Tips on caring for elderly relatives

Tips on caring for elderly relatives – Dynamic Aging: Part One

As the proportion of persons over age 65 in Canada climbs from 11 per cent at present to an estimated 24 per cent by the year 2031, it’s essential to provide more and better care for those needing assistance. The vast majority of older people are “well” elderly who remain healthy into their 80s (even 90s), often needing little or no help. Given safe household organization, social involvement and an active lifestyle, many of the well elderly can go on living at home to a ripe old age.

Regular medical exams can ferret out physical disorders that need treatment — such as incontinence, failing vision, osteoporosis, arthritis, Parkinson’s disease and depression. In Canada, the elderly must also learn how to overcome the hazards of winter living!

Family and friends (“informal caregivers”) do most of the

caregiving

According to experts from the University of Toronto’s Centre for Studies on Aging, “the ability to keep frail older people out of institutions rests mainly on the backs of relatives and friends, who provide about 80 per cent of needed assistance to the elderly in Canada.” those looking after the elderly can enlist varied services — home support agencies, visiting nurses, aides, physiotherapists, social workers, homemakers, social clubs and Meals on Wheels — which help to maintain a senior’s independence.

Maintain independence as long as possible

Surveys show that seniors fear the loss of independence and admission into long-term care facilities above all else. The spectre of reliance on others is upsetting; even losses such as no longer driving a car can be hard to accept and may be resisted long after it is unsafe to do so. Anyone looking after older people must recognize their intensive anxiety over the loss of freedom and respect the wish for continued independence. The average age of entry into geriatric institutions in Canada is 82, but we tend to over-institutionalize our old people. About seven per cent of elderly citizens in Canada reside in long-term care institutions (excluding those occupying senior citizens’ apartments and retirement homes), compared to only five per cent in the U.S. and U.K, and four per cent in West Germany. Large numbers of the frail elderly occupy Canadian hospital beds, many awaiting transfer to long-term care facilities. (Other countries, such as Britain, have fewer long-term care hospital beds and shorter or nonexistent waiting lists.) “In effect,” notes one University of Toronto geriatric expert, “we warehouse rather than rehabilitate our elderly. Yet given the know-how it is often quite possible to support them at home rather than in a nursing home, by making full use of multi-disciplinary services and suitable housing arrangements”.

Better community services, transportation and social activities are crucially required to help make aging more dynamic and successful. Geriatricians seen an urgent need for more varied living arrangements suitable for seniors. Supported housing (with centralized care available), retirement homes, or innovative boarding arrangements (e.g., a live-in student who gives assistance in return for a room) can help seniors remain independent. To this end, municipal governments are urged to relax zoning by-laws to permit accessory apartments, garden suites or other residential options that help families care for aging relatives. High and low tech devices can prolong the ability of frail seniors to stay at home — for instance vital function monitors, surveillance devices for wanderers or emergency alarm systems — but they are not well enough known, readily available or easily affordable.

When the condition of an older person deteriorates to the point that relatives can no longer cope, a full investigation of all possible institutional options and a thorough discussion of the choices is advised. This will help to reduce and possibly eliminate resistance by the elderly person and relieve the caregiver’s inevitable feelings of guilt and doubt. When the time comes, institutional care will be more pleasant if close ties are maintained, making sure seniors still feel part of the family by taking them on outings, sharing a meal, sending letters or gifts and providing clean laundry or new clothes.

Never do for the elderly what they can do for themselves

It’s a common mistake to expect incapacity in old age. But there are wide variations in the abilities of older people. A healthy, vigorous 85 year old may require far less support than an ailing 55 year old. It is vital to distinguish normal physiological changes from treatable disorders. Older persons and their caregivers often fall into the trap of “ageism” erroneously attributing disabilities to old age, adopting a resigned, fatalistic attitude instead of seeking help. Many seniors suffer needlessly from preventable or reversible ailments such as vision deficiencies (wrong glasses, cataracts), arthritis, incontinence and depression. Declining capacities often stem from poor diet, insufficient exercise, lack of stimulation, over or under medication or self-defeating expectations. Medical conditions are rarely a direct result of aging and most can be alleviated by sound medical advice and good community support. Yet many elderly people don’t consult a physician, under-report or self-treat symptoms because of embarrassment or fear of losing their independence — known as “avoidance behaviour”. (Geriatricians talk of the iceberg of disability: for every elderly person who seeks medical advice, many more suffer in silence.)

Compare the different situations and needs of three people in their 80s. The first is 85 year old Mrs. Smith, with two daughters living in the same city, who is somewhat forgetful (remedied by reminder calls or notes). Because of a worsening heart condition, she no longer goes for walks, finds it hard to vacuum, shop and climb the stairs. Fearful of losing her independence, Mrs. Smith doesn’t mention the heart problem when her daughters urge her to be more active. They believe she’s just stubborn and ‘set in her ways”. However, a visit to the family physician reveals the heart failure, medication is ordered and a visiting home care program arranged to monitor blood pressure, cardiac function and medication use. As a result, Mrs. Smith can safely go on living at home. By contrast, Mr. Jones who is 89, lives alone with no relatives nearby, has no heart or other medical problem (except a touch of knee stiffness due to osteoarthritis) but eats poorly, can’t be bothered to cook for himself and grumbles about his loneliness. All he needs is some encouragement to eat better (perhaps by arranging for Meals on Wheels) and to become socially involved, maybe in a geriatric day program. The third example, 80 year old Mr. Waleska, has oncoming dementia due to Alzheimer’s disease. He is confused, irritable, extremely forgetful and a frequent wanderer — often lost and brought home by neighbours or the local store owner. Independent living is no longer a safe option for him. After a family conference, his children jointly take on the costs of long term care.

Use all available support and community services

Caregivers should investigate and use all the supplemental support they need or can afford from community, government, nonprofit and private home support services. It’s wise to enlist simultaneous help from several organizations such as senior’s health centres, day hospitals, out-patient medical and psychiatric services, hospital-based home care, geriatric day centres, community and social clubs (e.g., “Second Mile” or “Senior Link” in Toronto).

* For housekeeping help: Visiting homemakers will clean the house, prepare meals, shop and do laundry. Provinces and municipalities may subsidize services.

* For personal hygiene: A private or non-profit trained helper, suggested by a physician or other healthcare professional, may come in to assist an elderly person with bathing, dressing, eating and some homemaking activities.

* For safety, to alleviate and summon emergency help if needed: Telephone security checks may be organized. A volunteer, friend or neighbour may telephone seniors each day and if there’s no answer, initiate emergency procedures. Many hospitals or private organizations supply electronic devices such as beepers that alert emergency units if seniors need help. Building superintendents may keep a watchful eye; letter carriers may check on seniors daily in some communities.

* For social needs: Many clubs and senior day programs offer companionship and rehabilitative activities. Studies show that social support benefits health — even support as simple as someone to chat with, to share the occasional meal, provide companionship or attendance at religious services.

* For food: meals on Wheels will deliver hot meals in many areas.

* For medical disorders: Some healthcare services provide multi-disciplinary assessment teams (of nurses, social workers, physical and occupational therapists, recreation experts, physicians, dentists, audiologists, dietitians, respirologists, speech therapists and others) to offer advice and help. Therapeutic, educational, social and recreation programs may be provided, with cost sometimes covered by provincial healthcare plans. Home care visits may be arranged for those who qualify under Ministry of Health guidelines. Geriatric day care or home care programs (sometimes funded by provincial agencies) have many advantages over hospital stays. Pioneering efforts include New Brunswick’s extra-mural hospital or “Hospital Without Walls” which provides hospital care at home, British Columbia’s Quick Response Team (in Victoria) and the Regional Geriatric Program of Metro Toronto ( affiliated with the University of Toronto).

Ways to avoid institutionalization include:

* Granny flats (zoning requirements permitting): self-contained, portable units temporarily installed on the property of relatives with single family homes (not too successful so far).

* Accessory apartments: where part of a family member’s home or an added room is converted to create a small, self-contained unit.

* Group homes: (such as Abbey Field Homes in Britain) where people share th expenses, staff and management of a common home and communal rooms such as the kitchen and living-room, while retaining their own bedrooms and possibly bathrooms. Jointly hired staff can help with or provide cooking and maintenance. (Consult local health departments).

* Foster care: where elderly persons who cannot live alone move in with an unrelated family that provides meals and personal care for an arranged fee.

* Home sharing: elderly home owners with extra space may take in tenants who give housekeeping help in exchange for reduced rent.

* Supported housing: residences within a neighbourhood or a section of an apartment building, or specially designed multiple-unit buildings, that provide elderly people with self-contained units connected to a central administration area by a call system. Residents usually come together for some meals and social activities.

Encourage activity: it can make people act and feel

younger

Although regular exercise can make one feel (even look) younger, many seniors are slow to don sneakers. Reduced cardiovascular function, muscle wasting and bone loss are no longer considered a natural part of aging, but a result of inactivity. Yet only about one-fifth of the current elderly population is physically active at a level that upgrades heart health. Studies confirm that the elderly can greatly improve their quality of life and perhaps ward off osteoporosis by regular weight-bearing exercise. A brisk walk gives a good workout, provided it’s done at the right pace and for at least 20-30 minutes, three times a week. (Getting a dog often gives seniors an extra incentive to walk!? For those who can’t walk, swimming and stationary bicycles give a good work-out. Regular activity improves lung capacity and weight control, and may help to lower blood pressure and decrease blood cholesterol levels. A recent U.S. study demonstrated that eight weeks of regular exercise in those over age 65 increased muscular and cardiovascular strength. One University of Toronto expert says that “even in their 70s, some people can push their functional ages back by as much as 20 years by regular exercise, the gains showing up as more efficient cardiovascular function (hearts able to pump blood with less effort). Exercise also enhances the ability to cope with stress, offsets depression, facilitates sleep and enhances appetite.” Recent studies show that exercise may even help to keep the brain in shape. A 1989 study comparing cognitive (mental) scores in a group of elderly people who exercised with those who did not, found both mind and body performances better in exercisers than in the inactive.

Promote good nutrition — it is often overlooked

Nutritional requirements in old age roughly parallel those for other adults, although after age 50 fewer calories are required for each decade. But some of the elderly are malnourished because of poverty, physical disabilities, multiple medications, social isolation and a natural decline in smell and taste which reduces appetite. Widowed or single people often lose interest in preparing meals for themselves. Difficulties in mobility, seeing and chewing may make it burdensome to prepare and eat food. In particular, older people must remember to eat high quality, easily digestible protein such as fish, chicken and eggs. Getting enough calcium is also essential, to reduce the risks of osteoporosis. Besides milk, good sources of calcium are canned salmon (eaten with mashed bones), milk products — such as yogurt and cottage cheese — and some green vegetables such as broccoli. Since chewing can be difficult for some, especially those with ill-fitting dentures, they may prefer soft, pureed foods, but should choose meat, vegetables and fruit rather than ready-made combination dinners or soups. Be sure to round out the meal with starches such as pasta, potatoes and rice. Dehydration is another risk for the elderly who should remember to drink enough fluids. Vitamin and/or mineral supplements may occasionally be prescribed for older people, but only after a thorough medical assessment.

Keep tabs on medications

Over-medication, inappropriate prescribing (doses not properly geared to the elderly) and harmfully interacting drug combinations can compound rather than ease the disabilities of aging. Most drugs are tested in young and middle-aged adults and standard drug doses may endanger older people who metabolize the same drugs differently. The World Health Organization (WHO) and other agencies have issued guidelines for prescribing drugs to the elderly:

* no drug should be used if there is an effective and reasonable non-pharmaceutical alternative (e.lg., physiotherapy or behaviour therapy);

* a medication should not be prescribed if it is only marginally useful;

* pharmacists should be consulted to avoid drug interactions.

Thorough medical/physical check-ups advisable

Successful care of the elderly means distinguishing the so-called “normal” changes of aging from those due to underlying diseases that can be treated. Besides ongoing therapy for chronic, long-term conditions (such as diabetes, arthritis), medical exams permit early detection of newly developing conditions (such as low thyroid function or vision loss). During medical vists, the elderly shouldn’t remain passive but discuss any worries about their health or treatment. Make a list before-hand and report any abnormal occurrences, pain or discomfort. Even a seemingly small or meaningless symptom may give clues to some underlying disorder. Caregivers can act as affirmers or advocates, helping to overcome language difficulties and explain things, but should never assume the role of “parent” or exclude the elder from the discussion. The elderly person and caregivers should disclose any and all symptoms and bring along all medications being taken. Enquire about the medications prescribed — what they do, how they act, whether they have side effects and about possible non-drug alternatives. Those worried about an aged person’s ability to live alone or the extend and appropriateness of medication can ask the physician how best to manage the situation. Referral for specialized geriatric evaluation helps to reveal the overall picture. Geriatricians stress the need for house calls by family physicians, particularly for the frail elderly, to permit assessment in the home surroundings. A house visit might reveal hazards such as an unsafe bathroom 9danger of falls), a poorly lit staircase (more risk of falls), unopened pill boxes (failure to take prescribed medication), a hidden whisky bottle (explaining alcohol-induced dementia) or the inability of a seemingly competent 80-year old to use the telephone (memory loss due to Alzheimer’s disease).

COPYRIGHT 1992 Strategic Inc. Communications Ltd.

COPYRIGHT 2004 Gale Group