction from someone who isn't physically present. She wants to get up and walk around, so she will continue to do it. A later bed-time probably won't help either. When she is tired, she is tired. The problem is not that she's going to sleep too early and would sleep more deeply if she was kept up until she was even more tired. Nudging the bed-time by half an hour just means she will be up and wandering a bit later than usual.

MIL is similarly inclined to your mum. Atg her first CH they would scold her and make her go back in her room. This led to toileting and hygiene problems because she was afraid to come out and ask where the toilet was. The CH was not staffed to manage wakeful residents.

At her current CH she is managed more appropriately, and it helps a great deal that she has an ensuite toilet, although at night when she is more confused she often comes out to ask the night carers to show her where the toilet is. She often has not a clue as to where she is - sleep seems to press the reset button and she could be in a cabin on the Starship Enterprise - her surroundings are alien and she cannot make sense of the fixtures and fittings.

For the first few weeks there she was confused and distressed at night and often became angry at attempts to get her back to bed. She was dressed and determined to go home so they just let her walk until she got tired. Every hour or so they would encourage her back to her unit and get her back to her room. Some nights she slept pretty well, perhaps only getting up once, but every few days there would be another disrupted night, followed by a sleepy day. She now sleeps much better, but still has some wakeful nights.

Often MIL is wakeful because she is hungry. She eats well but there's a long gap between tea at 5pm and breakfast at 8am. She is constantly taking food from the kitchen, or other residents' rooms, and hiding it in her bedroom drawers. Often she has tea and toast in the early hours. We suspect that this is a long-standing pattern but when someone lives alone you don't know what they get up to at night.

The staff encourage her to stay in her nightwear as a prompt to understanding that it is night-time, but often she puts her clothes and shoes on and gets back under the covers. I think there are times when she feels vulnerable and she feels safer with her clothes on.

IMO, most elderly people do not need the solid 6-8 hour nightly block of sleep that suited them years ago. Their body clocks and hormones change, their bladders and kidneys don't function as well, they feel the cold, they experience stiffness, aches and pains from long periods of immobility. I think old people are designed to potter about and nap when it suits them, conserving energy and mental processing power, topping up their energy needs by snacking rather than digesting large meals, and so on.

Obviously you don't want your mum to be disturbing other residents, so staying in her room is to be encouraged. The carers tell me that MIL often settles after she's had a snack, or a little escorted walk around the home. They are providing her with physical comfort, and company, so that she can relax enough to get more sleep.

A low level of anxiety often makes night-time sleep difficult. It is the time when we feel most vulnerable. It helps to know that someone younger and stronger is keeping watch at the cave mouth to ward off the wolves and bears!
Thanks for this wonderful description! Its just a perfect understanding of how dementia people should be considered - they live in their own worlds, and its a huge struggle to try to adapt to our world.
My husband is sundowning during most of the day and evening, he only stops when he's in the car with me driving somewhere (anywhere!) and even then he asks 'where are we going' frequently - its normal day to us. So we get out and about almost every day!
My husband has also recently forgotten how to flush the loo - so he tried to clean the loo with the brush...... Good job that I know better than to expect him to re-learn how to press the flush with any regularity.

How does one manage to get through to people that what is happening is a strange sort of 'unlearning'? And that what was considered to be important MUST be re-aligned regularly? For instance - mu hubby finds getting washed and dressed extremely difficult, as if he was four years old. Maybe some people think that I should be encouraging him to re-learn such skills.

Labelling things are completely irrelevant! Hubby loses the kitchen, walking around with a cup and plate to find a friendly draining board, and just walks past the open door (how?) and ends up back where he started (its a medium Victorian terraced house! where we have lived since 1990) because he cannot see/recognise an open door!!!!!
Putting a label on the door would make no difference - if he read it he wouldnt be able to necessarily read it as a direction, its just a word.
Just like the flush handle on the loo - he would not benefit from having a label to read!

And I'm not even getting into night wandering.......
 

Lindy50

Registered User
Dec 11, 2013
5,239
Cotswolds
I agree emmdee, I love Katrine's description above :)

Mum lives essentially alone so I'm never really sure what she's up to. When I went yesterday, there was that unmistakeable aroma of poo around the flat....but not on her, nor in the bathroom. I found it when I went to the kitchen to make some tea. Poor mum, she had soiled three pairs of knickers and her nightie. One was in the mop bucket, one in the pantry :)eek:) and I eventually located another in a cupboard. But the shocking thing was, she picked one pair of really dirty knickers up to inspect it, and poked another with her stick....then just sat down for her tea!

My previously spick and span mum has lost all sense of hygiene.....and I don't think any amount of explaining from me would help. So I just clear it up, get her to wash her hands, and change the subject......:) x
 

Witzend

Registered User
Aug 29, 2007
4,291
SW London
My mother has always wandered a lot in her CH, including long phases of half the night. Being a specialist dementia CH, they accept it as 'normal'. The place was in fact purpose built and designed with plenty of 'wander room'. I know the night staff have often made her a cup of tea and a piece of toast during the night.

Any CH that says it can cope with dementia should not be put out by this. If they are put out then they should not say they can cope, since it is so often a feature of the disease.

I do hope your worries will be needless.
 
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Crag

Registered User
Jan 3, 2015
76
Dad would go to bed at 6pm if I'd let him, but then would get up far too early.
I don't mind him having a nap in the chair in the evening but have been trying to find ways of entertaining him to keep him up later. Not always easy when I have to be up for work early.

I'm not too brilliant of thinking of things that will entertain him through the winter months without causing problems, and would think if had to go into a care home they'd be better at it than I am.
He can get tired and confused when trying to play board games, but have this week digitised all his old photo slides from the 60's, 70's and early 80's, and have had a couple of nights this week running them through a slide show on the TV, which not only has kept him up but he's been a lot better in himself, remembering things in the present day that I wouldn't expect him to eg. the age of my niece whose birthday is next week.

So my next mission is to do the same with his shoe boxes full of photo prints.:rolleyes:
 

Witzend

Registered User
Aug 29, 2007
4,291
SW London
Thanks for this wonderful description! Its just a perfect understanding of how dementia people should be considered - they live in their own worlds, and its a huge struggle to try to adapt to our world.
My husband is sundowning during most of the day and evening, he only stops when he's in the car with me driving somewhere (anywhere!) and even then he asks 'where are we going' frequently - its normal day to us. So we get out and about almost every day!
My husband has also recently forgotten how to flush the loo - so he tried to clean the loo with the brush...... Good job that I know better than to expect him to re-learn how to press the flush with any regularity.

How does one manage to get through to people that what is happening is a strange sort of 'unlearning'? And that what was considered to be important MUST be re-aligned regularly? For instance - mu hubby finds getting washed and dressed extremely difficult, as if he was four years old. Maybe some people think that I should be encouraging him to re-learn such skills.

Labelling things are completely irrelevant! Hubby loses the kitchen, walking around with a cup and plate to find a friendly draining board, and just walks past the open door (how?) and ends up back where he started (its a medium Victorian terraced house! where we have lived since 1990) because he cannot see/recognise an open door!!!!!
Putting a label on the door would make no difference - if he read it he wouldnt be able to necessarily read it as a direction, its just a word.
Just like the flush handle on the loo - he would not benefit from having a label to read!

And I'm not even getting into night wandering.......
I don't think it's usually possible to get through to people who haven't lived with dementia. They simply cannot comprehend the situation. So many times I've heard people say e.g., 'But surely, if you tell him often enough...' or imply that if only the person would make an effort, or try a bit harder, or stop just sitting about 'being lazy' they would still be able to do or remember X or Y.

To be entirely fair, when we were very new to dementia with FIL, we were labouring under some of these delusions. It took us ages to realise e.g. that no matter how often we told or reminded him of something, or made nice clear notices or reminders, he was going to forget again 5 seconds later, or virtually the instant he had turned his eyes away from our nice clear laminated A4 sheet.
 

Ladybird23

Registered User
Feb 28, 2014
127
Witzend, sums it all up. Thank you.

As you say people who have not lived with Dementia have not got a clue. Just wished I had joined TP earlier so that I was prepared for what was ahead and helped my sister more.
 
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Roseylee

Registered User
Sep 24, 2014
25
Hi, Mum has been wandering at night In care home too. she was in first nursing home for 8 days before they suggested transfer to dementia residential home which happened 2 days ago. They were just not geared up for her wandering in the nursing home. Now new home have said that first night was fine, then last night she is wandering again. She has worked out what the pressure mat next to her bed does (alert staff she is on the move) so the little minx has slid it under her bed so that she can get out of bed undetected! She is wandering, going into other people's rooms, shouting when they try to take her back to bed. During the day she is pleasant as anything, and has made some friends, and can toilet by herself, but in the night she is wet, so perhaps this cAuses it? Anyone had this happen? Will they suggest light sedation for night time? We just feel like the parent with a bad child, such a role reversal.
 

itsmeagain

Registered User
Oct 20, 2010
95
Thanks for this wonderful description! Its just a perfect understanding of how dementia people should be considered - they live in their own worlds, and its a huge struggle to try to adapt to our world.
My husband is sundowning during most of the day and evening, he only stops when he's in the car with me driving somewhere (anywhere!) and even then he asks 'where are we going' frequently - its normal day to us. So we get out and about almost every day!
My husband has also recently forgotten how to flush the loo - so he tried to clean the loo with the brush...... Good job that I know better than to expect him to re-learn how to press the flush with any regularity.

How does one manage to get through to people that what is happening is a strange sort of 'unlearning'? And that what was considered to be important MUST be re-aligned regularly? For instance - mu hubby finds getting washed and dressed extremely difficult, as if he was four years old. Maybe some people think that I should be encouraging him to re-learn such skills.

Labelling things are completely irrelevant! Hubby loses the kitchen, walking around with a cup and plate to find a friendly draining board, and just walks past the open door (how?) and ends up back where he started (its a medium Victorian terraced house! where we have lived since 1990) because he cannot see/recognise an open door!!!!!
Putting a label on the door would make no difference - if he read it he wouldnt be able to necessarily read it as a direction, its just a word.
Just like the flush handle on the loo - he would not benefit from having a label to read!

And I'm not even getting into night wandering.......
What a great post, both yours and the one you quoted.
 

opaline

Registered User
Nov 13, 2014
182
I read somewhere that asking a person with dementia to remember is like asking a blind person to see . . . x
 

Katrine

Registered User
Jan 20, 2011
2,839
England
Hi, Mum has been wandering at night In care home too. she was in first nursing home for 8 days before they suggested transfer to dementia residential home which happened 2 days ago. They were just not geared up for her wandering in the nursing home. Now new home have said that first night was fine, then last night she is wandering again. She has worked out what the pressure mat next to her bed does (alert staff she is on the move) so the little minx has slid it under her bed so that she can get out of bed undetected! She is wandering, going into other people's rooms, shouting when they try to take her back to bed. During the day she is pleasant as anything, and has made some friends, and can toilet by herself, but in the night she is wet, so perhaps this cAuses it? Anyone had this happen? Will they suggest light sedation for night time? We just feel like the parent with a bad child, such a role reversal.
Roseylee, she isn't a 'good girl' in the daytime and a 'naughty girl' at night. I hope that the CH staff don't label her behaviour in this way. It's great to hear that she seems happy and has made friends. The ability to socialise is so important for her emotional well-being. It also means she is likely to respond well to carers as they get to know her. It really is very early days.

When MIL went to her current CH they had some instances where she was verbally and physically aggressive, until the staff worked out what things made her furious with indignation and frustration. Then they found out the best ways to distract her without direct confrontation. And also the best ways to use her people skills and emotional intelligence to the benefit of her fellow residents, under appropriate supervision.

I am so glad MIL lives in a CH where they accept that people need to wander. It isn't naughty, it isn't intentionally disruptive or attention seeking, it is NORMAL. It is a NEED, not a perverse preference or undesirable habit.

Obviously the night time wanderer will get tired during the day and will miss out on social activities and meals if they are awake all night and asleep all day, so I'm not advocating just letting every resident do what they want, when they want. A structured environment is of great benefit to people who no longer understand time and daily routines.

Staff should have the skills to encourage that person to rest, perhaps after a drink and snack, but never to force someone to be in their room alone just because the CH is short staffed, or because night staff don't think keeping residents company is part of their duties.

Time and again we are told how MIL just needs friendly reassurance that all is well and then she settles down again. She often wanders in search of the toilet. She's lived there for 16 months, with an en suite toilet in her room, but at night can be very confused and doesn't know what to do. If she couldn't find anyone to help her then her anxiety would quickly accelerate. How many of us could go back to sleep easily with a pounding heart and nausea, triggered by fear?

MIL needs someone close by to respond straight away. BTW, she was put on 2-hourly night checks early on and this still continues. Sometimes they inadvertently wake her up and she gets up, but usually she just murmurs that she's fine and goes back to sleep. The small child analogy is appropriate here. Physical comfort and reassurance are essential to getting a good night's rest. A good night for an elderly person may be 3 blocks of 2-3 hours at a time. Over time, and with non-judgmental observation, the staff should work out what suits your Mum best.

Keep in close contact with them in these early days so that her care plan develops with your input. A good CH will welcome the insights of the people who know your Mum best. Behaviour issues can be clarified and addressed when the staff have a context for why she does certain things. Often lifelong habits (we all have our strange ways!) can be assessed by staff as 'dementia behaviours' when actually they are just adaptations to a new environment.

Avoiding the alarm mat is an example of your Mum adapting and improvising; something MIL is also still able to do. Just because they have dementia does not mean they are stupid - far from it. I know you are worried that she might have a fall, so it's not a joke, but you have to admire her resourcefulness. The staff will find a solution. A motion sensor alarm might be more suitable than a mat. It is triggered when motion interrupts a laser beam. Ask them to get the OT to advise on suitable equipment to try out.
 
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Roseylee

Registered User
Sep 24, 2014
25
Roseylee, she isn't a 'good girl' in the daytime and a 'naughty girl' at night. I hope that the CH staff don't label her behaviour in this way. It's great to hear that she seems happy and has made friends. The ability to socialise is so important for her emotional well-being. It also means she is likely to respond well to carers as they get to know her. It really is very early days.

When MIL went to her current CH they had some instances where she was verbally and physically aggressive, until the staff worked out what things made her furious with indignation and frustration. Then they found out the best ways to distract her without direct confrontation. And also the best ways to use her people skills and emotional intelligence to the benefit of her fellow residents, under appropriate supervision.

I am so glad MIL lives in a CH where they accept that people need to wander. It isn't naughty, it isn't intentionally disruptive or attention seeking, it is NORMAL. It is a NEED, not a perverse preference or undesirable habit.

Obviously the night time wanderer will get tired during the day and will miss out on social activities and meals if they are awake all night and asleep all day, so I'm not advocating just letting every resident do what they want, when they want. A structured environment is of great benefit to people who no longer understand time and daily routines.

Staff should have the skills to encourage that person to rest, perhaps after a drink and snack, but never to force someone to be in their room alone just because the CH is short staffed, or because night staff don't think keeping residents company is part of their duties.

Time and again we are told how MIL just needs friendly reassurance that all is well and then she settles down again. She often wanders in search of the toilet. She's lived there for 16 months, with an en suite toilet in her room, but at night can be very confused and doesn't know what to do. If she couldn't find anyone to help her then her anxiety would quickly accelerate. How many of us could go back to sleep easily with a pounding heart and nausea, triggered by fear?

MIL needs someone close by to respond straight away. BTW, she was put on 2-hourly night checks early on and this still continues. Sometimes they inadvertently wake her up and she gets up, but usually she just murmurs that she's fine and goes back to sleep. The small child analogy is appropriate here. Physical comfort and reassurance are essential to getting a good night's rest. A good night for an elderly person may be 3 blocks of 2-3 hours at a time. Over time, and with non-judgmental observation, the staff should work out what suits your Mum best.

Keep in close contact with them in these early days so that her care plan develops with your input. A good CH will welcome the insights of the people who know your Mum best. Behaviour issues can be clarified and addressed when the staff have a context for why she does certain things. Often lifelong habits (we all have our strange ways!) can be assessed by staff as 'dementia behaviours' when actually they are just adaptations to a new environment.

Avoiding the alarm mat is an example of your Mum adapting and improvising; something MIL is also still able to do. Just because they have dementia does not mean they are stupid - far from it. I know you are worried that she might have a fall, so it's not a joke, but you have to admire her resourcefulness. The staff will find a solution. A motion sensor alarm might be more suitable than a mat. It is triggered when motion interrupts a laser beam. Ask them to get the OT to advise on suitable equipment to try out.
Thanks Katrine. A great overview of the situation. You are right, it is still early days. The manager of the home seems nice, but has been off over the weekend, so the person that gave us this info had probably only seen Mum once and didn't strike us a necessarily very old on the phone. Not that the age of the carer matters, but perhaps someone older may have taken a wider view on the situation.