Advance planning eases care during aging process

Seniors and their relatives should prepare now

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. Some 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 facilities, 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," says Rantz.

Michael Doran, CSW, coordinator of caregiver services for Health Outreach at 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," says Doran.

Provide list of community outreach centers

To help families prepare for the care of aging relatives, hospice staff members 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 community outreach centers have access to the resources that families may eventually need for an aging relative, says Schelmety. 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 are also 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, local chapters of the Chicago-based Alzheimer’s Association provide services for caregivers of relatives diagnosed with this disease.

As relatives age, it is important for family members to foster their independence, but the family also should stay involved and supportive as needed, says Browning. 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," says Browning. Relatives also can encourage visitors. Interaction with other people and the stimulation of talking about current events and topics 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 can know when it is necessary to intercede, says Schelmety. For example, some forgetfulness is common as people age. Therefore, it would be wise to take steps to prevent 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," says Schelmety.

Caregivers should be familiar with the signs of dementia, which include consistent loss of memory that affects activities of daily living and the ability to participate in social events, says Browning. In this case, an elderly relative would need more assistance and may need to be moved to an assisted living facility.

Older adults are also at risk of depression, which is underdiagnosed and undertreated, says Browning. 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, rendering them more susceptible to fractures, says Schelmety. Thus, home modifications may be required to improve safety, such as installing better lighting and removing throw rugs. "One out of three people ages 65 and older falls each year, and fractures are the most serious consequences of the falls. Many of the injuries can be prevented," she explains. People can obtain environmental safety checklists to evaluate their homes.

Review all medications

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, says Schelmety.

Certain immunizations and screenings are required for good health as people age, so it is a good idea for people ages 65 and older to begin seeing a physician who specializes in geriatrics, says Schelmety. Older adults should be vaccinated against pneumococcal pneumonia and influenza, because these illnesses are among the top 10 leading causes of death for this age group.

While good health practices are vital at any age, there are many things the elderly can do to maintain health as they age. For example, to increase strength, flexibility, and balance, they need to make exercise a part of their daily routine. Good nutrition and hydration are important as well, says Schelmety.

Communication between the aging adult and his or her caregiver is very important for as long as interaction is possible. Good health practices, living situations, and care provision should all be discussed, and advance directives should also be put 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," advises Browning.