This is part of the article series in Tube Feeding due to Alzheimer's/dementia/dysphagia Resource page.
Elderly patients, if placed on an incline would tend to slide down on the bed. This is due to gravity, muscle weakness that causes them unable to support themselves in that position and feeling uncomfortable when placed in that position.
While we can tell and advice someone to be conscious and not to slide down, it is hard to reason with a person who have Alzheimer’s or dementia because they will forget what you say the next moment.
It is especially dangerous for a person on tube feeding or elderly with weak digestive system. They would need to remain upright (minimum incline of 30 degrees but preferably as upright as possible) for a minimum of 30 minutes after food. If not, reflux or regurgitation may occur when they cough or burp and food travels upwards. If it goes to the lungs, there is a risk of developing aspiration pneumonia.
How to prevent elderly from sliding down
Honestly from my experience, we cannot prevent them from sliding down be it in the bed or on when on a wheelchair. Sliding is the name of the game. My mom who have Alzheimer’s and is on tube feeding, notoriously just love to slide almost all the time.
I have to place my mom on an incline position all the time because she is on tube feeding due to dysphagia. Elderly who are on tube feeding must remain in the upright position. Also, due to dysphagia that developed from her advanced stage of Alzheimer’s, she usually could not swallow her own phlegm or mucus, nor spit it out. The tube insertion had created a lot of irritation on her throat resulting mucus production that requires daily phlegm suction. Still, mucus would build throughout the day and there is a danger of the mucus going to her lungs if she dies down flat.
Even though she is on the hospital bed and we can adjust the include at her hip and head sections, she would still slide down. So I definitely know how you feel.
While we cannot totally stop them from doing so, we can minimize the occurrence of sliding down by placing a wedge right below their butt on the bed or at the wheelchair. I bought mine from Mitex Carry Sheet (facebook https://www.facebook.com/mitex.carrysheet), a Thai based company. It is also known as an anti bed sore pillow as shown below:
By placing it below the butt, you can then raise the incline of the bed. I have the one above and another pillow that is less steep from the same company. I use the less steep pillow and position my mother’s butt on the seat of the pillow (meaning higher up than the picture above). Then I raise the bed incline.
The pillow would help to stop the sliding because it does not allow the hip to move beyond the point. But our smarty pants old baby may know how to go around this. For example, they may move their body so that they now sleep in another direction, ie in a diagonal shape. My mom does this if left to her own devices long enough.
Without the pillow or wedge, I had to keep lifting her up frequently, sometimes up to two or three times in 30 minutes. Which brings me to my next topic…. how to lift elderly who have slide down the bed.
How to lift elderly who have slide down the bed/ reposition to the top of the bed
The following video in Thai language provides many tips for lifting patients up in various positions. I have learned a lot from watching Thai videos because many of these videos are made for caregivers in mind who are taking care of the elderly at home. Hence consideration is given for single lifting and not everyone can afford a hoyer lift or a wheelchair with removable side handles.
I will start with 3 persons assist, then 2 persons, 1 person and finally my own way of doing it.
Reposition up the bed with 3 person assistance:
If there are many people in your home who can assist, then you can use the position described in the video above.
The three person places their arms in the location as shown in the screenshot from the video above. At cue, all three lift the patient upwards towards the head of the bed. This method is helpful if the person you are lifting is big size or heavy.
Reposition up the bed with 2 person assistance:
The video also shows how to do it with 2 persons’ help using a sheet (they use the bedsheet or towel as Thai hospitals do not use slidesheets):
First tell the person what would happen. Then roll the towel or bedsheet at the patient’s side.
Grip on the rolled sheet at the shoulder and hip level. Then on cue, both person lift up a little and slide upwards as shown below.
Tip: What the nurses taught me when my mom was in the hospital:
Sometimes, you cannot get the sheet under the person. If you need to lift the person quickly, the nurse taught me to hold on to the upper arm sleeve with one hand and the waist band of the pants/skirt with another. Each person hold one side- but must be holding the same position but opposite side. Meaning similar to the picture above, instead of holding up on the sheet, we are holding the person’s clothes. The bed needs to be flat. Then on cue, both person do the lifting and move upwards.
Advantage of this method is that it is very fast. And once you are good at it, on cue, you can even do like a sliding motion which requires very little strength and is easy to perform. However the disadvantage is that it would caused the person’s clothes to move upwards. And you need to be careful and ensure both person hold the same position on opposite end. If there is an imbalance, eg one person holding the sleeve and another hooking the elderly’s arms, it may cause the material of the clothes to eat into the skin of the elderly.
Special slider sheet made by Mitex.in.th:
I bought the following sliding sheet from Mitex.in.th (facebook page: https://www.facebook.com/mitex.carrysheet ). They have this carry sheet that is quite easy to use and can even be used to carry the person up from bed to wheelchair. In the video below in their YouTube channel, they demonstrated how to use the sheet to move the person up and down the bed with two or single person assistance. Do note that if you wish to contact them, even though the FB page is in Thai language, the person in charge can speak English (and his grammar is actually better than me):
That is why I feel fortunate as in Thailand, they make products and videos with the caregiver in mind. In Thailand, most of the sick and elderly are looked after by their families at home. Usually everyone chip in to help but during the day, while most are at work or at school, there is a dedicated caregiver, usually a family member. So a lot of videos are made with a single caregiver in mind. No hover lifts or something bulky and expensive. Often it is simple, functional and affordable products.
Reposition up the bed with 1 person assistance:
Most of the time, you may find that you have to do it alone. Example in the middle of the night where everyone else is asleep. Below, also a screenshot from the video, is how you can do it for single lifting provided the elderly person can assist:
Have the person lie down with knees bent and hands on the side. Place one hand below the shoulders and another below the hip. Then on cue, ask the person to straighten her legs as you move upwards. Both need to move at the same time.
Another video below where a slidesheet is being used and the caregiver moves the hospital bed down and then pull from the back:
My method for single person lifting:
This is something I discover how to do on my own recently. Prior to this, I have to get help all the time to reposition my mom upwards. Sometimes multiple times within 30 minutes. Now I manage on my own.
I will describe it the best I could.
Based on the picture above, first also flatten the bed and remove the pillow. If I am on my mom’s right side, like the nurse above, I place my left hand beneath the nape of her neck. Then my right hand is hooked below her right armpit in an upwards hook position. I stand at a ready stance facing my mom as per picture above with both knees bent. Then I bend both knees and tilt my body to the left (which is the direction towards the head of the bed). With this, I could slide her upwards without using much strength.
If I am on my mom’s left hand side, then it is the opposite. I would then place my right hand below the nape of her neck. Then my left hand would be placed below her left armpit and then I would bend my knees and move my body to the right direction.
Sometimes, I place one knee up the bed for leverage.
After that, I place back the pillow on her head and the anti bedsore pillow below her butt. Then raise the bed incline position of her head upwards. With this, I no longer need to go around waking people up when my mom slides down the bed.