Parents caring for the parent support thread (Part 1)

Reading the posts about joint replacements and alternatives with great interest. MIL has horrible, horrible arthritis in both knees and both shoulders. (Shoulders are worse see the moment but knees are noisiest) She’s in a great deal of pain with very limited mobility. Tramadol helps a bit but not much and she refuses anything stronger. The Ortho she saw a week or so ago is not a fan of stem cell therapy (although the Dr she saw before moving up here in May was). The current Ortho basically said joint replacement or status quo. We don’t think she’s strong enough for the surgery, or disciplined enough for the rehab. And she’s deathly afraid of complications affecting her cognition.

So, interested in more experiences others have had with alternative treatments for that…

Haven’t checked in to this thread in a while. MIL is somewhat adjusted, although it’s day to day. I just wish she had something in her life that she thought meaningful or joyful.

You may remember that after my mother had moved here (New England) from CA, she moved to Tucson. A big part of it was her arthritis (a form in her chest more than knees or other joints.) The humidity here was tough on her, as well as cold winters.

I know that it is time consuming for us and perhaps difficult and costly for our elders, but my advice is to first research alternative therapies and treatments as I mentioned in a previous post. Then make appointments with those specialists that will perform the treatment that you are inquiring about. If you consult only with an orthopedist that does cortisone injections and knee replacements only, then those are the alternatives they will recommend. Here is a list of treatment options: .healthline.com/health/total-knee-replacement-surgery/alternatives#physical-therapy

The treatment I mentioned for knees and joints in general is PRP, a form of prolotherapy. It is not stem cell therapy, just to be clear. It involves spinning blood to increase platelet content in plasma, and injecting it into the joint. The platelets are very rich and tighten things up while reducing inflammation. This may mainly apply to tendon issues, but research is being done on its effects on arthritis. For us, it has worked miracles and avoided surgery and extensive PT.

My brother and I took my mother to Vermont because my brother has acquired what used to be her second home and is renovating it. We had her look over some stuff that belongs to her (she was not up to this really so I made decisions). My brother bought her two nips of gin because she looked for gin in the house and there wasn’t any. Nips are 1.691 oz (liquor store told me!). First drink, she got tipsy, slurred speech, wobbly, and emotional but in a positive way. Second drink, worse. Then she lost count and wanted what she said was her “second.” We told her she had had two and we didn’t want to give her a third. She became vicious, telling us she wished she had different children and none of us cared etc. We tried distraction, explanation again of how it was her third (to no avail) and finally I had my brother put water over the ice and gin residue and she was satisfied with that. Quick change back to friendly because she didn’t remember being angry. This was like being in a tornado.

We are both shaken. Granted, being in a different environment and tired etc. might have played a role.

There doesn’t seem to be much help with this problem. I am going to try a respected psych. hospital’s geriatric unit for advice. Or maybe AA?

Clearly the alcohol is making dementia worse. Plus Lunesta, that covers half her 24 hour days.Not good.

Right now I am bringing her gin again, diluted 2 parts gin, one part water, moving toward 50-50. She isn’t noticing. I KNOW of course she has issues with measuring and remembering how many she has had. Objectively, she is NOT capable of dealing with alcohol in her room. We also witnessed her craving for more and more.

The time it takes to go through a bottle would seem to indicate she is having 4 oz a night. That is more than 2 drinks via the jigger I bought her but better than the 7-8oz she was having months ago. But too much.

Now, if I don’t bring it to her and she has none, she calls us 20 times a day and cannot have any conversation other than about gin. She gets angry and relationships with everyone tank. She goes into other residents’ rooms (sometimes with their consent after the fact, sometimes with them there) to get gin. She makes scenes in the pub.

With the gin in the room, she is pleasant, leaves other residents alone, doesn’t call, but stays in her room more- and falls. Yes, she has had one fall - no wounds- since I resumed bringing the (now watered down) gin.

I think abstinence would be easier. Would she forget about drinking the same way she forgot about nicotine gum? In the hospital she never mentioned it.

The problem is, that all AL’s have pubs and also residents drink in their rooms.

I cannot explain to her that she has dementia and her friends don’t. I have tried in a roundabout way. She has no idea she has such extensive problems (she says it is normal aging). There is no way to explain why only she cannot drink in her room.

Sorry to vent but this goes around in circles. Our goal has been to keep her in her apartment. I considered living with her, as I have said on here, but not a good idea. I am going to start looking at memory units because abstinence is possible there. More money and she would lose her apartment and friends.

Ugh. At a loss.

Oh, so sorry. I followed your previous posts about your mom, history of alcohol abuse, risk falls, and problems with AL, such a difficult situation. She is clearly an alcoholic and I think that if you tried to detox her in a detox unit it would be impossible to return her to the AL because of the pub and alcohol available. I think detox and a memory care facility is the best and safest option for her. Sending hugs.

Just brainstorming here: If you could find a safe and reliable way she could be provided her two gins a night, and no more, what would be the down side? Sounds like she is easier for everyone, including herself, when she gets the drinks.
Of course, it’s not healthy and it’s not good, but then she has dementia, so she really isn’t healthy and good. Obviously it is a much more destructive habit, but it reminds me of my mother and her ability to pack away cookies and candies and nut. She should be a 400# diabetic, but she is not and I figured, once Daddy died and she was in her late 80s, why admonish her to ‘eat healthy.’ I keep her fully stocked with all the sweets she loves and say more power to her, eat it up and enjoy it, and remain 100#.
I know the alcohol has much more serious ramifications, but in comparing them, if my mother was a complicated diabetic, she would still crave the sugar and I would have to balance her joy in the moment versus prolonging life versus the complications and damage they might do.
I hope that does not sound harsh, I have had these thoughts for some years as we tried to regulate the diets and habits of several seniors and I do wonder what the point of fighting it is, once, of course, you’ve avoided dangerous and painful, to them or you, complications.

If I can remember correctly, I believe her mom had several falls and arguments with other residents and with the Pub for access to more alcohol. Her dementia prevented her from remembering she was given her 2 drinks. They were watering down the alcohol in the bottle that was in her apartment. I would also worry that her mom would start to look for alcohol in her friends apartments.

She has been to detox. Upon return to the AL Wine Wed. and the pub got her back pretty fast.

If I don’t bring gin (and I am now diluting 50:50 with water) she becomes venomous, won’t talk to her children (except me because she needs me, but she is mean if no gin), makes scenes at the pub, and yes has already gone into others’ apartments. Her friends call me to tell me she has done that and say they don’t mind. One time the other person wasn’t in the apartment and my mother told her after the fact. I do NOT want other residents put in this position.

Somemom, you are voicing what many have told me-she is 91 and let her enjoy her drinks. I cannot have that attitude. The point is there is NO safe and reliable way to provide two drinks that are consistently measured for her.

  1. she cannot manage measuring
  2. she forgets how many drinks she has had
  3. she craves more anyway

This is the crux of the problem- not some puritanical effort to make her into a teetotaler.

If she makes a mistake, she falls. She is on Coumadin. Every fall creates literal hemorrhage and large wounds. The AL nurses are not allowed by regulation to treat these wounds but visiting nurse is not enough. Due to her congestive heart failure and edema the wounds leak like crazy.

The AL is going to kick her out if this continues. The experts I have talked to say that a good goal is to keep her in the apartment as long as possible.

She gets pretty tipsy after 1.5 oz. And she WAS drinking 7 + oz before detox. Then we got her down to two one oz. drinks in the pub. She would be okay with that. She would ask for more, forget she had had two, make scenes but many nights that was okay.

However the AL changed the policy so that residents could only have one in the pub and the handout and directors’ speech said that residents could choose to drink in their rooms. I asked about my mother and they said, sorry, we cannot write a handout for one person who is an exception.

The other issue is that with gin in her room, she stays there, watches the news, eats upstairs and isolates. She is in her room all day by herself. I myself feel that that is her right, and who doesn’t like to veg out alone? But I honestly saw some improvements when she was forced to go downstairs to the pub and then dinner.

Right now I am in a holding pattern with 50:50 dilution and avoiding bringing food so she has to go down to dinner.

She has had one fall with bruising since resuming in her room but no wounds.

My brother, who is a top notch lawyer and hardy as they come, is still upset by the weekend when he tried to talk her out of a third drink that she said was her second, and the venom that came his way. He said to her"You care more about gin than us."

Noone can think of a solution so we’ll see how this works. Thanks all.

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@compmom - I wish I had more than a virtual hug for you, but that is all I have to offer. I am so sorry you are dealing with this.

Thanks Hoggirl. Hope all is well with you and yours.

Ah! Well, then, getting kicked out of her apartment for her behaviour means this is not ‘harmless’ in terms of the effects on her. I wish they would let you pay the med aide to give her the booze.

Are there no AL facilities with memory care floors near you? That’s where we had to send my parents, though it looks like we may be moving toward the nursing home. My father is a fall risk (and refuses to use a walker or a cane), but my mother is a elopement risk. If they didn’t have a locked floor, she would be out the front door walking home. With her the biggest issue is candy. She eats it all in one day, if you let her.

Another virtual hug for you, @compmom. I wish I could do more.

Another virtual hug. I wish I had a suggestion @compmom. The only thing that worked getting my parents off the wine was moving to a location in which nobody drank. I will be the candy eating old woman.

I asked both the AL and MD if it was possible for her to get a med order for two 2, one oz drinks, in her room or the pub. Got a no. For one thing, aides aren’t allowed to distribute controlled substances and even alcohol might be an issue. The AL told me nursing homes will do this, though. I thought about meeting again with the doctor and getting the order anyway to see what the AL would do!

I really have tried everything from fake gin to labelled bottles for each day with premixed drinks to nips to no gin at all in her room to going to the pub with her myself. Unbelievable. The AL nursing director said in 30 years she has never dealt with a situation with an alcoholic + dementia (+ strong personality)>

I am embarking on a tour of memory units. That is clearly in the future and that way I will be ready if they kick her out or if we feel she is at risk in the AL. The memory unit in her current AL may not be the best option. They require me to take her somewhere for 2 weeks and then bring her back. I live in a small apartment and can’t see us going to a motel together for two weeks! Not sure why they require it - maybe so she forgets her apartment.

We would feel sad though, however inevitable this might be. She still likes to spend time alone in her apartment, watching news and sports on tv, and reading (How does she read? Is she really reading?). She has friends there and they sit together at meals. They take care of her (when she forgets that she ordered already). And the cost of memory care is much higher…

The truth right now I that my involvement is like private care and the AL is okay with her being there with me around. I do my art and tai chi classes, and try to keep boundaries and live my life but I do feel pressure to be there a lot so she can stay where she is.

What I do is nothing compared to those of you with parents at home with you though.

Thanks all. I have some ideas and you have been helpful. Going to start looking at memory units. Considering going to Adult Children of Alcoholics for suggestions (my brother should go too; I am no longer upset that she cares so much about gin but he is, I think). And if she notices the dilution then she will have to get one drink in the pub, that’s it.

Sounds like a plan, for now. Thanks again for advice and for virtual hugs!!

So I am not sure how I feel about this situation. Parents are in AL, dad has type 1 diabetes. At bedtime he is supposed to get sugar checked (and a snack if appropriate) and a shot of Lantus, a long lasting insulin. My biggest fear is him having a low blood sugar episode that is not recognized in time.

Mom tells me Sunday night she waited and waited for the bedtime meds but no one came and she fell asleep. Dad was okay in the morning. Mom is a little forgetful and could have gotten the story wrong I thought, but this worried me so I emailed the Dir of Nursing to ask if the shift nurse did forget dad’s meds. (It seemed so unlikely because it’s a small place and everyone loves dad and the nurses seem pretty on top of things)

The DON called today to say she was filling in as shift nurse then (staffing shortages are common in the industry). She was on the floor and she said mom was correct, dad did not get his check and Lantus. Insulin logs are kept separate from med logs (because a nurse has to admin them) and she thinks his page got attached to another patients and she did not notice. She apologized profusely and took full responsibility and said she would report the error (I guess that means something in the industry).

I know the regular shift nurse would remember to eventually find dad because he is one of the few T1 diabetics and everyone who works with him regularly knows how brittle he is. The vast majority of the time, dad’s sugars are in line and he is tested regularly enough that the staff knows when he needs food pronto.

The scary part of this is, if for some reason he was at 60 or 70 at bedtime that night, he could have gone into shock and possibly died if no one noticed or he didn’t recognize the low sugar.

The pragmatic side of my brain is saying that the staff are human and there are checks and balances and sometimes mistakes are made. I am very happy with the regular staff. I can’t think of anything else I can or should do but it did rattle me a bit. I honestly think something similar could happen anywhere, with the same slip in routines.

@surfcity nice that your place is honest. Sounds like DON is conscientious.

Sounds like that mistake won’t happen again.

When one has to staff for 24/7…

Below 40 is a more critical number; 60/70 if known about can bring it up with juice/cookie/crackers and recheck. Often the person is feeling fine and no telling sign of a low blood sugar. In the med drawer is probably a glucogen administration to bring a low blood sugar up more quickly.

@SOSConcern you would think there is a glucagon gun but dad’s expired and I have not bugged his doc for a new Rx! We do have tablets everywhere.

Dad used to give off classic signs - sweating profusely, acting grumpy or drunk, shaking, but since his brain injury, or due to his age, he now gives off no signs except occasionally weak legs if he is walking a lot. Today I was there at dinner and took him for his sugar check at 5:00 and he was at 50! I had no idea - mom is often able to judge how he may be based on what he had for lunch and if she saw him take a snack. They deliberately run him a little high, which everyone agrees is okay.

You are correct that the DON did the right thing in being straightforward with me. If she had hemmed and hawed and given excuses I would not feel as okay. She’s not my favorite person there but she normally doesn’t have much patient interaction so I can let that go.

@surfcity Maybe your dad’s dietary intake needs to be adjusted - more frequent snacks to keep his BS at more normal levels. Has he been on the same insulin - long acting and fast acting/sliding scale if needed?

Sometimes no rhyme nor reason why an older person’s BS varies so much.

At our facility, we have several glucagon injection kits, and last time I remembered one being used was with a relatively new rehab resident.

If he walks a lot, maybe he needs extra food at meal or snack time.