Hello:
I am working with a client who was diagnosed with Alzheimer's Disease
approximately 7 years ago. She has shown a steady decline in occupational
independence during the years but she has shown a significant decline in the
past month.
The family is 100% dedicated to keeping their mother at home.
The family reports, that about three weeks ago, the client was walking
in/out of the home with SBA. While outside, the client fell, apparently when
striking at a caregiver. Since her fall, she has shown tremendous decline in
her ability to walk, stand and transfer. Prior to the fall, the client would
stand in the bathroom while the family cared for hygiene. To day, the client
required max assist (X2) to stand. The possibility of a hip injury/fracture
remains, but all orthopedic x-rays were negative.
The questions I have are:
1. What are the likely causes of the client's recent decline:
a. Normal progression of the disease
b. Fear of falling/standing secondary to recent fall
2. Based on the above, or any other plausible explanations, what treatment
approaches will best facilitate this client to be able to increase her
participation in toileting and transfers.
Thanks,
Ron
P.S. I am seeing the client today and Friday and plan to make a decision
about which direction to take our remaining therapy. Should we continue
working on remediation of underlying issues or begin adaptive strategies to
decrease the family's burden and promote the client's safety
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