A friend of mine recently asked about what to bring someone in a nursing home who “had a breakdown” following the death of the partner. One of my replies was; “bring yourself”. Aging doesn’t grant us immunity from depression, life happens and we suffer losses. These situations often lead to feeling blue or depressed. That would be true for any age group. However, our society equates age with being depressed. We need to advocate for a change in that viewpoint.
Why do older people often seem depressed?
When these things occur, does medicine consider treating the depression? More than once I have heard medical personnel begin their discussion with the words, “Well this person is elderly.” Age is a stage of life, not a disease. A person who suffers from depression is no different than a person who suffers from anything else. We should be looking for the causes at any age. Patients who receive treatment for depression do better on recovery from physiological conditions than those whose depression is ignored.
Depression can lead to other losses. Another senior told me his friend had finally married a long-time girlfriend. He had a heart attack and they got a divorce. The senior did not see the connection but I did; an untreated depression could have contributed to the marital problem.
What about antidepressants? Sometimes they work and sometimes they don’t. Medications are tested people who are under age 65. If your senior is 75, 85, or 95+, they are in a different place physically than they were earlier in life. Think about this in terms of yourself. Consider your age, and think back 30 years. What were you doing? How was your health? What was your energy level? Are you the same as you were then? Why do we expect medications to work the same way on seniors who might be 30+ years older than the test group? Thus, it was no surprise to me that the friend in the nursing home also had “struggled with her antidepressants”.
What about other forms of intervention? A senior who has lost a spouse might benefit from Cognitive Behavioral Therapy. What grief support groups were brought to this person? Notice I said “brought to”. When depression hits, it may sap the sufferer’s ability to get themselves to the group. Support/help to get a person to the group might be necessary at first.
CAUTION: When you hear statements like “ending it all, no use in living, hopeless, or thoughts on death”; call for help. This level of depression requires more drastic intervention. While emergency situations call for drastic measures, those should not be the only ones employed.
What other things could you do to help a person suffering from depression?
In my decades of work with seniors, I look at the person first; who were they? What used to matter to them? What would help them restore a part of their life to what it was? Then, I look at many ways to respond. I consider what makes the suffering person better, not what makes it convenient for the staff. Giving a pill and walking away won’t do it. Bring yourself; the present of your presence is the best medicine.
The opioid epidemic is in the news. We don’t associate seniors with these issues. However we should be aware of the problems they can create for seniors. We caregivers do what we can to examine in-home help before they participate with our seniors. Agencies run “background checks” on potential employees. However, these methods do not always reveal drug use. Here’s where we are now:
I usually do not make specific resource recommendations but this one is excellent:Current Drug Trends
Sgt Bruce R. Talbot (Ret) MPA
I strongly recommend you take this course.Let’s keep our seniors safe.
Commentary on article: “Why Are African Americans So Much More Likely Than Whites To Develop Alzheimer’s?”
This Washington Post article, “Why Are African Americans So Much More Likely Than Whites To Develop Alzheimer’s?” described the current sampling problems. Too few representatives from certain groups lead research to an warped result. I’m not sure the average person understands the effect of a poor sample on results. Here are two examples. The first is a photo of President Elect Truman holding a newspaper whose headline read: Dewey Wins. Dewey didn’t. The newspaper got it wrong because they called people to survey their voting preferences. In those days not all people had phones!
The second was a TV program; Hee-Haw. Nearly all urban critics panned it. However, the Nielsen Ratings showed it was quite popular in rural areas. The rating agency surveyed people in rural areas as well as cities. The program stayed on the air due to a more representative sample.
A truly effective treatment/cure for Alzheimer’s disease requires everybody. An effective treatment must also account for future population trends. Each decade, the US population becomes less white. We already have many mixed-race citizens. If we don’t understand the components of our genetic salad we cannot effectively ad-dress it. Everyone bears the costs, regardless of our racial background. It is in our national interest to reach out to all communities now so we all benefit in the future.
The article sited the Tuskegee experiment as a cause for hesitation by African Americans. The article did not mention a more modern version of inappropriate behavior; using the cancer cells of Henrietta Lacks without her consent. I hurt for her family. Recruiting more African Americans should address the Henrietta Lacks issue as well as Tuskegee.
I can also see the potential for greater help to minorities as we find ways to treat Alzheimer’s. Minorities shoulder a greater personal burden. My firm works with caregivers as well as seniors. We note that communities with fewer financial resources place an even greater burden on caregivers. Thus, the disease injures those who care as well as those who suffer. In The Washington Post article, other family members moved home to help. The article does not discuss the financial costs to these adult children. AARP estimated that caregivers could lose $569,000 in lost wages, lost promotions, reduced savings, and lost pension benefits. That’s a double-whammy I’m not sure our country could withstand. Please read this article from the Washington Post and pass it on.
If you put a frog in cold water it will stay there, even as the temperature is gradually increased until it’s cooked. However, if you drop a frog in hot water it will jump out. This illustrates to seniors’ lack of tolerance for hot weather.
Every summer there are warnings to check on the elderly, and make sure they are keeping cool and hydrating. Our seniors are survivors of a bygone age when there was little or no air conditioning; often only found in restaurants and movie theaters. The signs from that era showed the words with snow on the letters! Many seniors may consider it an expensive luxury, or an annoyance when the cool house is affects the joints. After all they have enjoyed many summers, and did just fine!!
What they don’t take into consideration is that their physiology is changing as they age. They become less tolerant of extreme temperatures. Also, they often don’t take into consideration that health issues, and medications play a part. Climate change has made summers hotter and today’s houses assume air conditioning in the way they are built.
The particular danger occurs when the air conditioning has been on for a while and then turned off. The senior, like the frog in cold water, feels too cold. As the house gradually warms, the body will attempt to adjust. Sometimes they fall asleep. They are unaware that the house is heating to the realm of being dangerous. This drowsiness or daytime sleep may interfere with taking medications or proper hydration.
When you call or check on seniors, if they speak more slowly, or have slurred speech, get help. If the senior is slower or more wobbly than usual answering the door, has evidence of confused mental processes, it is imperative to get them to medical attention.
Here are some very useful ways to avoid these problems. If the senior is feeling too cold, sweaters and socks are recommended. Protect the joints and keep the air conditioning on. Turn up the thermostat set point; even if the house is set in the high 70’s it will still be cooler than the outside air. Check for drafts. Perhaps the favorite chair is too close to a vent. Deflectors can keep the air circulating away from the senior. This way, the climate control will keep things from getting dangerously hot.
Caring for one’s self in summer is as important as protecting one’s health in winter. That goes double for seniors. Hydration in summer is important for everyone and especially seniors on “water pills”. Chronic conditions and other medications can also affect fluid balance. If the doctor prescribes an new medication, questions about fluid balance would be good to ask during the hot weather. However, not all seniors heed the need for drinking enough water. They may not feel thirsty. BTW: Children also have to be reminded to drink enough water because they get distracted easily.
Some seniors “theorize” that if they do not drink more, they will not need to use the bathroom as much. I have observed this pattern repeatedly. On one occasion it led to a severe drop in blood pressure which led to the senior passing out. On another occasion, the senior became so dehydrated that she had to be hospitalized. In both cases, the family was not aware of the senior’s decision not to drink. Therefore, be aware that this can happen, observe how much the senior drinks, (not how much they say they drink) and provide things they like.
The logic of some senior’s attitudes or responses escapes me but I did observe this pattern in another situation. Perhaps this perspective will help you as much as it helped me: My younger sister hated to take baths. She saw that our father used after-shave and it made him smell nice. One day, she was found with an empty bottle of his after-shave: she drank it. While my mother called the doctor, I asked her why she did it. She replied that she would “sweat” after-shave and smell nice so no more baths. Keeping this story in mind has reminded me to ask careful questions about fluid intake and not settle for generalizations. BTW: this sister also ate the mud pies she made.
We all know that “kid logic” is not the same as grown up logic. I am not sure that our society knows that sometimes senior logic works remarkably similar to kid logic. Not all senior suffer from these logic issues. However, please be aware that they can develop and manifest especially in summer.
Equation for conflict: 1 elderly parent + 3 adult children = 5 opinions in 6 minutes. Sadly, the one who pays the price for a lack of clear direction is the elder! Some front-line caregiving children say the worst part is getting other family members on the same page. They experience the parent differently so they view the situation differently. Failure to resolve these conflicts creates consequences beyond the parent’s life. I’ve seen old resentments divide adult siblings and keep them apart for years. How sad! How unnecessary.
If families would realize consequences could reach this far, they would decide to create a consensus. Families can add a neutral party, knowledgeable about the senior journey. Knowledge is a key requirement. Elder care and research are exploding! Let’s add a note of caution on expertise. Just because a family member is a nurse or doctor does not make them the most knowledgeable in THIS area. A family member who sites background as the definitive opinion has lost sight of two factors. First, how does their medical background relate to senior specialty? Second, they still have their own skin in this discussion. That doesn’t lead to impartiality. It’s a standard in the counseling industry not to counsel their families. In the same manner, a referee’s presence offers perspective because they are apart from the discussion while acting as a part in it.
If your family meetings were fruitless or failed; it’s time to call a referee. A referee should be a professional with experience in geriatrics. The referee could be a social worker, a counselor, or a mediator. The key qualifications are that they know geriatrics and they understand response to conflict.
Many families do not take advantage of such professionals. Some believe that these topics should be handled in the family. Why? Are all tax matters handled in the family? Do families seek legal help? Elder care is changing so rapidly the DIY approach is not longer informative. I recommend some expert input. It’s not “overkill” and it could keep your family out of trouble.
Do not assume your doctor is the expert. He (She) may not have geriatric training; ask. Your doctor may not have taken additional or up-dated training. Some doctors specialize in geriatrics but will not act as referees. Sometimes other family members refuse to pay for professional services. That’s usually done to stall the discussion, or avoid developing solutions other than theirs.
When a professional isn’t present, family disagreements can become endless. That leads to no decision. Lack of decision is as bad for the elder’s care as a poor decision. Here are three examples; a family lost a daughter, through death, to caregiving. Another family’s the elder almost lost his home to gambling debt. A third family discovered two aunts had been scammed of over $50,000 by a domestic. In each case, if family had involved a professional, received a thorough assessment, and developed a plan, interventions could have worked.
Many adult children dread discussing certain topics with their parents such as driving, or moving to a facility. That discussion works better if the adult children have a consistent front. Reaching a consensus works better when discussions are productive. If your family seems to go round and round; get off the un-merry-go-round!
Get a referee.
Senior Sidekicks offers this service: Consultation.
At a social gathering a woman at my table stated she had not thought about herself as a future caregiver. She told me; “My parents are fine right now and thinking about them needing my care is scary.” Her comment made me think about what holds adult children back from preparing for caregiving. I see four reasons:
First: It’s scary. Certain factors make circumstances feel scary. When we don’t know what to expect; it’s scary. When we don’t know how to respond; it makes us feel helpless and scared. When we don’t know where to get help; it makes us feel alone and scared. No one wants to be in that situation. It’s normal to withdraw when we don’t know what else to do. There is a better way; preparation.
Our society has found ways to meet other challenges by preparation. For example, I live in tornado country. We never know when the weather will change. Yet, we don’t sit paralyzed: we prepare and respond. We have weather warnings, sirens, shelters, and drills. We may have tornadoes, but we don’t take these lying down! Because society prepared, life goes on. Life could go on for caregivers as well if they were prepared.
Caregiving preparation follows the same preparation pattern. Learn about it. Make contingency plans. Engage others effectively. Preparation removes the scary parts of the process. I developed a course, Preparing to Parent Your Parent, to help new caregivers or future caregivers do that.
Why do some people respond to a course for caregivers like this? “I’ll deal with it when the time comes.” Really! Think about the other ways they prepare. Would they wait until their car slid off an icy road to check the tires in winter? Did they wait to study childbirth until they were in labor? If they would do those preparations; why not do the same for caregiving? The worst time to make plans is in the midst of a crisis!
A second reason for hesitation: The same person described her concern about elder-related information. She felt like she had so much to learn she didn’t know where to begin. She wasn’t sure how she could remember it. Information overload is a 21st Century condition. Some people have described it; “like drinking out of a fire hose”! The internet doesn’t give caregivers ways to order, relate, and manage information. We have always had ways to manage information. Remember the card catalogue in the library? It helped us find the right book. We didn’t need all the books at once because we knew we could return to get more information when we needed it. A caregiving preparation course does the same task as the library card catalogue; manage information. My course turns the information fire hose down to a drinking fountain!
The third reason future caregivers hesitate is they do not have role models from their early lives. There’s a reason for that missing link; the age change happened so quickly. Let’s compare; in Sangamon County, in 1910, the average life expectancy was 50-53 years (depending on gender and race). Compare that to 2010; when the average life expectancy was 77-78.8 years. That’s a big jump in only two generations! Contrast that change with millennia we have born children. People grew up seeing many adults caring for children. We received role models by social osmosis. We have not had the same numbers of seniors, for as long, very until recently. We don’t have an historic set of elder care wisdom yet. We can fill that gap with preparation. We can learn new skills just as we learned to drive a car. We can adapt to changes, just as we have adapted to the internet. We have already learned and adapted to other things; why not apply them to elder caregiving preparation?
The final reason caregivers might hesitate is worry about health. That is not a selfish attitude. Every organism is oriented to preserving itself. Taking care of ourselves as we care for others is an essential skill (and included in my course). Many elder caregivers are also responsible for children, spouse, house, pets, and the job! It’s not selfish to be worried about how to will meet the needs of all these other people and the senior’s. It’s admirable to have these concerns answered.
Preparation is the key to helping caregivers remove fear, overwhelming feelings, missing role models and caring for themselves.
An adult child responded to one of my visit reports in which I had written about her Mother’s use of portable oxygen. She replied that her Mother really didn’t need it; her attachment was all psychological. The adult child told me the Mother had been previously evaluated for respiratory functioning and found “barely qualified” for oxygen. I replied that my observations didn’t confirm that; Mother was currently gasping for air upon exertion.
After a hospitalization, the tests showed the Mother had pneumonia. Pneumonia can be subtle in the way it looks to observers. We might think of it as a disease that leaves the patient unable to breathe at all unless aided. Not really. In my years working with seniors I’ve noted a variety of presentations. Some seniors describe a “smoker’s cough”. Some seem to have a cough that just hangs on. Some report they have “allergies” (that present as a cough). Some of these self diagnoses turned out to be pneumonia. This is a factor that should not be left to chance. Remember Jim Henson (the creator of the Muppets) died of an untreated walking pneumonia.
We need to check because what we can see may not be the whole story. For example, I asked one of my social workers about a reported reference to a senior’s cough. She said the senior had this symptom for some time. I required her to get the senior an evaluation. The tests showed a severe pneumonia that required hospitalization!
How can caregivers know; we’re not doctors? When I talk to seniors, I keep these three points in mind; frequency, intensity, and duration. When the cough has hung on a long time, it’s a duration indicator. Ignore self diagnosis and get an evaluation. Why, because seniors are more at risk. They may not be as active, they may be overweight, or they may have compromised immune systems. Just because a senior was once evaluated doesn’t mean they are still functioning in the same way.
Who was right; both of us. The adult child observed her Mother clutching the oxygen tanks. She did. I observe the Mother struggling for air when she transfers to and from the car. She did. The evaluation didn’t throw out either observation, it linked them. The Mother was struggling and responded by becoming hyper aware of her oxygen tanks.
It’s helpful to remember this tale when home care, or facility staff report an issue. Their report may differ from your observations. Evaluations help provide answers and directions. Ignoring reports can lead to more complications.
"A Senior Moment" is written by Ms. Sara Lieber, owner of Senior Sidekicks. Ms. Lieber has over 30 years of experience in senior care.