falls and UTI's

Personal Finances Taking Care of Parents
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So:

  • Friday night, Dad fell.
  • Saturday morning, he refused to either get out of bed (too much pain) or go to the hospital (“never mind, I’m fine”). When Sis visited, he said he just wanted to sleep, so she said OK, fine to sleep in on a Saturday, but if he’s not better by Sunday, he should be seen.
  • Sunday morning he agreed to go to the hospital. Seemed like probably broken ribs, but x-rays showed nothing broken; however, he does have a “nasty UTI.”

He’s on IV antibiotics now. They’re planning to keep him for a couple of days. Of course I’m greatly relieved the problem is not what I feared (broken hip); that in fact it’s easily fixable (the UTI anyway; the soreness will just take time).

But I have questions for his AL facility, going forward:

  1. What can they do to prevent future UTI’s? Their default is to shower residents 3x/week; shortly after Dad arrived I insisted on daily showers, but they might’ve fallen back to a 3x/week schedule since then. He goes through enough Depends that I think they’re changing him often enough. Or are the elderly so susceptible to UTI’s that it will just happen sometimes regardless?
  2. What can they do to detect UTI’s in the early stages? I’m a little disturbed that it takes a visit to the ER for something else to discover a UTI. Given that UTI’s are common in the elderly, I think the AL place should just be checking routinely.

I also, of course, have questions about fall prevention. Dad’s problem is that when nature calls, he jumps up to answer, totally forgetting that he can’t stand or walk, and then down he goes. (He’s OK peeing in the Depends, doesn’t even feel it, but he does sometimes feel an impending poop.) He has never used the call button, and never will. This has been an issue all along, and it seems that the bottom line is that the only foolproof solution is restraints, which would be worse than the risk of falls.
On Saturday I emailed the administrator to ask about a bed with rails, and he’s going to look into that today, but Sis pointed out that Dad might try to climb over the railing and make things worse, so I’m not sure if a bed with pull-up rails would be a good idea after all. Meanwhile, I hope Dad’s not getting out of bed at the hospital; possibly the silver lining of his feeling sore is he doesn’t move much.

It’s frustrating. Falls & UTI’s are common enough that there should be some solutions by now. Dad’s certainly not the first or only one with these issues.

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mom did fall when she was at hospice. found out they would not let her have light to see by. so we bought battery powdered motion lights and stuck them all over the place so she could see were she was and plan her trips to the bathroom.

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He goes through enough Depends that I think they’re changing him often enough.

I’d try to find a way to check that. AL facilities are known to use supplies provided by a patient’s family for other patients. The only way I can think of at the moment is to visit a few days in a row and observe for yourself. Maybe coordinate with other family members.

On Saturday I emailed the administrator to ask about a bed with rails,

The one day my wife was in a rehab facility, they informed me they were not allowed to use rails on beds, even for patients with significant fall risks. Something about illegal restraints or something like that. Rather frustrating to me, especially considering that hospital beds almost always have rails.

–Peter

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I forget–is your father compos mentis? Can he understand the danger of falling if he doesn’t call for help? Maybe don’t call it help, call it an escort or buddy or “call a friend for company” so he doesn’t feel so weak/needy.

Do you know why your father falls? Does he have joint/strength/balance/neuropathy issues? Maybe some PT?

Routine UTI testing sounds like a great idea.

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"It’s frustrating. Falls & UTI’s are common enough that there should be some solutions by now. Dad’s certainly not the first or only one with these issues. "

Problem DW and I have found is that both UTIs and falls can be caused by a loot of things.
DW’s fall in January turned out to be caused by low sodium (i.e. electrolytes out of balance) as
a result of her drinking large - excessive - amounts of water. Drinking large amounts of
water tends to be one of the ways to avoid UTIs. Things interact and what is something a lot
of people experience tends to become - well complicated.

Howie52
Routine blood work can help a doctor see what problems happen - but what is causing the problems
is sometimes harder to figure.

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On Saturday I emailed the administrator to ask about a bed with rails,
----------------------------
The one day my wife was in a rehab facility, they informed me they were not allowed to use rails on beds, even for patients with significant fall risks. Something about illegal restraints or something like that. Rather frustrating to me, especially considering that hospital beds almost always have rails.

My mom was checked into rehab 2 weeks ago, post surgery for a broken femur.
She has half rails on the top section of the bed.
I also wanted More, but that was not possible.

There were three separate pages of forms to sign just for those rails -
Did we want them removed?
Was she comfortable with them?
Did she understand that thy were not restraints?
did she feel at all confined by their presence?
Was she clear that she could ask for them to be removed at any time? etc, etc…

Hospitals can have them, rehabs cannot.
Rehabs cannot have anything that would make it look as though patients are being confined/restrained, even when it would be safer for more bed rails.

peace & CYA
t

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…is your father compos mentis?
That depends. He can carry on an intelligent conversation, drawing on long-term memory for appropriate responses. And at meals, he uses utensils, and doesn’t try to drink from the ketchup bottle or anything weird like that. But his short-term memory is almost nonexistent.

He doesn’t remember that the call button is there, much less what it’s for. Back when he was living at his house, he would fall and then be pleasantly surprised when the EMT’s arrived to pick him up. He didn’t remember that he was wearing a medic alert pendant, and that it had automatic fall detection. Remembering to push the button, even then, was way beyond him. And that was years ago.

Mentally, he can’t multitask. If “answer nature’s call” is on his mind, he doesn’t remember that there’s even a possibility of falling, or that he could use help, or an escort, or buddy, or whatever anyone would call it. He feels like he’s 40 years old and can get to the bathroom and take care of business.

…joint/strength/balance/neuropathy issues? Maybe some PT?
He has strength and balance issues. As a matter of fact, his facility does offer PT, and he seems interested in doing that, so Sis is signing him up for it. The goal is for his mobility to improve so he can get around with a walker with only one person helping him, not two people, and that’s probably doable. (Assuming he cooperates long enough; last time he did PT he got sick of it and after several weeks refused to continue.)

But even if PT works as intended, it doesn’t solve the problem of his inability to get around by himself, and his inability to remember that he needs help. So it’s not a fall-prevention activity. At best, it forestalls the time when he becomes bedridden.

Doesn’t look like he’ll be getting a bed with rails.

Admin says “staff is pretty good at catching any changes in a resident that might be developing UTI,” and will have the in-house physician’s assistant follow up with Dad when he gets back. So, doesn’t sound like routine testing, but more like trying to establish things to look for in Dad’s case. My cousin said she could always tell when her mom had a UTI because she’d “get loopy,” which I hear is typical, but Dad doesn’t get loopy. Maybe he has other signs.

So: Dad’s feeling better and is scheduled to return to AL tomorrow. He’ll start PT, and follow up with the PA regarding UTI’s.

And we’ll just resume taking things one day at a time, and hoping that falls remain infrequent, and that they don’t result in broken bones.

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My mom was checked into rehab 2 weeks ago, post surgery for a broken femur.

She was living alone prior, wasn’t she? Best wishes for a full recovery. Rehab-to-AL is a common path, and given your dad’s already in MC, it’d be a lot to also have to find a place for your mom.
Although, if it comes to that, it could work out. When my dad went to AL, it was a huge weight off my shoulders. It was becoming increasingly difficult to manage him (and his mail, finances, house) while he was in his house.

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DW’s fall in January turned out to be caused by low sodium (i.e. electrolytes out of balance) as
a result of her drinking large - excessive - amounts of water. Drinking large amounts of
water tends to be one of the ways to avoid UTIs.

I’d amend that slightly…it wasn’t as a result of her drinking excessive amounts of water, but of drinking a substantial amount of water without increasing her salt intake. And since you need available salt in your system so the added water can be absorbed and used—instead of just beingsimply exited at the other end without doing anything helpful.

When I’m going to have blood tests that my functional medicine doc has ordered, my instructions are to drink copiously the day before, with added salt, and to have a large glass of water in the morning before coming to the lab, with a tad of salt. Those should be standard instructions, though most docs ignore this.

=sheila

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I’d amend that slightly…it wasn’t as a result of her drinking excessive amounts of water, but of drinking a substantial amount of water without increasing her salt intake. And since you need available salt in your system so the added water can be absorbed and used—instead of just beingsimply exited at the other end without doing anything helpful.

Just reread my post, and I have to amend it! It’s not complete. My apologies. My concentration is pulled in too many directions. Finally found a good and responsive restoration company to do our post-Ida mold remediation and rebuild. (And it turns out that our building’s insurance policy will be covering most of it—thank goodness!!!) So we’ve been going through everything in our downstairs, and throwing away/recycling/donating everything we don’t need/seriously want to keep. Our daughter came in from Paris for 10 days to pitch in and organize, which she’s amazing at. And so much had been accumulated in the almost 34 years we’ve lived here. Plus I’m trying to schedule cataract surgery (wanted it SOON but learned this morning that June 21 is the first available date) and my ankle replacement surgery. And there’s the frustrations and worries about my husband’s cognitive losses…which are nothing compared to Alstro’s situation, but…

So…this is how I’d intended to write it.

**I'd amend that slightly.....it wasn't as a result of her drinking excessive amounts of water, but of drinking a substantial amount of water without increasing her salt intake. Salt pulls water into the tissues, where it is used. When you significantly increase your water intake without also increasing your salt intake too, the added water will deplete your existing salt level, and any water not absorbed is simply peed out. So DW may not have absorbed enough water to help prevent a UTI. But she certainly depleted her sodium level, and got into trouble.**

=sheila

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"DW’s fall in January turned out to be caused by low sodium (i.e. electrolytes out of balance) as
a result of her drinking large - excessive - amounts of water. Drinking large amounts of
water tends to be one of the ways to avoid UTIs.

I’d amend that slightly…it wasn’t as a result of her drinking excessive amounts of water, but of drinking a substantial amount of water without increasing her salt intake. And since you need available salt in your system so the added water can be absorbed and used—instead of just beingsimply exited at the other end without doing anything helpful.

When I’m going to have blood tests that my functional medicine doc has ordered, my instructions are to drink copiously the day before, with added salt, and to have a large glass of water in the morning before coming to the lab, with a tad of salt. Those should be standard instructions, though most docs ignore this.

=sheila"

I’m trying to recall but I don’t think I have ever heard a doctor tell me to increase my salt intake.
DW’s problem came while I was in hospital and she was really worried. I suspect that she altered
her normal eating and drinking patterns but there is no way for me to tell for sure. She seems to
be doing much better and we are adding salt liberally.

Howie52

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I don’t think I have ever heard a doctor tell me to increase my salt intake.

My previous PCP, whose retirement coincided with the beginnings of the pandemic, had moved from a conventional to an integrative perspective over the years that I was her patient. And aspects of her knowledge base increased substantially, and some of her practices changed considerably as well. She began instructing patients to drink a lot of water for the day before and morning of a blood draw. She explained that if a person isn’t adequately hydrated when blood is taken for tests, some of the results may be distorted and appear higher than they really are. My integrative/functional medicine cardiologist/internist goes one step further, adding the bit of salt to ensure that the water doesn’t just go in and right out.

=sheila

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Sheila, wow, that’s a lot! Hugs!

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Update: Dad’s UTI is gone, but now he has pneumonia. Which shouldn’t be a surprise, given that he’s been lying very still for days on end to avoid the pain from his bruised ribs. So, another day, probably two, in the hospital.

I must stop catastrophizing. Saturday morning, I was convinced he had a broken hip, which would be a turning point in a bad way. Today, I’m thinking that pneumonia so often signals the beginning of the end, and feeling very anxious about that. But what good does that do? What will be, will be, however much or little I worry. There was a time when I was the caregiver and decision maker, and so it was important for me to anticipate all possibilities so I could be prepared to deal with them, but now my sister’s on site, and I’m not, so I should just let go and do stuff instead of mentally spinning my wheels.

Normally we Facetime weekly, but today Sis texted that Dad doesn’t want me to see him in the hospital and get upset and fly out there. :slight_smile:
So, OK. There were enough times when I was at his bedside when I was the one he told, “Don’t tell anyone I’m in the hospital, I don’t want a bunch of people to come running.”

Going for a walk now. I have some good books and magazines, but have trouble concentrating.

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I think you are wise to heed your sister’s info about your dad not wanting you to get upset and fly out.
None of us really can tell what is going to cause the final decline or what the circumstances might be. There are times we are surprised.

It’s normal for you to think about your dad’s medical situation and have trouble concentrating. Going for a walk is an excellent plan. Our thoughts are with you.

Robyn

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so I should just let go and do stuff instead of mentally spinning my wheels.

There are two kinds of logic here. There’s objective logic, which tells you that whatever will be will be, don’t obsess and twist yourself in knots. Then there’s emotional logic. He’s your dad, and though we know in our heads that the end will eventually come, when we suddenly see possible signs of that, it brings the realities of that loss to a viscerally real level. It is an inflection point in one’s life like no other. It’s an emotional boulder, and give yourself permission to experience it as it is. You are human. And that is part of being human.

In terms of no FaceTime for now, and your sensible reasoning…you don’t know if his pneumonia is a temporary blip or the beginning of the end. My thought is actually to get on a plane and make a surprise visit, hopefully cheering him up, and giving your sister some in-the-flesh support. And if he doesn’t make it through this, you won’t be torn with deep regret for having missed the chance to be with him. And if he does make it through, then it’s a nice gift for everyone, you included.

Good luck! It’s not easy decisions!

=sheila

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…the end will eventually come, when we suddenly see possible signs of that, it brings the realities of that loss to a viscerally real level…
True, and I recognize the phenomenon. Mom was touch-and-go for 18 months before she died. Dad’s had a few close calls already, when I was pretty sure he was a goner.

…permission to experience it as it is…
Thanks, yep, to a point. I don’t want to go down a rabbit hole. Especially repeatedly.

My thought is actually to get on a plane

I considered that, decided against it.

Real reason: I’ve been the go-to buck-stops-here person since Dad’s heart attack in 2003 until I moved cross country in 2020. I’ve done waaaay more than my fair share, and now I’m lazy.

Excuses:

  • Sis might see it as undermining, rather than supportive. She’s doing a great job as Dad’s advocate in the hospital; and I’m happy to let her take her turn.
  • It wouldn’t be “a” plane, it’d be two planes (so, 3 airports), and over 6 hours on airplanes, each way, during a pandemic which is still killing almost 1000 per day. Of course I’m vaxxed and boostered, but as someone over 65 whose booster was over 4 months ago, I prefer to be cautious a while longer.
  • Whenever I visit the AL place or a hospital, I get frustrated and angry about things they do wrong, regardless of how much they’re doing right. I’d rather avoid that.
  • If Dad imagines that my seeing him on Facetime would prompt me to jump on a plane, that thought probably brings him as much comfort as my actually doing it.

…if he doesn’t make it through this, you won’t be torn with deep regret for having missed the chance to be with him.
I’m not worried about that. I’ve long felt that how you treat someone day in and day out over the years is far more important than making a personal appearance at the end. I was with Dad a lot until visitation ended in March 2020, and have Facetimed weekly since then, send a greeting card at least monthly, etc. It’s not like I’ve restricted myself to phone calls while he sits there with no family.
I think the people with regrets are those who think “I’ll visit later” assuming there will be time, and are then surprised when time runs out. I’ve always felt time is short, and then been surprised when it wasn’t.

When Mom died, no regrets, just relief. I expect something similar with Dad, although of course I don’t know for sure.

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My thought is actually to get on a plane
*******************************
I considered that, decided against it.

Sounds like you’ve done a lot of good talking with yourself! :wink: And you’re reasonably (given the circumstances) at peace with your decision.

I hope he’s strong enough to recover from this bout of pneumonia, and return to his AL residence. And that the worst has been postponed.

=sheila

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