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.
Probably one of the hardest things for a family is to see an older loved one deteriorate in health or mental capacity. Nevertheless, when one is just this side of even thinking of themselves as elderly, it is a big question about how one would want to spend those last “golden years”. A younger person never gives it a thought. Maybe we should.
How does one prepare? My husband and I decided we would look at finances; get an insurance plan in case we needed to have extra assistance, and we’re taking a doctor’s advise. The advise was to live every moment one can…prepare a “bucket list”, so to speak, because it is more than likely the hips or legs will eventually give out…and we will not be physically able to do those things. Take a trip to places not seen; work on woodworking; become the best one can at an interest. In my case, it is writing, photography, and music.
Did I say music? Of course, I have always loved listening to the great composers, as can be seen on this blog site, but actually make music by myself?! Well, why not? When I was a child, I went to a private boarding school far from home. It was a lonely experience, but the one thing I had there was Mrs. Tollison, my piano teacher. Funny that I can still remember a person who has probably been dead fifty years! I learned the basics and even did a recital, but when I went home to my single parent mother, she could not afford a piano…and could not get one up the steps to our apartment even if she could pay for one. That was goodbye to learning how to play, so I turned to art lessons instead.
A few years ago, I sat down at the keyboard and found out that some of what I had learned at age 10 was still there. Then just this Valentine’s Day, my dear husband, who had seen me watch Beethoven’s life ( Dearly Beloved, the movie) over and over, surprised me with a piano. How blessed can one be to have such a husband?
All this leads me to the first topic…what about those last remaining years of life? I have included a video below that is at first glance appalling…even though I do not know all the circumstances. It does, however, beg the question….Why are the elderly often treated like children?
My mother, who passed away this year at age 93, read four or five books a week. Her mind was alert to the very end and she did have help with meals and the love of her family and friends, but I fought tirelessly to see that she kept her dignity until her last day on earth. She would have had it no other way. She refused medications that put her to sleep and even told the nurses , “I’m not taking that tiny one” when they brought them anyway. Dignity and alertness was important to her. She had a right to her own decision making.
Sometimes people wonder why the elderly get crankie or hard to live with. It may be medications…or it may be the loss of what was rightfully theirs all their lives…freedom to make decisions on their own. It is becoming clear that more and more society has its expectations. Even government wants to tell us what to eat, drink, and much more. Individual freedom may be at risk.
Sometimes we, as family members need to take a deep breath and sit down. We may need to say to this person getting up in years, “What do you really want? If we have someone come in to help out once in a while, will this be what you want..and need? ” There may be the tendency to want to take control without asking the hard questions. Most of us know when a person is able to function…even if the memory is a little diminished. If you have been a son or daughter who has not spent time in building a relationship, do you really have a right to tell a person what they should do or not do if they are in a relatively good state of mind? My advise would be to carefully consider how you are treating the ones in you life that will soon get to the last stages of theirs.
You view the video below and tell me what you think in “Make a comment”. I would be interested in the opinions from around the world:
- What does your culture say about the elderly?
- What is your “bucket list”? For those who maybe have not seen the movie with the same title, it is about two men who decide to do everything they wanted to do before they died. That is a “bucket list”.
- One thing we know is fact. We will die. Nobody wants to think about it…but we should. Not morbidly, of course, but if we can…..we want that moment to be with dignity.
Click on the video link below. (Turn on sound and forgive the commercial with this video. All these clips seem to have them…if we use them.)
Side-note: After viewing this, one may want to be careful about who we sign over our property to or what we put in our wills. )