Emergency Response…Or Crisis Mode?
As family members age, it’s more and more likely that we’ll be faced with an “eldercare event” - a sudden, dramatic change in the status quo, usually related to health. Here are some common examples of what can happen: A frail older person, living alone, suffers a fall, a stroke, or a heart attack and is hospitalized. She must now leave the hospital but cannot safely live alone any more. A healthy spouse who cares for a frail senior dies suddenly. Family members are scattered throughout the country or live overseas. Your parent lives alone, several provinces away. Your last few phone conversations have seemed strange; your parent is rambling and, occasionally, incoherent. Your phone rings at work. The local hospital informs you that Dad has been admitted to the emergency department. We hope we will never have to deal with situations like these, but it’s unrealistic to believe either that it won’t happen to us or that “we’ll deal with it when something happens”. When eldercare events occur, it helps everyone if we respond and cope well. Otherwise, we may become part of the problem, not part of the solution. Here are four steps you can take to prevent an emergency turning into a crisis: Acknowledge your emotions Even if you have thought about how you might deal with an elder care event, you cannot predict how you will feel when it happens. Elder care events can involve complex decisions, time pressures and the need to navigate unfamiliar situations and new relationships. Aim to reach a level of calm before responding to the news. Everyone can benefit from deep breathing and a few quiet minutes to wait for the adrenalin rush to subside. Change your self-talk if it’s making you more anxious. Self-talk can either increase your panic, or guide you to a more reasoned response. Tell yourself: “I am calm and capable. I have handled other difficult situations and I will handle this one, too.” Remember the resources you have drawn on in the past to calm yourself and make reasoned decisions. Assemble your support team. Who might I ask to come and stay with me? Who can give me emotional support on the phone? Who else do I need to call to let them know what is happening? Who can I contact to help me figure out what the right thing is to do for someone else? Implement an Emergency Plan you have worked out in advance. Make a checklist. Some situations to consider: At home: Will you need someone to look after your children or anyone else at home that counts on your care? At work: Notify your supervisor. Ideally, you will have had a prior discussion that helps them prepare for this type of event. If you are at a distance from the event, who will you communicate with to monitor the situation? Will you need to travel? What will you take with you? What will you need if you may spend long hours in hospital? Can you pre-pack an emergency kit? What information and documents will you provide to help health care professionals? Having a written plan, assembling your support team, and staying calm are important components of planning ahead for and managing an elder care event. © ElderWise Inc., 2013. You have permission to reprint this or any other ElderWise INFO article,if you reproduce it in its entirety, acknowledge our copyright, and include the following statement: Originally published by ElderWise Inc. We provide clear, concise and practical direction to Canadians with aging parents…and anyone wishing to do “age-smart” planning. Visit us at http://elderwise.memwebs.com/ and subscribe to our FREE...
Read MoreA Surprise Call From The Hospital
John’s aging parent, Mary, 90, lives in another province. One day, he gets the call he has long dreaded: his mother has fallen, broken her wrist, and has been taken by ambulance to the hospital. She has had surgery and her arm is in a cast. Is she ready to go home? Not so fast. John is told that his mother is showing signs of mild cognitive impairment and that the discharge planner wants an assessment. John must call the doctor for more information. John manages to talk to the doctor later that day. He learns that Mary is doing very well physically, but the doctor is concerned about the possibility of dementia and has referred her to the Geriatric Team. John asks if he should take time off work and come. The doctor advises him to wait a few days until the outcome of the assessment. During the next few days, John calls the hospital for updates. He talks to: the Registered Nurse on the unit; the Head Nurse on the unit; the Relief Nurse on shift; and the Discharge Planner. John is confused. Some of these professionals believe that Mary has signs of dementia while others are not sure. The discharge planner is concerned that Mary may not be safe to return home; John worries, because Mom has refused previous attempts to talk about moving to assisted living. Later, John hears from the Geriatric Case Manager that, for now, they have not confirmed dementia. His mother had delirium because of the injury, pain, unfamiliar environment and anxiety. Mary is moved to a transition unit. Soon after, Mary calls John to tell him that she is discharged and will get home care. John wonders if she will accept strangers coming into her house because she has refused previous offers of household help. John takes a week’s vacation time and goes to help his mother. During his time there, he meets: the community care (home care) coordinator; the home care nurse; a home health aide; the transition coordinator; the geriatric case manager; and an occupational therapist. Collectively, they offer the following advice: Arrange for Meals on Wheels Make changes for safety at home: get a bathroom grab bar; remove scatter rugs; add a night light; get Mary an emergency response system Mary should accept home care services for help with bathing John should get Power of Attorney to look after Mary’s finances Mary should write a Personal Health Care Directive John is told that they will follow-up to monitor his mother’s safety at home. If she is not safe, the team will encourage her to move into assisted living. John returns home and stays in daily phone contact with his mother. Contacting the health care professionals is difficult, given time zone differences and work schedules. They encourage him to talk to his mother so she can keep him up to date. But John senses that Mary is avoiding detailed questions. He assumes that she wants to appear to be doing well so that she can stay at home instead of living in a care home. Who am I supposed to talk to? How do I reconcile different opinions from the various professionals? Why is the medical team so guarded about what to tell me? When should I go help my mother – right away or when she is discharged? Will I have enough warning to arrange vacation time and travel? Why is Mom moving to another unit in the hospital? What is her diagnosis? What will she need from now on? On the medical team, who is responsible for what? Why are so many people involved? John finds out...
Read MoreSeniors in the Emergency Room
Each year in Canada, thousands of seniors arrive at a hospital emergency department (ER) - either by ambulance or accompanied by adult children. Many will make more than one visit within the year. About 50% of patients coming to the ER are over 65 years of age. The major reasons that older adults are taken to the ER include: falls; stroke; heart attack; infections; and delirium (acute confusion). For your parent, it may be more a matter of “when” rather than “if” this happens, so being prepared - with the right information and expectations - is key. It can help you to ease your way through the crisis, know what questions to ask, and to take care of your parent and yourself. What to Expect The ER is often busy and seemingly chaotic. The experience can be frightening and exhausting - for the senior and for family members. You may be there for several hours and even more than one day! All this time, your parent may be lying on an uncomfortable gurney. The ER might be drafty, too cold, or too hot. It is likely to be noisy 24-hours a day. Staff is often operating at full speed to cope with the continued flow of patients, many with urgent or life-threatening illness or injury. Most will welcome your willingness to help a family member. What You Can Do Whatever caused the trip to the hospital is likely to interfere with your parent’s ability to speak and act for themselves. You can provide needed information, be a valuable advocate, provide comfort, and help prevent health complications such as delirium and deconditioning. It’s important to look after yourself at this demanding time, even though it may seem appropriate to set your own needs aside. Although the health crisis might pass within a day or so, what follows might require your ongoing support for a long time. For more details, consult the ElderWise e-guide Seniors in the ER Vol. 5, No. 11, © ElderWise Publishing 2009. You have permission to reprint this or any other ElderWise INFO article, provided you reproduce it in its entirety, acknowledge our copyright, and include the following statement: Originally published by ElderWise, Canada’s go-to place for “age-smart” planning. Visit us at http://elderwise.memwebs.com and subscribe to our FREE e-newsletter. ...
Read MoreDrawbacks of Bed Rest
Sometimes acute injury or illness leaves a senior bedridden but too much bed rest can have negative health effects. For the older adult, bed rest or chair rest, even for a few days, can cause deconditioning; that is changes in muscle strength and muscle bulk that can result in dependence and impairment in balance. Muscle strength is important to perform daily activities. For example, strength in the quadriceps (thigh muscle) is necessary to rise from a chair, independently. Loss of strength in the muscles of the ankle joint may result in falls. Deconditioning can result in a loss of independence that lasts long after the acute problem has been treated. How does deconditioning begin? The human body is designed for movement. It is also subject to the forces of gravity, so that each move we make to stand and walk is a move against gravity. When we are at rest, gravity doesn’t have its usual effect. Without this force to pull against, muscles and bones get weaker. This weakness can lead to loss of muscle mass, muscle shortening, changes in the joints, changes in cognitive abilities, and reduced circulation. Keeping moving, even small steps or little stretches can make a big difference to recovery. How can you help? If you have a senior who is in hospital or a long-term care home, ask for a physiotherapist who can work with them to prevent deconditioning. Many hospitals have programs designed to help. Some even bring specialized equipment like a half-barrel or sling to help a senior in bed gently work their muscles. You can also ask the nursing staff to show you how to help the older adult do the exercises safely. As a family member, you can provide essential support and encouragement. If an exercise program is not offered or you have a senior who is at home and on bed rest, simple range of motion exercises can be done while lying in bed. Start at the shoulders and work through all the joints of the body gently moving the limb through its normal range of movement. These movements should be gentle and not cause strain or pain. 1. Make circles with the arms and straighten and bend the elbow. Rotate the wrists. Open the hand and then make a fist. 2. To help hips remain loose, lift the leg and move it away from the body, then return it to rest. 3. Bend and straighten the knee. If the person is able, bring the knee toward the chest and then return the leg to rest on the bed. 4. Rotate the foot in a full circle. Reverse the direction. 5. Even sitting up in bed a few times can help the muscles, since multiple muscle groups are required to move from a lying to a seated position. Sometimes we feel a person is safer lying quietly in a bed, and when bed rest is required it can be just what the doctor ordered. However, we should change our view that bed rest means complete rest. It should include working the muscles and bones that were designed to be in motion. Vol. 3, No. 23 © ElderWise Inc. 2007. You have permission to reprint this or any other ElderWise INFO article, provided you reproduce it in its entirety, acknowledge our copyright, and include the following statement: Originally published by ElderWise Inc., Canada’s go-to place for “age-smart” planning. Visit us at www.elderwise.ca and subscribe to our FREE bi-weekly...
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