Advance planning eases care for aging
Seniors, close relatives should prepare for aging
Planning is something Americans do on a regular basis. They plan their vacations. They plan for the birth of a new baby. They plan for retirement. And they even plan for death. Yet few plan for the aging process. "It is good for people to start to think ahead," says Marilyn Rantz, PhD, RN, director of the Center of Excellence in Aging and a professor at the school of nursing at the University of Missouri in Columbia.
Families need to consider the various scenarios that could take place as people age such as not being able to drive or maintain a house. Then they should research the services and options available within their community, and work with close family members to develop a plan.
Rantz has talked to seniors and family members who volunteered at nursing homes, assisted living, or senior centers to help them become familiar with the services available to seniors in their community. "That saved so much stress in those families who were proactive and took the time to understand what services there were in their community," Rantz notes.
Michael Doran, CSW, coordinator of Caregiver Services at Health Outreach, New York Presbyterian Hospital in New York City, often meets caregivers who are overwhelmed with the responsibilities of caring for an elderly loved one while trying to meet work and family obligations. "Quite often when people present for help, they feel things are out of control," he says.
To help families prepare for the care of aging relatives, patient education coordinators can provide information on what types of resources might be needed by seniors and their family members, how to determine when it is time to make use of such services, and how to find services that meet budget constraints and family requirements.
A list of community outreach centers would be very useful to families looking for help with the care of aging family members, says Collette Schelmety, RN, assistant nurse manager on the Acute Care for the Elderly (ACE) unit at New York Presbyterian-Cornell Hospital in New York City. These centers have access to the resources that families may eventually need for an aging relative, Schelmety says. For example, some have social workers who can help explain which services Medicare might cover, or they might offer home safety evaluations.
Local, state, and national agencies provide resources for older adults, says Jennifer S. Browning, MS, RN, CS, gerontology clinical nurse specialist at The Ohio State University Medical Center in Columbus. Senior centers within communities also are an important resource. They often have classes for older adults as well as social activities and meals.
Associations and organizations are good resources for disease-specific information. For example, the local chapter of the Alzheimer’s Association based in Chicago provides services for caregivers of elderly relatives diagnosed with this disease.
Preparing for potential problems
As relatives age, it is important for family members to foster their independence, but the family also should stay involved and supportive as needed, Browning explains. For example, social isolation could become a problem if an elderly person cannot drive or is not physically able to get out much. "They need frequent contact, even if it is just a phone call," she says. Relatives also can encourage visitors. Interaction with other people and the stimulation of talking about current events and things of interest is important, she says.
Caregivers need to be aware of the mental and physical changes that take place as people age so they know when to intercede, Schelmety notes. For example, some forgetfulness is common as people age. Therefore, it would be wise to take steps to prevent potential problems by putting a list of emergency numbers next to the telephone.
It’s also important for caregivers to encourage elderly relatives to participate in activities that stimulate their minds. "Seniors can improve their memory by continuing to be active in such recreational activities as Scrabble or cards," adds Schelmety.
Caregivers should note that signs of dementia include consistent loss of memory that affects activities of daily living and a person’s ability to participate in social events, and to take care of him or herself, Browning says. In this case, an elderly relative would need more assistance and may need to be moved to an assisted living facility. Older adults also are at risk of depression, which is underdiagnosed and undertreated, Browning explains. It is important for caregivers to know the signs of depression in the elderly.
"Older adults present differently. Their only complaint may be physical symptoms such as fatigue," Schelmety says. As people age, there is a decrease in strength and balance and bones become less dense, so they are more susceptible to fractures, she adds. Therefore, home modifications may be required to improve safety. For example, better lighting might be installed and throw rugs removed.
"One out of three persons age 65 and older fall each year, and fractures are the most serious consequences of the falls. Many of the injuries can be prevented," Schelmety explains. People can obtain environmental safety checklists to evaluate their homes.
Medications can cause confusion as well as falls. Caregivers should review all medications an elderly relative is taking and learn the side effects of each as well as the proper dosage and method of taking them. Medication containers need to be clearly marked for older adults, Schelmety notes.
Vaccinations are a must for older adults
Certain immunizations and screenings are required for good health as people age; therefore, it is a good idea for people age 65 and older to begin seeing a physician who specializes in geriatrics, she says. Older adults should be vaccinated against pneumococcal pneumonia and influenza because these illnesses are in the top 10 leading cause of death for this age group.
While good health practices are vital at any age, there are many things the elderly can do to improve the aging process. For example, to increase strength, flexibility, and balance, they need to make exercise a part of their daily routine. Good nutrition and hydration is important as well, Schelmety explains. Communication between the aging adult and his or her caregiver is very important as long as interaction is possible. Good health practices, living situations, and care should be discussed and advance directives should also be set in place.
"Caregivers should find out what the older adult wants — they shouldn’t assume anything. [Caregivers] need to communicate well with their loved one," Browning advises.
For more information about providing education for caregivers of older adults, contact:
• Jennifer S. Browning, MS, RN, CS, Gerontology Clinical Nurse Specialist, Inpatient Nursing, University Hospitals, The Ohio State University Medical Center, 841 Center Doan Hall, 410 W. 10th Ave., Columbus, OH 43210-1288. Telephone: (614) 293-3516. E-mail: [email protected]
• Michael Doran, CSW, Coordinator Caregiver Service, Health Outreach, 420 E. 76th St., New York, NY 10021. Telephone: (212) 746-4365.
• Marilyn Rantz, PhD, RN, Director of the Center of Excellence in Aging; Professor, School of Nursing, University of Missouri, Columbia. E-mail: [email protected]
• Collette Schelmety, RN, Assistant Nurse Manager, ACE Unit, New York Presbyterian-Cornell Hospital, 525 E. 68th St., New York, NY 10021. Telephone: (212) 746-0316. E-mail: [email protected]
Planning is something Americans do on a regular basis. They plan their vacations. They plan for the birth of a new baby. They plan for retirement. And they even plan for death. Yet few plan for the aging process.
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