96 YO Mother fall questions

New news just now. Mom's PT therapist just called. I've known them for many years as I've had PT there after joint replacements and spine surgeries. This is the first I've talked to them in over a year. She was concerned about mom's recent BP and her explanation of her visit to the hospital for it and related stuff I've talked about here on this forum.

My main point today is her BP at yesterday's visit. Mom had 48 for the bottom number. I can safely say in the ten years or so I've been privy to her vital signs, she's never below 70. There's a possibility she took too many Clonidine tablets in the hours before her PT visit. I know based on her BP machine records, she took a pill during the night (4:30 AM), then took her normal dosages at about 10AM. I spoke to her about it last night in person and she couldn't recall why she took the 4:30 AM pill.

We also discussed the possibility of having Mom's driving tested. They have recently added driving testing to what they do there. It looks like something good may come of it... she stops driving.

Otherwise, Mom seems good today. Her long time PT therapist also told me she tried pitching the "First Alert" to her. Mom refused anything like this.

I'll be checking her meds soon to see if there's a better way to keep track of her system. My wife has been confident that Mom's been putting the right pills in the right container and the scripts are up to date. I think there's something to be learned here.

woojr, excellent care. If I knew your mom, I'd tell her to refuse the driving tests at the physcial theapy office. And rely on the DVM.

@woojr There is a difference between putting the right pills in the right containers and remembering to take them at the correct time. There is also a fine line we walk when the kids or grandkids need to become the caregivers. It is hard to know when to take action with an independent adult - you want to respect dignity and autonomy, but is there a limit?

We had the med issue with our Mom, and it got serious quickly as she was also on coumadin to prevent further blood clots. She also had some impairment in understanding the passage of times after a stroke. Suddenly, after years of stable BP and INR, her readings were all over the place, she fell...Long story short, we began to find pills around her apartment, in sweater pockets, rolled under furniture.

Mom was only in her mid-eighties, and still pretty active in her apartment community. Although she fought it, we took over preparation of her meds, and whoever stopped by to visit checked to be sure meds were taken. When that still didn't work we paid for med supervision by the on-site nursing staff. (This was a continuum of care building and she was still independent at that point - except meds.) If it happened today, I would get one of the pill dispensers that sound an alarm and open each door at the correct time.

We had the same struggle with LifeAlert, until she took hers off one time, it was out of reach after a fall, and it was over 12 hours before my brother found her. She was so badly frightened that we never had to argue again. Hers was a discrete bracelet.

Back to when is it time to insist, if ever?
It seems you already know your Mom's mindset, that she wants to stay in her home and die there peacefully instead of being uprooted at this time in her life.

If there is no hope of changing her mind, then you just resign yourselves to being caregivers and being on call 24/7 for the rest of her days. And you and your wife and any others need to have a plan on how to do this, and what will happen if one of you no longer can. But you can insist on some conditions.

Driving might be a big one, especially if falls and dizziness become more frequent. An independent driving assessment is the right way to do it. They are also trained to determine if she can get some extra training to make it safe for her to drive yet.

If you believe her mind might be changeable, one or two of you need to compile a list of incidents that have happened over a short time - a month or two? Then sit down with Mom and express your concern - maybe over coffee and her favorite dessert.

Then ask the HARD question - "Do you want to take steps that will let you live longer safely, or do you just want to stay in your home and keep doing what you are now?" Point out that if she chooses to "take steps" they will be in her own time and with her input.

If she chooses not to make changes, and has a bad fall, her doctor and hospital will be forced to refer her for protective services if in their opinion she is not safe at home. Then she will be at the mercy of the system, and you as her family will have to scramble on short notice to find a place for her.

Also be honest about what you and your wife and any other family members can do now and into the future to help her.

I have friends who have just gone through this, or still are, with parents who are in their 90's or over 100. There is no easy way! My sister and I were in your shoes for over 5 years after my Mom's first stroke. There is nothing easy about it, but it is the greatest gift you can give your Mom and yourself IF you can do it.
Bless you for all the thought you are putting into this!

@woojr , that’s great news that the driving may stop. I’d keep in mind that if she harms others she (or her estate if she doesn’t survive)could be subject to legal action as well as family members who knew of her risk and didn’t prevent it. You can check with an attorney in your state to confirm this.

Does your mother have an Advance Medical Directive? That helps make it easier to enforce her wishes. Some people want to focus more on quality of life than quantity. It seems your mother has had both.

I recall determining my dad was not taking his meds correctly, though he protested and showed me his log book. I wrote down the date they were filled and how many he had left….and it was way off. He hadn’t gotten some refills in over a year! So….I took over the meds management. He was livid and a big deal. But my mother and I insisted. It was a huge ordeal. Undoubtedly, it extended his life, but he had dementia and I wonder if that wasn’t necessarily a good thing. Talking to a senior about being more careful with meds isn’t usually helpful. The only way to make sure is to have someone else administer it. There are devices that you program and they open the slot at a designated time and announce take this pill now. But, there is no way to ensure the patient will follow the instruction.

My dad eventually had very low pressure (bottom number 35) and was taken off BP meds. It can cause weakness, dizziness and falls.

@gently I thought I would agree, but then I found that OT has some therapists that work with drivers to make them safer. We are making an appointment for an evaluation to make my husband more comfortable in his car (stroke survivor).

@celia16 Yes Mom has advance directive. As far as auditing her pills, my wife has been checking her numbers and says she's been okay. I have a process when I call her, which is now at least twice daily if I don't see her, that includes questioning her about all the daily necessities. Like eating, BP, how do you feel, sleeping, bathroom use, itching, and whatever i say usually ends up pissing her off because I cross examine her on something.

I was just talking to my wife about a device automatically meting out the right pill and keeping a record. This thought led me to start searching "latest AI technology for adults." I just started a few minutes ago and it appears there's opportunities there. I'm not a tech guy but I think the falling and can't get up has a future.

As far as her BP, she's always searching for supplements instead of just taking her pills. Her philosophy has been, if one is good, a dozen is better.

@patient101 What gives this course credibility is she trusts the women working at her PT. She's been going there for a long time. First, they'll be honest with her. They relate well with older folks and have decades of experience. I think Mom would respect their reasoning. Also, I think the owner is getting nervous having her drive to and from his business. There are schools nearby and if she runs over the children, he's probably going to be liable in some fashion since they record a lot of her shortcomings. She wouldn't want to stop PT.

@woojr Excellent. Can you attend the PT?

@sueinmn Wow, great message. It's my wife and me in this and we've had our foot in the water since she had a stroke about ten years ago. I realized back then there would be a time when it would be her or me. A couple years ago she was scammed and I got the police and every other government agency involved that I could apply to. I saved her many, many thousands of dollars only because she forgot I was her POA after she'd had a stay in a facility recovering from an almost fatal UTI. With the help of her bank and the police and her financial guy, she finally cooperated to stop communicating with the scammers and changed all of her contact information. She hated me for at least a year. She believed she won the Publisher's Clearing House Sweepstakes and I cost her five million dollars. I've dealt with some hard issues and tried to remain sane through it. I have stories and records of the not so good times with mom.

I've been very direct, blunt, to the point with what she needs to do to remain in her house but ultimately, she lives in a world she controls. I've had it rammed down my throat and if some authority can remove her from her house, I'll believe it when I see it.

So about doing for her in the future. I figured out the most important part some time ago. It's trying to remain sane and forget that we have any semblance of a right to our own lives as our years dwindle away. If my wife wasn't an angel, I'd remember the hell it's been at times. But now, for some reason mom seems to trust me a bit. Maybe it appears I'm nibbling around the reality of this matter. The reality is.... what's next? I'll tell you. She just told me she's taking her car to get it inspected. It's a 15 mile drive. Last time (two years ago), she drove to the inspection station but didn't tell me because it failed. There was a dealer about a mile away from her house. She gets it serviced there and drives by it regularly. I told her the dealer can do the inspection after she told me about it failing. Trust me, it gets worse.

Summed up, as @celia put it "that's great news that the driving may stop." At this point we take what we can get. So that means I'll get to take her car for inspection since I know I have no other choice. Trust me, I can ask hard questions, the problem is I'm usually asking myself.
Thank you for your help.

Suggestion if the OT, or PT, report shows a need to stop driving but your mom wont follow these recommendations -

See if they can suggest training that may improve these specific skills, and plan on re-testing in 3 months to see if there is an improvement. If there is no positive change you have more information that shows this is more of a permanent loss of skill. Even if mom doesn’t listen, it will help you to know how to proceed with the next step.

The OT will probably evaluate vision, cognition (memory, attention, judgment), and physical skills (range of motion, reaction time) needed for driving. If she is driving somewhat successfully at this time, she may pass the memory and range of motion sections. Reaction time, quick judgements and field of vision may not be 100%. The OT may be able to provide therapy that could improve these, maybe.

It is very difficult, painful, and a strain on relationships ( yours and your mothers, and, yours and your spouse’s relationship because of the time and burden of decisions this involves). But I get it, what else can you do? Been there, done that.