Dr. Hive - my mom fell, twice for "no reason"

[Ginevra]

Can you help me think this through and understand what might be happening? Mt mother is 71 and has advanced Parkinson's Disease. She walks with two canes and has poor balance. A few months ago, she reported that she "fell," but insists that she neither tripped nor passed out. She describes this as, "I don't know what happened. One minute I was standing and the next, I was on the ground." This doesn't make any sense to me without at least some momentary loss of consciousness. Maybe the break in kinesthetic awareness is so quick that she doesn't realize it, but I don't think a person can just fall suddenly without loss of consiousness for at least a second or two.

 

She just had another such fall, Wednesday. She fell backwards and hit her head on the wood floor very hard. She "doesn't feel good" and is "tired." She did not go to church yesterday (hardly ever misses church) and said she can't come to my Dd's graduation tonight. I told her she probably has a concussion, but she blew it off with a "maybe." She said she went to the doctor and told him about the fall, but apparently he didn't do/say anything insightful about it.

 

I am worried about these "falls" and I am also worried that she is not getting competant care or she isn't being truthful about what the dictor is saying/doing. What do you think?

[Guest]

My first thought would be to wonder if she is having mini strokes? I know several people that have had them...my gpa and the lady I caretook for, and they had little to no symptoms after the fall. They were both very tired for a day or so, and the doctor wasn't really able to determine anything because they were fine by the time they were seen the next day.

[zoobie]

Suggest she get checked for a UTI

 

Would she let you go with her to an appointment? Who's her medical PoA person? Might be a good time to get all of that set up if it's not already. My stepmother cares for her mother who has advanced Alzheimer's (she lives with them). Her sister has PoA and won't sign anything over to my stepmother. So she emails the doctor with concerns, the doctor emails the sister, and eventually stepmother gets in on the information. It's the most insane setup ever but has been going on for 7+ years. Anyway, don't do that. But you can call her doctor to relay concerns even if doctor can't tell you anything.

[trulycrabby]

Quill, I am sending you a pm.

[PrincessMommy]

It could be mini-strokes or heart issues.   My mom went through a period of falling (sounded similar to what you mom described).  It took a long time to figure out she needed a pacemaker...and sadly, by then some damage had been done.

 

The only reason why they found it is because she was in the hospital getting stitched up after another "fall" and she had a heart episode then. 

 

It all sounds very similar to what was happening to my mom.  Lack of good care...not sure what my mom was really telling her doctor.. getting passed around.  It didn't help that she had some heavy meds in the house and we all suspected she was self-medicating. 

 

hugs and prayers that you find some helpful answers.

[TrixieB]

Do you know for sure that she went to the doctor?  And that she told him/her exactly what happened?

 

Would your mom agree to allow her healthcare information to be released to you?  Would she allow you or another family member to accompany her to appointments, and into the exam room when necessary?

 

To me, this scenario seems unlikely:

 

Elderly person, who is an established patient of Dr. X, and is known to have existing health issues and poor balance, falls twice.

Patient tells doctor about recent fall, stating that she hit her head hard and doesn't feel well.

Doctor brushes it off.

 

If it really played out this way, IMO it's time for your mom to find a new doctor.

 

[Guest]

Suggest she get checked for a UTI

 

Would she let you go with her to an appointment? Who's her medical PoA person? Might be a good time to get all of that set up if it's not already. My stepmother cares for her mother who has advanced Alzheimer's (she lives with them). Her sister has PoA and won't sign anything over to my stepmother. So she emails the doctor with concerns, the doctor emails the sister, and eventually stepmother gets in on the information. It's the most insane setup ever but has been going on for 7+ years. Anyway, don't do that. But you can call her doctor to relay concerns even if doctor can't tell you anything.

My dad is still here, so presumably, it is him. But it is a good point to think about. She would let me go with her. I cared for her when she had breast cancer, so I am in the loop with her medical issues better than my other sibs.

[Catwoman]

I'm so sorry about your mom, Quill. :(

 

I remember that years ago, one of my aunts had Parkinson's, and as it progressed, she took more and more falls until it was no longer safe for her to be without someone to watch her 24/7. She was so weak. It is an exhausting and incredibly stressful job, and is honestly too much for your poor dad to handle. He could end up hurting himself trying to prevent her from falling or from trying to pick her up off the floor. Also, the mental strain must be awful for him.

 

Does she see a specialist for the Parkinson's or is she still seeing her regular doctor?

[trulycrabby]

I was going to send a pm, but am in a rush right now and will have to send it later.

 

I know quite a bit about Parkinson's Disease. Falls are extremely common with PD, partly because it is a movement disorder and the person cannot react fast enough once a person gets off-balance, and two, because the small, shuffling steps are likely to make the person trip over his or her own feet. Doorways and narrow spaces are especially problematic as they trigger the tendency to "freeze up," meaning this person is unable to move for several seconds. "Freezing" can easily make a person lose his/her balance and fall.

[Suzanne115]

I would be very concerned about mini strokes.  Before my dad had a bad stroke, he had been falling down a lot.   I wish we had known about mini strokes and their symptoms.  I'm sorry she is going through a hard time and you are too.  Health issues can be so stressful.

 

Suzanne

[Guest]

Before I even read this post I thought of my mother with PD. They have trouble with their gait. It does not surprise me at all they might have trouble walking and thus, fall. I don't know if the canes are enough. Would a walker be better? My mom had a fall a few years back that was quite bad. She had to have hip surgery and injured her thumb as well. It has not been the same since. She cannot grip the walker, etc properly. She continues to wear things, do OT, etc. I would urge your mom to consider another way to get around. I cannot imagine trying to juggle two canes. My mom is in a wheelchair a lot, but is too weak to move it herself and does not want an electric (she could not operate the hand control, anyway).

 

What kind of doctor did she see? I suspect she did not see the right dr. I mean, maybe she downplayed the fall, but it alarms me. Was it the neurologist she saw? I would guess you see them because she hit her head. Not sure.

 

My parents are not satisfied with mainstream doctors/solutions but they go to the dr for things like that. I think some PD patients are weak. Of course a lot of times hips break, then you fall (not the other way around). I would make sure she figures out a safer way to get around. You don't want to risk more falls. My mom had to stay in a physical rehab place for weeks after that fall.

She has a neurologist whom she sees on a regular basis; he manages everything with the PD. I don't know who she saw when she fell last, but I doubt it was the neurologist. I think it would be extremely negligent if a neurologist did not follow up with that.

 

I expect she is very resistent to using a different walking support inpart because their home is so cramped and hard to maneuver. It wasn't huge under the best of circumstances, but my parents also tend towards hoarding, so walkways are cramped and difficult.

 

I am sure it is stressful for my dad. He is not in great health, either, and he is not a tower of emotional strength. This is why she stayed with me after she had her mastectomy. (Which is not to suggest that I am a tower of emotional strength! Just a bit more than my dad.)

[fraidycat]

If I were you, I'd probably insist that my Mom make an appointment with her neurologist and attend the appointment with her to make sure she is not downplaying her symptoms.

[MyThreeSons]

My Dad had Parkinson's.

 

Two thoughts: As someone else mentioned, it seems likely to me that these falls could be caused by "freezes". If your Mom is in the process of taking a step when a freeze occurs, she could be off balance at that moment in time, but unable to do anything except fall. A walker would help tremendously. There are several types available, many of which will fit through standard-sized doorways, and easily fold up to fit in a vehicle. 

 

MOST IMPORTANTLY: Please be sure her neurologist is someone who specializes in working with PD patients. All neurologists know about PD, but not all are especially tuned in to working with PD patients and their caretakers. You want someone who is fluent in PD. 

 

Best wishes to you and your family.

 

[Luckymama]

No advice, just a big :grouphug: for you!

[Guest]

I don't know if you can make time, but I would suggest helping them declutter or at least rearrange things for safety. My parents moved to another home and had one or two safety bars put in the bathroom. Things are still difficult for them with Dad lifting Mom a lot. They finally got some outside help but it is mainly to give my dad some freedom a number of hours a week. Would your parents allow outside help?

Not if it costs any money. They are poor as can be.

[Catwoman]

Not if it costs any money. They are poor as can be.

Will Medicare or their health insurance cover anything at all?

[KungFuPanda]

The fall doesn't seem unusual. If you have issues walking, and you take an uncertain step, and you are unable to balance yourself quickly and properly, the only option IS to fall. Before my son was in a wheelchair, there were lots of instances of him just falling suddenly. It's not that strange when your ability to walk is compromised. Just think how many times a misstep or stumble would become a fall if you didn't have the muscles or reflexes to correct yourself.

[hornblower]

You know, I think the problem with falls in seniors is that they're so common that people shrug them off - even people in the medical profession who should know better.

but for seniors falls are also the main cause of hospitalization, injury & becoming invalids.

Maybe it's because we have subsidized health & senior care, and therefore we have a vested interest in keeping our seniors healthy & mobile & independent for as long as possible, but we have a whole chunk of public health dedicated to fall prevention.  Have a look at the prevention strategies they identify for community living here: http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/index-eng.php#s4-2-1

I do think it should be taken very seriously. I think I would encourage a thorough review of her medications, check of blood pressure, check vision, check for signs of TIA's.

Clean out the house clutter, check her shoes, check mobility aids, check exercise & fitness & consider some physiotherapy in case changes in disease progression require some changes in body mechanics &/or building up some strength in areas.

I'm not above scaring people a bit into some sense. One bad fall & broken hip can mean the end of living independently & having to move to a care facility. 

 

[Guest]

Will Medicare or their health insurance cover anything at all?

I have no idea. I'm not even sure how I would find out something like that or how I would pursue getting any type of home care help.

[Guest]

The fall doesn't seem unusual. If you have issues walking, and you take an uncertain step, and you are unable to balance yourself quickly and properly, the only option IS to fall. Before my son was in a wheelchair, there were lots of instances of him just falling suddenly. It's not that strange when your ability to walk is compromised. Just think how many times a misstep or stumble would become a fall if you didn't have the muscles or reflexes to correct yourself.

I don't think falls are unusual. It's the odd way she's describing them that alarms me. If you trip or stumble, you know this. If you feel dizzy and fall, you know this. It's her insistance that she did not trip, that she "doesn't know what happened," her belief that she did not faint, that concerns me.

 

Even the fact that she fell *backwards* is alarming to me, because I recall hearing that falling forwards is the natural tendency if one faints or stumbles. How does one fall backwards on a flat surface with no idea what caused the fall?

[Katy]

I agree with all of the above.  She should be checked for concussion, UTI, TIA, and just general worsening of her Parkinson's. 

 

If it's Parkinson's (and that's possible, it is a progressive degenerative disease) It's probably time to switch to a walker and declutter for safety. Eventually she will need a wheelchair.  She may benefit from physical therapy, both to help her adjust to using a walker more safely and with balance exercises (depending on the stage of Parkinson's).

 

It might be time for you to look into what resources are available, in terms of medicare, etc.

 

ETA:  can you or a sibling start going to the doctor appointments with her? 

[gardenmom5]

Can you help me think this through and understand what might be happening? Mt mother is 71 and has advanced Parkinson's Disease. She walks with two canes and has poor balance. A few months ago, she reported that she "fell," but insists that she neither tripped nor passed out. She describes this as, "I don't know what happened. One minute I was standing and the next, I was on the ground." 

She just had another such fall, Wednesday. She fell backwards and hit her head on the wood floor very hard. She "doesn't feel good" and is "tired." She did not go to church yesterday (hardly ever misses church) and said she can't come to my Dd's graduation tonight. I told her she probably has a concussion, but she blew it off with a "maybe." She said she went to the doctor and told him about the fall, but apparently he didn't do/say anything insightful about it.

 

I am worried about these "falls" and I am also worried that she is not getting competant care or she isn't being truthful about what the dictor is saying/doing. What do you think?

 

I'll start with - when I had pneumonia, one second I was standing looking at the mail, the next I was on the ground.  it happened that fast. 10ths of a second.  I felt myself falling, and never lost consciousness.  I don't recall having felt anything that would have explained why I collapsed.  I was surprised to find myself on the ground.

 

My mother had an increasing number of falls, while there is one she may have blacked out (and it was the last one before I said "enough" and took over things), most of them she definitely did not.  she had TIAs (mini-strokes) which do cumulative damage to the brain (they did not always result in a fall).   the frequency of falls increased over time. 

 

did your mother tell the dr she "didn't feel well", or "hit her head going backwards"?  It may be time to take over talking to her dr. about what is going on with her because you can't be sure she's given all the pertinent information.  are you in the same general area?

 

Costco has a good price on the 'seated-walkers' that also have hand-brakes.  it would be more stable than two canes.  believe me I know how hard it can be to get them to use something to help.  I had many disagreements with my mother wanting to allow her her dignity but still keep her safe, until the day came I told her she didn't have a choice anymore and started taking over her medical care and talking to the drs themselves. 

[Daria]

My mom, who is a similar age but doesn't have Parkinson's had a couple falls like that, including one where she broke her pelvis.  It was hard to get the medical professionals to take it seriously. That is, they took her broken pelvis seriously, but saw it as "sometimes the elderly trips".  Eventually, she was diagnosed as having low blood sodium and they gave her medication that works for about 8 hours out of the day. 

 

Now, after the pelvis she's very very shaky on her feet, but before the falls she was fine, so I think that new Doctors who see her think that the shakiness caused the falls, but from my perspective it's the other way around. 

 

It's probably a long shot, but I'd ask about blood sodium.

[gardenmom5]

since other's have mentioned TIAs, let me say a few things.  (my mother, my grandmother, several of my grandmother's sisters . . .  - my mother was an only child or it is highly likely a sibling would also have had them.  I consider myself at genetic risk.)

 

TIAs can last from mere seconds to 24 hours.  then symptoms will disappear.  the damage to the brain is cumulative.  in the early stages it is very difficult to diagnose and there is no apparent damage.  there isn't much for treatment.  however, eventually the damage becomes too great for the brain to recovery and there is a reduction in function.  it can start to be detected as damage builds up. physical symptoms that increase over time are feebleness, confusion, falls, and dementia.

 

I would also urge a med check.

[Guest]

You know, I think the problem with falls in seniors is that they're so common that people shrug them off - even people in the medical profession who should know better.

 

but for seniors falls are also the main cause of hospitalization, injury & becoming invalids.

 

Maybe it's because we have subsidized health & senior care, and therefore we have a vested interest in keeping our seniors healthy & mobile & independent for as long as possible, but we have a whole chunk of public health dedicated to fall prevention. Have a look at the prevention strategies they identify for community living here: http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/index-eng.php#s4-2-1

 

I do think it should be taken very seriously. I think I would encourage a thorough review of her medications, check of blood pressure, check vision, check for signs of TIA's.

 

Clean out the house clutter, check her shoes, check mobility aids, check exercise & fitness & consider some physiotherapy in case changes in disease progression require some changes in body mechanics &/or building up some strength in areas.

 

I'm not above scaring people a bit into some sense. One bad fall & broken hip can mean the end of living independently & having to move to a care facility.

 

 

What are TIAs?

 

I agree that falls are a serious concern. My friend's mother died from injuries sustained falling down stairs. All these things you are recommending are very logical and sensible, but they won't happen. The dynamics behind things like their cluttered home, lack of money, doggedly pursuing medical answers - they are all very problematic. My mom is very defensive about the state of her house. She is weirdly religiously superstitous; she can barely call a disease by name. She behaves as if she will not elect to pursue medical help, although with the cancer, she did as I "made" her. her dental health is a catastrophy but she is not doing a thing to address it. Money. Denial. Fear.

 

*sigh* I don't know what to do and I wish I had normal parents.

[gardenmom5]

  Eventually, she was diagnosed as having low blood sodium and they gave her medication that works for about 8 hours out of the day. 

 

Now, after the pelvis she's very very shaky on her feet, but before the falls she was fine, so I think that new Doctors who see her think that the shakiness caused the falls, but from my perspective it's the other way around. 

 

It's probably a long shot, but I'd ask about blood sodium.

 

I've a friend whose husband was so excited to find out he had low sodium.  since conventional wisdom is the elderly need to cut salt, his intake was way too low.  he got to increase his salt and have things as salty as he liked!  ;-p

 

Not if it costs any money. They are poor as can be.

 

I don't know about where you live, but here there are services for low-income seniors that will help with basics and food.  My mother didn't qualify so she didn't use them.  (and she fought tooth and nail about bringing in outside help.)

[trulycrabby]

Okay, I tead your original post several times; the first time I read it I didn't realize she had fallen backwards. As disturbing as falling backwards seems, it is a classic Parkinson's symptom. I think she needs a walker instead of the two canes because a walker would keep her weight shifted forward just enough to keep her from falling backward.

 

It sounds like your mum doesn't want to talk about her falls or medical care. She very well could have had a concussion, and we really don't know what the doctor did or didn't do because we just have her word for what happened. Not that your mum isn't truthful, but she might be afraid of losing her independence and is reticent to share information with you. Or, she could be experiencing some cognitive decline, which can happen with PD.

 

If possible, I would start going with her to at least some of neurologist appointments. The neurologist should be a movement disorders specialist if you live in a city big enough to have one.

 

If you haven't already done so, you might read a few books on PD to learn more about the disease and caregiving for a person with PD. The Michael J. Fox Foundation is a wonderful site for information: https://www.michaeljfox.org/

 

Hope this helps! :grouphug:

[Katy]

TIA stands for Transient ischemic attack, it's more commonly called a mini stroke.

 

Here's the Mayo Clinic details:  http://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/basics/symptoms/con-20021291

[hornblower]

gardenmom5 talked about tia's above - transient ischemic attack aka mini-stroke

http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/TIA/TIA-Transient-Ischemic-Attack_UCM_310942_Article.jsp

your situation sounds difficult. Sometimes the best thing we can do is nothing. Help was offered & help is available but if people won't take it, you have to let them falter and fall on their own terms. There's a tremendous pressure on children to help their adult parents but if the parents don't want it, or the relationship is difficult, it's ok to just step back & live your own healthy, happy life.

[MyThreeSons]

Now, after the pelvis she's very very shaky on her feet, but before the falls she was fine, so I think that new Doctors who see her think that the shakiness caused the falls, but from my perspective it's the other way around. 

 

My beloved adopted Grandma broke her hip when she fell as she took the last step down a flight of stairs. The orthopedic doctor who did the hip replacement surgery told us that he was of the opinion that in many older people, it's not the fall that causes the fracture, but it's the fracture that causes the fall. 

[MyThreeSons]

I have no idea. I'm not even sure how I would find out something like that or how I would pursue getting any type of home care help.

 

A few places to start:

 

A local Parkinson's Disease support group. The people in the group will be excited to share information with you. If you can't get to a meeting yourself, join an online group -- there are some on Facebook, for instance.

 

The local public library. Ours has free copies of a publication that has tons of information for seniors.

 

Her doctor. There should be someone at the doctor's office who can point you in the right direction.

 

The county social services department. 

 

Her insurance company. 

 

A local nursing home or assisted living facility. Even if she's not yet ready for that, they will have resources to get you started. 

[Carol in Cal.]

You've already heard the top two things that popped into my head--Parkinsons' freeze, and a TIA (mini-stroke).  For the second, it is very important that she get a carotid artery scan.

 

Another thing that can cause that kind of fall is an absence seizure.  Sometimes people become epileptic in their old age (I have a relative like that) and start to have brief periods which they don't recall in which their brain stops functioning briefly.  If they are sitting down, they might not even realize that anything happened, but if they are standing they will fall.  Others need to describe the symptoms to the doctor for this to be taken seriously.  A brain scan is then done.

 

Another thing is a drop in blood pressure from standing too quickly or from medication that produces lower than normal blood pressure, even from OTC meds like Sudafed or blood thinners.

[Mabelen]

Another vote for it is Parkinson's disease. My dad had it and he too would fall like that. It may be time to find a better mobility arrangement.

[matrips]

My 86yo mil has fallen like that before, and is very aware of medical issues. Her husband was a doctor and she a nurse. She does have a pacemaker but otherwise in excellent health. She takes tai chi to help with balance. She does say that she has to keep moving when she stands though, even just shuffling feet and moving, and can't stand for too long. If she does, she faints and falls down. I can't remember the reason why this happens, but it does. Could you see if your mom happened to be standing for awhile before falling? Maybe it's something similar?

[Melissa in Australia]

:grouphug: