“7 Essential Lessons for Caring for the Elderly” was written by Cathleen Favaro and reviewed/edited by Katie Dodd, MS, RDN, CSG, LD, FAND.
Cathleen is an Occupational Therapist specializing in geriatrics. She is a Certified Geriatric Care Professional and a Certified Dementia Practitioner. You can find more information at www.planforwellness.net.
Caring for the Elderly
America is aging. Sixty-five million Americans are currently caring for the elderly and that number is rising significantly in the upcoming years.
Whether you are caring for the elderly now or realizing you will be soon, there are some important things you will need to consider.
This article will review the top seven lessons for caring for the elderly.
I want to share research that shows caregivers who manage stress and have a plan in place report having a higher sense of purpose according to a Johns Hopkins study.
Others who report caregiving as being stressful and financially taxing are less healthy, have compromised immune systems, and have a higher incidence of taking medication for depression/anxiety than their non-caregiving peers.
Having a plan is important for the holistic care and well-being of the family as a whole.
Lesson 1: Audit Your Current Situation
The first lesson in caring for the elderly is to take a comprehensive look at your family dynamic.
How many people are you already responsible for? How much time and effort are involved in caring for them? If you are employed, how does that look as far as time and responsibility?
How is your mental & physical health as well as that of your significant other? If there are already stressors, can you make changes to fit in the caregiving of another person?
Lastly, how is your loved one’s health? Do they need assistance for doctors’ appointments and setting up medications for the week or are they needing physical assistance with activities of daily living? What are their health diagnoses now?
Understanding the health risks and expected progression of those diagnoses will help you identify what their needs will be as time goes on.
Lesson 2: Considerations for Cohabitation
When it comes to caring for the elderly, you may decide it is best to live together. The decision to cohabitate can be very beneficial to all parties, but can also have their challenge. You should also enter into an agreement to live together with ground rules.
Here are some ground rules to consider for cohabitation:
- Don’t make promises that they will always be there and you will never let them go to a nursing home. This puts pressure and potential guilt on you as you do not know what the future holds. The leading cause of dementia patients being admitted to a nursing home is the “behaviors” becoming too much for the family.
- Set boundaries. Whether they move in with you or you move in with them, there has to be mutual respect for space and noise level to ensure all people are comfortable and feel heard. It’s harder to try to set this up after the fact.
- Loved ones (especially with dementia) do better with routines. Keeping a calendar can provide consistency and comfort.
- Keep your elderly loved ones active. Engaging them in your social activities, game night, and making dinner doesn’t just keep them busy. It gives them a sense of purpose. Additionally, they feel useful and needed. Humans need this. It is so easy to provide care and do FOR them instead of WITH them. Doing so can lead to depression, resentment, and isolating themselves from the rest of the family.
Lesson 3: Understand “Normal Aging” (Cognition & Falls)
This is a good time to discuss what is “normal aging” and what is not. Two primary considerations are cognition and falls.
Cognition and Aging
Let’s be honest, we all have some slowing of mental capacity. For example, we forget why we entered a room or call the wrong kid’s name when we need them. That is normal cognitive change.
Abnormal changes are forgetting the loved one’s name, changes in cognition that impact their life and work performance, becoming confused as to what season or month it is, and difficulty with basic math skills.
These are just a few examples. Symptoms can progress and get worse over time. If your loved one is experiencing these deficits, they should be tested for dementia.
If your loved one experiences this type of confusion with a fast onset over a couple of days, it could be an infection or delirium brought on by medication changes or dosage issues.
When caregiving for the elderly, talk to their healthcare provider if you have concerns about their cognition.
Falls and Aging
People tend to believe everyone starts to fall as they age and that is NOT a fact.
The cause of falls is typically attributed to weakness. In turn, this leads to balance deficits and change in walking patterns (gait). However, falls can also be attributed to many other causes.
Potential Causes of Falls
- Weakness (ex. malnutrition and muscle loss)
- Home hazards (like area/scatter rugs)
- Adverse drug events (medication causing changes in blood pressure, dizziness, or slowed heart rate)
- New glasses or bifocals
- Fear of falling
- Etc.
Unfortunately, people tend to get what they fear the most. And those who are afraid to fall tend to become more sedentary (weakness), take shorter steps (gait changes), & potentially hurry to get back to sit.
Some falls can be attributed to having an infection or oxygen levels being low, but a majority fall for the above reasons. If your loved one is falling, contact the doctor and request an order for physical therapy.
Lesson 4: Therapy Services for the Elderly
Physical therapy services can be very beneficial, particularly if services are provided early. Ideally noticing the ambulation changes before the fall could prevent it. Reach out to your loved one’s doctor to express concerns and request an order for therapy services.
Therapy can take place in outpatient clinics, day programs, rehabs, nursing homes, and hospitals. Physical therapy can help improve balance, gait, and function in the comfort, security, and familiarity of their own environment.
Therapy services are not typically long-term services. They are short-term services to address the noted deficits and maximize the patients’ abilities.
While physical therapy works primarily with balance and gait in fall reduction or prevention, they may also refer your loved one for occupational therapy.
Occupational therapy can help to address any deficits noted in toileting, dressing, or other activities of their daily living they may be struggling with.
It is also important to note that if your loved one is having difficulty with eating, eating less, or if they are coughing when they drink. They may require additional referrals for speech therapy (Speech Language Pathologist-SLP) or medical nutrition therapy (Registered Dietitian).
Lesson 5: Home Modifications
The fifth lesson is about home modifications ideas. Whether your loved one will be living with you or just coming to visit, you want to consider the safety of the environment. Particularly if they require an ambulation device, such as a walker or cane.
When caring for the elderly in your home considerations should be made for bathroom access, any stairs in or outside of the home, lighting, and generalized safety concerns.
It is typically recommended to remove any area or throw rugs. And oftentimes people remove carpeting altogether. This provides a less resistive and smoother surface.
If your loved one requires a wheelchair, are the doorways wide enough? Is there a ramp or can the outside be hardscaped to access the home? Is there a second floor the aging loved one needs to access?
Can they access the bathtub (even with equipment like a tub bench) or is there a walk-in shower?
Lighting is also important as we all have some loss of visual acuity as we age. Having automatic nightlights in the hallways to use the bathroom and throughout the house is helpful.
Technology is also a huge benefit to aging in place with smart homes or by including Alexa devices and Ring doorbells.
Considering these things early on can save on larger and often unexpected expenses later on.
Lesson 6: When Home is No Longer Appropriate
If the time comes that home is no longer appropriate for caring for the elderly, knowing what care and assistance is available ahead of time will be very helpful.
Assistance in caring for the elderly can range from in-home assistance to skilled nursing facilities (nursing home) to retirement homes to assisted living facilities and more.
Home care can be privately hired through word of mouth or you can hire through an agency. Care.com can be a helpful resource for finding home care resources.
Additionally, adult day programs are also a great alternative to get your loved one out of the house to socialize with peers. An added plus is often day programs have therapy or other services there. These are typically paid out of pocket or with long term care insurance.
Living elsewhere is often necessary but can be confusing and stressful. That being said, finances are a factor. Most assisted living is paid for from private funds and long term care insurance whereas Medicaid can often pay for nursing home care.
There is also a program called PACE which allows elderly people to live independently with the support to stay there.
It is important to do your homework to know what is available in your area as well as your loved one’s financial information to help decide the right option for them and your family.
Talk to your healthcare provider and/or request assistance from a Social Worker who can be a great resource for finding services in your community. Eldercare Locator is another helpful resource.
Lesson 7: Have Your Legal Documents in Order
Lastly, you want to protect yourself, your loved one, and your family by having the appropriate legal documents in order and all together.
These documents include (but are not limited to):
- Power of Attorney (POA)
- Health Care Proxy (HCP)
- Physician Orders for Life Sustaining Treatment (POLST)
- Advanced Directive
- Do Not Resuscitate (DNR), as applicable
- Etc.
Many states have a document that is completed with the doctor called a MOLST, POLST, or Five Wishes. It is a doctor’s order for the amount of care the person wants such as a ventilator, feeding tube, and even hospitalization.
If your state does not have one of these, it is important to at least have a Do Not Resuscitate (DNR) with the doctor if that is your loved one’s wishes.
Review all the documents with your loved one while they are of sound mind and know where they all are kept. A Social Worker can also assist with which documents you should be completing.
If they have any immigration papers, discharge papers from the service, divorce papers, deeds to property, and banking/investment papers, keep them all together where you know where they are.
If your loved one is diagnosed with dementia and deemed to lack capacity and these documents are not in place, you will have to go to court for guardianship.
Caring for the Elderly Conclusion
This includes our 7 lessons for caring for the elderly. We hope this information is helpful for you.
Please know that Cathleen at planforwellness.net is available to offer more guidance and assistance in this area of caregiving for the elderly. Caring can be hard. Cathleen can help take much of that guesswork away and help you plan for the changes that happen in aging.
Best of luck to you!