N.W.BOYER…Christian Author

BIG DECISIONS…for Grandmother and Grandfather

If you are trying to make a family decision about the care of your elderly parents, THINK TWICE…MAYBE MORE than twice!!!   

It is not easy when elderly people are at home with the rest of the family, who are also at home.  Children are not in school; parents may be working from home and the stress goes on until life can go back to some normality.

What about the parent that you have loved so long and they have loved you?  If they are dealing with the beginnings of physical or mental decline, it may be that you are thinking, “What do we do?  I don’t know if I can give them proper care. I only want what is best.” for him/her/ or them. No one doubts the love between families, but this pandemic has changed family dynamics all together.

Not everyone has the built-in options of home health care professionals, but placing a family member in an assisted living care is also extremely expensive. For those who could afford such arrangements, is this truly the best answer. Think about it.  Because these facilities have a “no visitors” policy, it may be the last you would be able to see your Mom or Dad face to face..or they see you, for some time to come.  It may not only be a permanent separation, but a death sentence to those unable to cope with such loneliness. It is not unusual for the elderly to stop eating when depression sets in.

As we know, years ago and in many other countries, the elderly lived within the same house as the rest of the family. They had interaction, care and to die was not a lonely experience.  This blog does not intend to give you an answer to this difficult decision that perhaps you or a friend may be going through concerning your elderly loved ones, but it does give some food for thought.

Think what you would want for yourself as you continue to climb the AGING ladder.

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This is an informative article written by Sara Harrison in Wired.

IT TOOK SIX weeks, several long, frustrating phone calls, and a consultation with Apple Care before Laurie Jacobs got her 89-year-old father up and running on FaceTime. Jacobs, who is a geriatrician by training and is now the chair of the Department of Medicine at Hackensack University Medical Center in New Jersey, was worried about how her parents were coping during the pandemic. They live in a long-term care community, but they felt isolated and lonely. Over the phone, Jacobs couldn’t tell how her mother, who has some cognitive decline, was feeling or if she was walking comfortably. “The communication at a distance is very difficult,” she says. “You don’t always get the whole picture with an older adult on the telephone.”

And, like so many other Americans in quarantine, her parents were running out of things to do. “They seemed bored and somewhat depressed by the lack of stimulation, so further ways for them to interact was very important,” says Jacobs.

woman looking out the window

The Covid-19 pandemic presents a doubly complicated situation for older people:  Not only are they at higher risk of contracting the disease, and more likely to develop severe infections and die from it, but they are also the most likely to struggle with—and suffer from— the consequences of prevention strategies like social distancing. For people with dementia, Alzheimer’s disease, or severely reduced mobility, social-distancing guidelines can be impractical and nearly impossible to follow, making prevention and treatment even more complicated.

Seniors, especially those above age 80, have been hard hit by the virus. That’s in part because they often have comorbidities like diabetes and hypertension, which make them more likely to be hospitalized. Doctors aren’t sure why those conditions make the effects of the virus worse, but both conditions are associated with greater expression of the ACE2 receptor, a protein on human cells that the coronavirus latches onto to start replicating.

Many older adults also have chronic, low-grade inflammation, a state called “inflammaging,” in which the body is unable to control the release of cytokines, small proteins that are supposed to help modulate the body’s immune response. This dysregulation could put seniors at great risk of “cytokine storms,” a condition reported in severe Covid-19 cases during which a patient’s immune system spins out of control and starts damaging healthy organs.

Seniors are also more vulnerable because of immunosenescence, a slow deterioration of the immune system that is a normal part of aging. When people are young, the immune system has a big reservoir of T-cells and B-cells ready to fight infections. These are called “naive cells,” meaning they haven’t encountered any bacteria, viruses, or other pathogens yet. When those naive cells encounter an infection, some of them learn to recognize that pathogen and become ready to fight it off if the body gets exposed to it again. “As we age, we lose that reservoir of T-cells and B-cells,” says Wayne McCormick, head of Gerontology and Geriatric Medicine at the University of Washington. “It’s hard for us to make new ones, although some people seem to retain that capacity better than others.” That means the person’s body may mount a less robust immune system response than it would have done when they were younger.

Immunosenescence also means that diseases present differently in seniors, which may make it difficult for their doctors or caretakers to recognize a Covid-19 infection. While many Covid-19 cases include fever, for example, in seniors the symptoms might also be due in part to dense living conditions, under staffing, and a lack of personal protective equipment. And recently, health authorities have realized that the virus is spreading rapidly in work communities where employees are housed in crowded conditions, share long commutes on shuttles, or cannot easily socially distance, like meat packing or farm work.

assisted living care

Whether they live in a long-term care facility, nursing home, or in a family home, many seniors have unique needs that make it impossible for them to socially distance. Some need help eating, washing, going to the bathroom, or moving around. “You can’t do that using Facetime,” says Eric Widera, a professor at the University of California San Francisco who specializes in geriatric and palliative medicine.

Yet for older adults living in their homes, social distancing can cause isolation and loneliness. Most of the places people would go to socialize—senior centers, libraries, churches, temples, or synagogues—are closed. Families are discouraged from visiting. “We’re worried it’s going to cause a wave of true loneliness,” says Widera, which can lead to serious health problems including worse cognitive function, higher blood pressure and heart disease.

While older adults are the most likely to catch Covid-19, they also may be less likely to benefit from a vaccine.  Because seniors don’t raise the same immune response that younger adults and children do, they generally don’t respond as well to vaccines. They also aren’t always included in clinical trials. “If you look at the last many decades of research, the vast majority of randomized control trials do not include older adults. And if they do, they don’t include frail older adults, who are at risk for this,” says Widera. “That’s one of our worries: That we’ll be looking at potential treatments, vaccines, but not actually testing it on the people who are at the most risk of developing this disease.”

older man praying

For people with dementia or other kinds of cognitive decline, things get even more complicated. Widera points out that people with dementia may not remember they need to wash their hands more often or refrain from touching their face. And dementia patients often wander. In communal living or care facilities, they might walk in and out of other patients’ rooms, down the hall, or into common living areas, all of which increase the likelihood of catching and transmitting the disease. Diagnosing Covid-19 in those patients could be even harder, too. “People with cognitive impairment may not be able to report their symptoms very well,” says McCormick. “Even if they had a cough an hour ago, they may not remember that they did.”

man coughing

Patients with dementia also have unique challenges if they end up in the hospital. Covid-19 symptoms can worsen their confusion and delirium, as can being in an unfamiliar setting like a hospital room. These patients may be terrified when they’re separated from their family or their usual caregivers and are being tended to by staff covered head-to-toe in protective gowns and masks. With nurses trying to limit patient interactions to reduce the need for this protective gear, patients are often isolated for much of the day.

Martine Sanon, a professor of geriatric and palliative medicine at the Mount Sinai Hospital in New York, says that usually they encourage family members to be part of the care team and to help orient and comfort their loved ones, but with limited protective equipment, and with fears about spreading the virus, those options aren’t available. “The families have been tremendously wonderful,” she says, often using FaceTime to play favorite music in the background or to call patients by a familiar nickname. “That does help.”

At Hackensack University Medical Center, Jacobs says usually they try to use non-pharmacological methods to help soothe distressed and confused patients. “The way we manage that usually in the hospital is basically staff sitting with a patient, reorienting them, using music, using touch,” she says. But with Covid-19, it’s too dangerous to have someone sit with a contagious patient all day. Instead, the hospital now relies on medication to calm patients down.

While mortality rates are higher for older adults with Covid-19, many do survive. What recovery looks like for them is more complicated. “That’s the other shoe to drop,” says William Greenough of Johns Hopkins. Older adults are likely to be weaker and to recover more slowly after a hospitalization, he says. With so many hospital gyms, rehab, and physical therapy facilities closed, that’s going to make their progress even more difficult.

None of these issues—loneliness, immunosenescence, difficulty recovering from hospital stays—are new problems, and none are unique to the virus. But the novel coronavirus exacerbates the many challenges older patients already face. “Covid-19 intensifies and complicates everything,” says Greenough.

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Besides all the upset for the average family during this Pandemic, the saddest part, as described in this article, are those who have spent their entire lives raising and loving families…their children, grandchildren and other family members.
Yesterday, I called a man who is in his 90’s at a Veteran’s Hospital in VA to be certain he got some books I sent him.  I asked, “How’s your family? Do you hear from your son?” He answered, “They are so busy, you know.” 
man sees himself in the mirror
Think about all the meals that Grandma made for the family in your life time!  Think about the Grandfather who taught you to fish! Thinks about the trips planned and enjoyed together…and so much more.
Senior couple sitting on a bench
Think about how you have watched them slowly become older, but still having fun! They don’t deserve to have their last days being sad and lonely.
elderly kiss
Ben Franklin said, “Those who love deeply never grow old; they may die of old age, but they die young.” 
More and more, the people in their younger years of 50-80 are making plans for themselves.  If they have a nest-egg/and or affordable insurance, they will decide exactly how they will spend the last years of their lives.  This takes a great deal of pressure off the decision making of their family because they have already put it down in writing…with wills,  exact funeral plans and living wills about hospital visits.  They don’t want to wait for the children to make decisions for them. If your elderly parents have good mental ability, suggest that they go this route for it is highly recommended.
You ask yourself, “Where did the time go?”  Now, too many are isolated with no recourse because plans weren’t made and there was a fear of thinking about death and dying.
  Do whatever you can to make a bright spot in their days. 
If you are so lucky to have a parent with you at home, cherish these moments…even the difficult moments.  You will not have them forever…nor will they have you. 
If your loved one is already in a nursing home or assisted living, call them regularly, sent them cards, books or drawings from the grandchildren…so they know that you still care.
showing grandma the baby
REMEMBER, SOMEDAY YOU WILL BE MUCH OLDER!
As you pray, God will give you guidance.

 

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