Welcome to Caring for Mom Blog Site
This is a blog with topics of interest to most caregivers of older adults. As a Geriatric Care Manager, I have a breadth of experience working with all kinds of different situations with older adults. This blog is an attempt to share some of the information and experience that I have acquired. My education includes a Master's in Gerontology from Webster University. I have also worked in managed care and in a residential care facility. If there are any topics you would like to see covered, please feel free to comment or contact me.
Diane M. Keefe
Geriatric Care Manager
Recently, I attended a Grief seminar and learned many strategies for helping someone who is grieving. Older adults fit this category as they are often losing spouses, friends, careers, social status (when they retire), financial status and the list goes on. Seventy-five (75%) percent of all deaths occur in persons 65 or older. Many of my clients would lose a spouse or have a health incident that they could not get past. They would become stuck and could not live their life in the present. They stayed in the past.
Grief is experienced differently over the life span. Research has shown that the early parent-child attachment bond is crucial to determining how easily a bereaved person moves through the disorganization phase of the grief and into the reorganization phase of the grief process. It is important for the bereaved person to experience the pain and process it as well as to establish the meaning of the relationship with the deceased. Sometimes, they must be nudged to increase functioning in the present and to develop hope for the future.
Loss/grief is experienced in the left side of the brain. One of the ways to help someone through grief is to engage them in right brain activities such as art projects, crafts, poetry, singing and other creative endeavors. They are still processing their grief while doing these activities and it activates their pleasure center. Women tend to express their grief verbally and through journaling. Men experience grief differently. They may do a project or go out for a night of male bonding. They are more private and less expressive. Exercise, meditation, yoga, tai chi and other forms which utilize breath and physical exertion will help in processing grief.
Learning how to relax the sympathetic nervous system is a key factor in processing grief. During grief, the sympathetic nervous system is activated. This starts the fight or flight response. The person feels tense and cannot relax. They are in their left side brain. When they switch to a right-side brain activity, it activates the parasympathetic nervous system which is the relaxation response. It is the more creative, holistic, intuitive, visual and sensory side. When a person is grieving, they are stuck in the left side brain but when they are in a creative activity, they free themselves from the grief temporarily allowing them to process.
If you become aware of someone who has recently lost someone dear to them, check on them frequently. Some people withdraw and stop eating. They need people around them. This often happens during the illness and funeral arrangements but after everyone leaves, reality hits. Set up a phone tree schedule so they are getting regular contact. Bring food to make sure they are eating or invite them out to eat. Social interaction is extremely important. If they seem to be withdrawing, find support groups in the area and accompany them to the first meeting. If that doesn’t improve the situation, set an appointment with a grief counselor. Some people need to talk about their relationship with the deceased and to process with a professional who will help them take steps to rebuild their life.
If you ask a younger person what happens during aging, they have no idea. They may describe graying of hair or wrinkling of skin. Aging is a very personal experience. Not everyone ages the same and not every organ in the body will age the same. Some people may look young and live life with gusto. Others may look old by the time they reach 50 years of age. Sixty is usually the age at which a person is described as mature or aged. The largest demographic of our population is the 85+ segment. In the past, most people did not live much after 50. Today people are living into their hundreds. It is changing the way we will live our lives.
Aging occurs from the time that we are born. After 30 years of age, the blush is off the bloom. Here are some of the changes which occur for someone over 60 years of age: 1) loss of height; 2) gradual deterioration of muscles with age including those in the shoulders; 3) the diameter of the hips increases with age; 4) elasticity of the lungs decreases requiring more effort to breath; 5) total body water declines to about 54% in men and 46% in women; 6) there is a decrease in muscle mass; 7) Major organs show loss of mass; 7) Movement becomes more difficult as joints stiffen and muscle strength lessens; 8) The exchange of oxygen and carbon dioxide in the lungs becomes less efficient; 9) Changes occur in the heart muscle and in the walls of the arteries; 10) The digestive system becomes less efficient causing necessary dietary changes; 11) There is an increase in the frequency of urination. 12) Medications are not absorbed as well. These are just a few of the changes that take place. Men generally increase in weight until their middle 50′s and then gradually lose weight. Women tend to continue to gain weight until their 60′s before beginning to lose.
To live a fulfilling and quality life, the old adage ‘Use it or lose it’ is apropos. The brain uses 20-25% of the oxygen in the body and must be pumped from the heart. What is good for the heart is also good for the brain. Exercise, eat healthy, nutritious meals and stay socially and mentally engaged in activities that promote well being and continued learning. If you stay involved in life and have rewarding relationships, you will most likely live a long and healthy life. Enjoy your life, share your talents with the community, enroll in your local community college to expand your mind.
Here are a few statistics for you to ruminate upon…the average lifespan for a male is 74 and the average lifespan for a woman is 79. By 2030, 21% of the population is projected to be 65 and over. This means that the average retiree of 65 years has 15-25 years left. In the past, the first stage of living involved growing up and figuring out how to become independent. The second stage meant finding a mate and reproducing. Today there is a third stage after 50 in which older adults can live and give back to their communities. Many are following passions that they could not do when raising their families. Aging is being redefined.
Hoarding is described as the collecting of belongings to the point that it interferes with living and relationships. My mother hoarded after my father passed away. She had had a few mini-strokes (TIAs) and it may have damaged the center of her brain in which decision-making took place. As a result, she grew more and more cluttered and more depressed. She apologized every time we visited because there was not a surface on which to sit or eat. In the end, we moved her to an assisted living center where she was able to remove herself from the clutter. She felt better immediately and we helped by monitoring her small apartment to make sure it stayed under control.
However, there are other reasons why people collect so many things. It is typical that hoarders are most often women, especially empty nesters. During the time they were raising families, they were required to do the acquiring of food, clothing and other necessities for their families. Later, when everyone has left the nest, those impulses to shop continue. One author has found the hoarding happens across the economic spectrum and has a link to emotional deprivation and the amount of warmth expressed in the family during adolescence. This is not a modern phenomena as it has been chronicled throughout history. It may also be linked to ADHD and Obsessive-Compulsive Behavior.
Hoarders cannot throw anything away. It is important that family members not dispose of their belongings behind their back. Instead, counseling is recommended. The therapist can help guide them to a plan where they are in control. One neighbor owns several houses. She lives in one but uses the other to store her belongings. It has become a safety and health issue as it attracts creatures. Most hoarders have lots of interests and cannot bear to part with their belongings either because they think they may need it again or because it brings back memories of fond times. Many seniors who grew up during the Depression era have those deprivation fears so they keep things they may need in the future. Many have kept clothes from their childhood.
If you are concerned about a hoarder, go to The National Study Group on Chronic Disorganization. They have compiled a five point Clutter-Hoarding Scale to assess potential clients. If pathways are blocked; books are stacked to the ceiling; piles are causing a fall hazard and the carpet has been unable to be vacuumed in a long time, it may be time to seek a professional or do an intervention. Assure them that they are loved and appreciated and ask the therapist how to best support them during their therapy.
Hoarding
A stroke happens when a blood vessel is blocked or clogged preventing oxygen and nutrients from getting to the brain. When this happens, cells die. There are two types of strokes: 1) Ischemic strokes occur when blood clots in the vessel because of fatty deposits which may also travel from another part of the body. 2) Hemorrhagic strokes occur when blood vessel bursts and bleeds into the brain. Sometimes the pressure caused in the brain tissue results in injury. Without oxygen, brain cells cannot function and they die.
What are your risk factors? If you have high blood pressure; smoke cigarettes; have diabetes; have high blood cholesterol; are overweight; lack physical activity; suffer from artery disease or heart disease; experience TIA (Transient Ischemic Attacks) mini-strokes; or have abnormal heart rhythms, you are at risk for strokes. If you experience mini-strokes, it is predictive of having a major stroke in the future. If you are experiencing symptoms, do not wait. Call 9-1-1 immediately. If symptoms can be controlled within one hour, most damage can be reversed. If a person waits, the damage can be permanent.
What are the effects of a stroke? The effects of a stroke can vary. The brain is the control center for the body. Depending on which part of the brain is damaged, a stroke can cause problems with movement, speech, vision, memory and behavior.
These are the warning signs of a stroke:
- Sudden numbness or weakness, especially on one side of the body
- Sudden confusion; trouble understanding or speaking
- Sudden trouble seeing
- Sudden dizziness, difficulty walking, loss of coordination or balance
- Sudden severe headache with no known cause
What can you do to prevent strokes? What is good for the heart is also good for the brain. Twenty to twenty-five percent of the oxygen in the body is used in the brain which has to be pumped from the heart. A good brisk walk or low impact exercise is extremely important to keep your brain and heart in good health. Sometimes injury or illness changes the way you exercise. Yoga, Tai Chi and water walking are wonderful forms of low impact exercising. Secondly, eat a low fat and high fiber diet. Keep your weight within reasonable boundaries. Read; do crossword puzzles; play Sodoku or follow the brain exercises offered on a number of websites including AARP. Do not sit in front of the TV all day in your lounge chair. Keep actively engaged socially. Studies have shown that those who are actively involved in community and social activities age well. Drink alcohol in moderation (1 drink for women, 2 drinks for men). Do not smoke. Follow your doctors orders and take your medication correctly. Know your numbers and keep them in line. You will have a great chance of aging well.
First off, my best suggestion is not to travel with someone having dementia. They prefer to be in places where they feel familiar and comfortable. Sometimes, however, there may be family gatherings or a trip to visit children or grandchildren.
Let me share a story of something that happened with my mother. My sister came from Colorado to visit with the family in Toledo, Ohio. She wanted to visit my other sister in Tiffin and decided to take my mother with them. They stayed in a hotel in adjoining rooms. In the middle of the night, my mother got up and walked outside the room. She became disoriented and didn’t know what room was hers, what her name was or with whom she came. Consequently, she ended up at the front lobby desk in her PJs. They figured out who she probably came with and called the room. My sister and her husband came to get her and after that they couldn’t sleep because they were afraid she would leave the room again.
Here are some pointers to make your trip go more smoothly.
- Take scented body lotions to rub and soothe when the person is distressed. Lavendar scent works well.
- Have all clothes labelled with the person’s name
- Call the Alzheimer’s Association and order an ID bracelet which can be used to identify them if they wander.
- Also order a door alarm from the Alzheimer’s Association because the person may exit the door at night when they become confused about where they are. It will end up giving you more peace of mind and better sleep.
- Take a nightlight that you can use to help identify the bathroom.
- Bring music that is soothing.
- Bring pictures of loved ones.
- Notify the front desk that a person with dementia is staying with them and give them a picture of the person with identifying info.
- If travelling in a car, be sure to stop frequently for rest stops. Pets often offer a lot of comfort to someone who is travelling.
- Make sure they stay hydrated by offering water and other liquids.
Finding the Caregiver who is a good fit for your loved one requires much scrutiny. Write down what times you need to have covered and what you expect them to do. What types of qualifications do they need to have? For instance, if you need someone to administer medications or insulin, you will need a private duty nurse. Many home health agencies have companion services. This is an individual with minimal training who is there to make sure meals are cooked and eaten; medications are taken on time; laundry is washed and light housekeeping is done. Sometimes, they will provide transportation for the older adult to the grocery store, bank or beauty shop for an extra charge. When care gets to the point of needing assistance with transferring from one place to another; taking blood pressure or helping with toileting, a CNA (Certified Nursing Associate) is required. Also, check with a nurse to see what assistive equipment can be put in place to aid the mobility of the older adults.
What qualities should you be seeking? They should demonstrate respect for the dignity of the older adult, patience; exhibit a warm and caring attitude and show interest in getting to know their interests. Someone who just sits in front of the TV and acts like a babysitter does not provide socialization or mental stimulation which older adults need. They also need to understand boundaries, meaning that they do not pry into personal business or talk too much about their personal problems. That only adds to the emotional burden the older adult already feels and, sometimes, they feel compelled to help them. When the older adult begins to lend money, there is a problem with the caregiver. Bringing a stranger into the home of a vulnerable older adult can open the door to many problems. Do a criminal check on the individual and check with your state’s family registry.
How do you keep a check on how the caregiver is doing? First, have the caregiver keep nurse’s notes about what happens during the day. Second, privately talk to the older adult about how things are going. Sometimes the older adult resents having their independence intruded upon by having someone else in the house. They will try to actively sabotage the situation so be cautious about believing everything they say but also be observant. Third, make unannounced visits to see what is taking place. If the caregiver brings someone over without prior approval, that is a red flag. If things begin to disappear, that could be a red flag. Do not allow caregivers to pay bills or handle banking transactions. That should be the responsibility of a trusted family member or Power of Attorney. Some family members have installed cameras to monitor how things are going.
What activites should be taking place? Suggest places that the caregiver might take your loved one within his/her capabilities. Plan at least one activity for them to look forward to every day. Ask the caregiver to read the paper to them. The caregiver can involve the older adult in activities around the home like baking bread or cookies; setting the table; planting flowers; organizing closets, etc. Music can greatly improve the mood of all individuals. Dancing, walking in nature for fresh air or participating in chair exercise will contribute to their mental clarity and physical well-being. Reminiscing over photo albums or talking about life during certain periods of the older adult’s life will bring out their memories. You might suggest writing their memoirs or writing a letter to their relatives about wisdom they would like to pass on. Learn about hobbies they used to enjoy and see if it is possible to reinterest them. There may be some modifications that need to be made to make it easier for them to participate. Take them to adult education classes. Many universities will allow adults 65 and older to audit classes (no grades) for minimal or no fee. Older adults who stay interested and active lead more positive and healthy lives.
Getting seniors to drink water is very difficult. Tea, Coffee and sodas do not count. As a Geriatric Care Manager, I have accompanied many seniors to the hospital and watched multiple staff members try to draw blood out of a dehydrated senior. The veins are flat and it ends up being a painful experience.
Seniors also have to go to the bathroom more than others. It may be one of the reasons they do not want to drink water as it adds to the number of times they have to visit the bathroom. If they have a problem with urinary incontinence, this can add to the problem. However, not enough liquids can contribute to urinary tract infections which are very common in older adults.
To encourage seniors to hydrate, have water available in an easy to use drink container. Home health or family caregivers can offer the individual water on a regular basis. Make sure beverages are not sugar laden or containing caffeine as caffeine acts as diuretic. It is not important that they drink large quantities but that they drink small amounts on a regular basis.
Since water keeps everything moving in the body, it will contribute to overall health and aid in having regular elimination and bowel movements. It may also contribute to clearer thinking. Keeping an elder hydrated will preserve their overall well-being.
Depression can be experienced as a result of many different factors and during different age groups. Older adults are inclined to experience depression as a result of losses of a partner or loved one, divorce, physical illness, change of financial condition, and so on.
Professionals will test to discover the cause of the depression. If it is physical, it could be caused by sleep apnea or other sleep disorders, neurological conditions such as Parkinson’s or Huntington’s disease, stroke, vitamin B1 deficiency, thyroid conditions, autoimmune conditions, infections or cancer and requires a medical doctor’s care. Depression may also be caused by sudden changes due to divorce, loss of a job, discovering that one has Alzheimer’s disease, major illness that limits mobility and other social changes that may upset a person’s sense of self, autonomy and security. A therapist or psychiatrist may be called to assist the person in managing their depression. Successful aging requires that older adults be able to adapt to changing conditions.
A person with dementia may also exhibit depression. Depression can make a person seem demented. An older adult with dementia will lose both short and long term memory. A depressed person will only exhibit short term memory loss. Distractibility or lack of concentration is common in persons with depression. Sleep disturbance is seen in both depressed persons and those with dementia. Another change common to both is appetite changes except a depressed person may be aware of the changes and a person with dementia will not have noticed. In addition, both depressed individuals and persons with dementia may experience grooming changes. A depressed person may not be motivated to groom themselves; a person with dementia will not care and may forget how to groom themselves.
If you have observed someone needing to be helped, refer them to their doctor first or call Behavioral Health Response 314-469-6644 or 1-800-811-4760, a mental health hotline available 24/7 with counselors available to speak with you. You may also call the Mental Health Association of Greater St. Louis at 314-773-1399 if you need information or referrals.
When you notice depression in a loved one, first eliminate any physical conditions that could be the underlying cause. Then seek assistance as depression can cause physical illness over time and the person will have a low quality of life. Depression needs to be addressed sooner rather than later. Exercise, good nutrition and positive thinking can go a long way toward encouraging good mental health. However, if medications are prescribed and they are not working, have your doctor try something else and get counselling. Sometimes having someone listen intently brings clarity to the person talking about their challenges.
I’ve found a great website for finding all kinds of assistive devices to help older adults. It is www.parentgiving.com. Check it out!
Geriatricians specialize in older adults and the aging process. These medical professionals are in tune with the changes in the older adult that can affect medications administered. Geriatricians work toward prevention and preservation of the condition of older adults but are also aware that aging cannot be cured unlike typical medical professionals who ascribe to the “medical model”. Geriatricians will perform cognitive assessments and look for signs of dementia so that they can prescribe medications to prolong the functioning of the older adult. They will monitor the gait of the patient so that physical therapy can be prescribed to keep the older adult mobile. Geriatricians tend to be more attentive to older adults because they genuinely like older adults and chose to work with them in this profession.
Case Managers are normally social workers who assist the older adult patient in a facility such as a hospital, rehabilitation center or residential facility. Their job is to facilitate all of the patients needs while in the facility. This may include monitoring insurance benefits, arranging therapy, chaplain services and discharge planning after the patient leaves the facility. Their responsibility stops once the patient leaves the facility.
Chaplains are available in residential care facilities and in hospitals to assist families and patients in dealing with illness and the repercussions of illness. They also work with death and dying issues. They can be an invaluable support to the patient and family. Often the patient will open up to the chaplain when they cannot talk to family members about their feelings and desires.
Geriatric Care Managers can be nurses, social workers, physical and occupational therapists and gerontologists. Select someone with the background that is needed to match the needs of the older adult. Geriatric Care Managers will assess the physical, cognitive, psychosocial, legal and financial condition of the older adult and develop a Care Plan to address the unmet needs of the person. They are available to accompany older adults to medical appointments and monitor for changing condition. Because they are the advocate for the older adult, they can often speak on behalf of the older adult with family members who are pushing for a specific course of action that may not reflect the desires of the older adult. They will also offer alternatives and explain the normal outcome of certain decisions or courses of action.
Hospice professionals are invaluable in supporting the patient and family with end-of-life issues. They offer comfort measures for the patient so that the highest quality of life can be attained at this time. They offer counseling for family and patient regarding death and dying. In addition, they offer continued support to the family after the death occurs. Hospice takes place in the facility or at home. The hospice nurse will treat the patient when a minor physical ailment occurs but no extreme measures are taken to keep the patient alive.
In summary, geriatric professionals can make a significant difference in helping family caregivers get through difficult times. Their experience and knowledge can offer caregivers the alternatives and likely consequences of actions. Geriatricians are specifically trained to work with older adults. Case managers will guide care and discharge plans in a facility or hospital. Geriatric Care Managers advocate for the individual. Chaplains and hospice professionals help both family members and the patient deal with end of life issues. Knowing how to work with these professionals will ensure your loved one’s care will be the best it can be.
