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.
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.
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.
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.”
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.”
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.
All of our lives we take for granted that we will still have our youth…even in our young adulthood…and into our middle years. We have the feeling that life will go on and on. When we finally reach the latter time of life, it is with some shock that we wonder where all the years have gone.
This realization came to me in the past few weeks when I was shopping for a bathrobe for my 92-year-old Mother, who was in the hospital with congestive heart failure and pneumonia. For the first time, it was certain that she was going to need full-time care, not just someone to help on occasion. I had seen other families with this situation, but had never experienced it myself. It was quite unsettling.
My Mother is a proud woman, who was a beauty in her younger years; a woman who helped out the war effort in WWII, and owned her own business. Even at the age of 92, soon to be 93, she takes care of her own banking and investments; writes her own letters, and reads 4-5 books in just two weeks. Her mind is clear, but her body is weak.
The realization that life does have an ending has set in. We will each be in this place one day, should we live so long…barring all accidents.
The emotions have run from high to low. There have been sad moments. Mother had to make definite adjustments to her life as she entered an assisted-living facility, but she is doing well. She wants what is best for her and she wants my husband and me to have time ,without worry, as we are beginning our years of retirement.
The biggest disappointment in coping with this situation has been the process. It is my opinion that no elderly person should be put through the wringer when making the decision to get extra care. This is a time of big decisions and should be made as simple and correct as possible. What are a few things of which I speak?
- Moving from hospital to rehab.to Assisted-Living (Getting the records correct.)
- No facility should tolerate a nurse or assistant with an attitude. A registered nurse made the statement about my mother, “I’m not walking way down that hall to take her blood pressure” This was either because she was too lazy or too tired…but certainly not professional. Hire someone who takes the patient and their profession seriously.
- Insurance companies should use what they can from hospital records… and not put a weak, sick patients through a page after page interview. Also look at the fact that she never missed a payment for years. This is what she paid for and what medical doctors now says that she needs.
- Take into account that the elderly often cannot hear well. Don’t send someone who cannot speak English clearly.
- When a doctor’s signature is needed for a critical oxygen supply, sign it….and don’t ask “Is she going to continue to be my patient?” Perhaps, that is her decision.
Both my husband and I wondered, ” What do people do who do not have a family member there to intercede on their behalf?” It must be very difficult.
The statement that I repeated and repeated to every care-giver was that my Mother had a very good mind; thankfully no dementia. Just because she cannot hear you, does not mean she does not understand. “Speak up…and slow down…and we will be just fine!” So often, even in the best of places…and we looked at many…people were sleeping all day in wheel-chairs in front of nursing stations.
I had to practically fight for people to listen to me that all the medicines being given better mean something necessary for my Mother….and not to give her something that just makes her sleep. She likes being alert , playing Scrabble, and reading her books too much to ever have that kind of life. As for this writing, I will not go on and on. I think my readers get the point.
I am reminded of one of my favorite movies, Chocolat directed by Lasse Hallstrom. One of the most interesting characters is Armandi Voi, who is an older woman played by Judi Dench. She is living her life the way she wants to despite the protests of her daughter, who is concerned about her mother’s health issues such as diabetes. One of her lines ,when asked to play a game in which she is to say what she sees in the game, she replies :
” I see a cranky old woman too tired to play games.”
She wanted to eat what she wanted; dance if she felt like it and not be told by anyone how she should spend her last days. She is a dignified, strong-willed woman living in the French country-side in a town where the people believed in tranquillite’ (tranquility). There was not much tranquility in this town, but this is exactly what this woman wanted. Should a diabetic ignore all medical expertise, as Armandi Voi did? Of course not and she died early because of it. However, there is something to be said for doing things as one wants to. After all, this life was lived long and well. There are some privileges.
I think this is true of those who have a short life left to live…is just a little tranquility and dignity to live those last days. This is all my mother wants. It is what you will want when you are her age. Whether you are 32 or 92…the day is coming. Live each day. Give it your all. Take a look at the Mother or Father that you may still have. Give them that extra measure of love and thank God for each sun-rise. Visit them and let them know you care. For anyone that may be old and feel a little tired, the angels will smile if you turn over one night and enter your eternal rest in peace. We should all be so blessed.