Changes in Mental Status

Change in Mental status is a general description for any alteration in a person’s ability to think clearly. This may be a decrease in alertness, an increase in confusion or other change such as increased suspicion of people around the person with the change. This should usually be evaluated in the ER so that the cause can be identified and treated as quickly as possible in order for the person to have the best outcome possible.

There are many reasons for a change in mental status for our aging family members and friends. The most concerning would be stroke and the easiest to treat would be a urinary tract infection (UTI). Any infection could be a cause of confusion in an elderly person but for some reason UTI’s do get missed for several days if the proper tests are not completed quickly. This will happen in the ER because the lab is in the same building while results may take a couple of days in the doctor’s office.

Choosing the best doctors for yourself and your aging relatives

As we age, we are more likely to need the services of health care professionals. These will probably be recommended by your Primary Care Physician (PCP) in response to a change in your medical condition. If you are not getting the recommendation from your PCP there are couple of things you need to consider when choosing a specialist.

The first and foremost issue to settle is whether or not the MD is Board Certified in their specialty. Any licensed physician is able to treat any person for any disease but most will focus in a particular area of medicine. They will also participate in additional education regarding the most current treatment of this area of focus. The very best will become Board Certified. This will include additional testing and continuing education to keep up with the latest standards of practice.

The other issue to resolve is how well do you interact with the MD? If you do not feel comfortable working with the doctor or cannot communicate well your care will not be the best. Always take the time to find the doctor who makes you feel that you are important enough to listen to.

ER visits and the Aging

It is very likely that each of us will need to be seen in the ER at some time or another. It can be an overwhelming experience but if you and your aging relative have taken the time to be prepared things can go as smoothly as possible.  Some things you may set up for emergencies include beyond your identification and personal information include the following:

·         A complete list of all medications you (and your loved one) take. This needs to include medications prescribed by the doctor, over the counter medications and any herbal remedies. This needs to include the amount of each medication and how often each medication is taken. Include a list of allergies with your medications.

·         A list of your doctors that includes first and last names, telephone numbers and specialties.

·         A list of chronic health conditions and at least a brief medical and surgical history.

·         The name and contact information of your Medical Power of Attorney

·         Your health care insurance name and identification numbers. This will be on your insurance card and contact information will be on the card as well.

·         The name and contact information of your religious or spiritual leader if that is important to you.

The reason to keep this information together is to allow you to focus on the emergency that caused you to come to the ER and not need to remember details that are important but hard to recall. This information can be written on a paper and kept in your wallet (and the wallet of your Medical Power of Attorney) or stored on line by a Medic Alert company and made available by information on a Medic Alert bracelet or necklace.

Caring for Relatives with Special Challenges

I have just become aware of the death of the husband of a friend. While this is very sad, he was 85 and had been ill for sometime. He died at home and no extraordinary measures were taken. The problem left behind is that his wife, my friend, has challenges that make it very hard for her to handle the day to day responsibilities to keep the bills paid and the house maintained. She is 60 and is a person with Asberger’s syndrome which is often described as a high function type of autism.

Fortunately, there is a will and she has two step-sons who will be able to assist her and possibly become conservators for her and the estate.  I am aware of another situation where this was not the case and the lack of a will complicated matters so that nothing was settled for nearly a year. This wait occurred while the intellectually challenged son of the deceased struggled regarding his own care and living arrangements. In that case, the nephew of the challenged person was able to step in to help.

If you are aware of a person with intellectual challenges, the challenges presented by autism spectrum disorder or physical challenges due to mobility issues and are close enough to pose the questions, be nosy. Ask if arrangements have been made. Offer to help find the proper attorney. If this person is in your family, take the time to be part of the solution.

Helping without Insulting the Aging

As our loved ones age they will probably need some help to remain in their own homes and to continue to be relatively independent. They also have their pride and do not wish to be a burden to us. The trick is to balance what they need, what they can do for themselves and how to step in only when needed.

Abilities will decline as people age and sometimes there is an event that will radically change what they can accomplish for themselves. A stroke, a fall or a cardiac event may result in a need for help but remember that it is possible to recover from these events and come to a new normal in relation to what we can do for ourselves. It is as hard to let our aging loved ones struggle with a task as it is to watch a child learn a challenging skill. In both cases, stand ready to help but let them go as far as they can alone.

When ongoing help is needed, it is very hard for most folks to accept your help because they do not want to be a burden. Reassuring our loved ones that it is a privilege to help is a good start but expect to meet some resistance along the way.

Emergency preparedness, more than just scouting

I haven’t posted anything in several days because I have been focused on the news from Japan and worrying about the family of friends living there as well as the people of Japan in general. We, as a nation, have come to be friends and allies with our former opponents and we find ourselves trying to find ways to help in a nuclear event that is not of our making.

One thing that has been evident in so many of the news stories is that the Japanese are helping each other with great generosity of spirit, no one appears to be taking advantage of the chaos by looting and caring for and protecting the elderly is as much a priority as caring for the children. This is an example of how each member of the community is valued.

Another thing that has been mentioned time and again is that the Japanese have taken personal responsibility to have emergency supplies. This is a very good idea for all of us to imitate. Now is an excellent time to sit down with all of our relatives and work out what supplies need to be available in the home (check abcnews.com for a fundamental list) and plan for how we would find each other again after a disaster. This would need to be tailored to fit the types of disasters that are more likely in your area. I don’t expect tornadoes on the East or West coast but they are so very common in the Midwest. Earthquakes are a significant concern on the West coast but are not unheard of in the rest of the country. The flood plains are well identified and flash floods occur with alarming speed in the Southwestern deserts. Your emergency plans and supplies need to take this into account.

Fire Safety and the Aging

We are about to shift to Daylight Savings Time, when we go to bed on Saturday night we should be moving our clocks forward an hour to be sure that they are right when we wake up on Sunday morning. The local fire house is also reminding us to check the batteries in our smoke detectors. Now is the time for us to check the smoke detectors for our aging relatives as well. This will serve safety in at least two ways. We will be sure that there is a working battery in a working smoke detector for our relatives. We will also keep them off of ladders.

If we don’t change the batteries twice a year (spring and fall) they will fail at some time. It seems perversity that they fail in the middle of the night but there is a solid scientific reason for this, when a battery is weak it will fail when the temperature drops as it does at night. Be sure that your aging relative knows that the smoke detector will make a chirping noise when the battery is dying. I can’t tell you how many times I have visited a patient in their home to find the smoke detector chirping and the patient without any idea what the noise is. Also, as we age our hearing will often decline and we may not hear the chirp.

It is never appropriate to remove the dead (dying) battery to stop the noise and do nothing to re-establish the smoke detector. The presence of a working smoke detector has saved many lives in the past and will save many in the future.

If your loved ones smoke, please take the time to be sure that they do not smoke in bed and that they handle the ashtrays safely. If you can get them to stop smoking they will be safer, their lungs will work more effectively, they will be burning less money and food will taste better. All this will only work if they are willing to make the effort.

Abuse and the Aging

Mickey Rooney just testified before Congress regarding how he believes that he has been abused by his step-son and step-daughter. There is some indication that Brooke Astor was financially abused by her son and daughter-in-law. While these are both cases involving a great deal of money and control of that money, there is a thread common to many cases over the entire spectrum of aging persons; the persons who are entrusted to care for persons when they are unable to care for themselves fail in their responsibilities.

We need to be aware of what is happening with our aging friends and relatives. Abuse takes many forms and some are more evident than others. Frequent “falls”, bruises, broken bones and other injuries are relatively obvious if you are seeing your relative regularly. While this may not be actual battery by the caregiver, failing to obtain medical care is also abuse. In either case, this needs to be reported to someone. If there is an immediate danger, call 9-1-1, if not check with the county office of services to the aging, the person’s primary care physician or clergyman.

If you notice that someone lacks clothing that is in good repair, appropriate for the weather or if the house is not being maintained, check up to see what is happening. If the aging person is losing weight, follow up. The weight loss may or may not be related to being deprived of nutritious food in large enough quantities.

Don’t wait for the aging person to speak up if you are concerned. The abused individual may be ashamed that they have lost control over their finances, health care, etc or they may be frightened to talk to anyone for fear of retaliation. The abused person is often in a situation that can not be changed from within; if you are concerned, take action. Keep in contact so that you will notice changes that need to be addressed.

Traveling with the Aging or Chronically Ill

When you are planning a trip and one or more of the travelers has a chronic medical condition there are certain precautions that should be taken to limit problems. Take a complete and accurate list of all medications that each person is taking on a regular basis. This should also include medications prescribed by a doctor but taken on an as needed basis such as pain killers or allergy medications. Take all prescribed medications in their original containers. This is especially important if you are taking a narcotic for pain relief. This is even more important if you are leaving the country. Customs officials can be quite intent about medications. Be sure that you have something from your physician if you are taking any medication in an injected form such as insulin.

If you or your traveling companion has need of equipment try to pack it in as compact a package as possible. If you need to stow this item in the hold of the airplane, be sure that it is in a suitcase or other devise to keep it from being damaged. Purchase insurance for the full replacement cost of any equipment for loss or damage. If it is possible, take it on the plane as carry on luggage. Check ahead with the airline to be sure that they are aware you will be bringing medical equipment and to see if they have special requirements.

Purchasing insurance for your equipment is only part of the picture. Purchase travel insurance to be sure that you can get home for medical treatment if needed. If you have a medical emergency in a foreign country, try to be stabilized before you are transferred if that can be accomplished. Use your judgment concerning the medical facilities where you find yourself and never be shy about insisting that things be attended to as quickly as possible. If you are overseas, don’t hesitate to call the American Embassy for help. That is part of their job.

Traveling with the Disabled

Although this blog is generally aimed at issues facing the aging and their families, this is one area that applies without regard to the age of the persons involved. When we have a family member who has difficulty walking or needs a wheelchair, travel becomes more of a challenge and there are destinations that need more planning than others

The key to traveling with someone with mobility issues is planning. Here in the US, the Americans with Disabilities Act (ADA) has made it easier for people to have access to hotel rooms, restaurants and resort destinations. Museums, amusement parks and historical sites are also at least mostly accessible. If you plan to travel to Canada, there will be some mobility issues in the older sections of the cities; there is reasonable accessibility in most places. There is a law in the UK similar to the ADA which improves mobility but it is essentially impossible to retro fit as castle. Plan your itinerary around what you can do and what obstacles may exist in your destination.

One thing to keep in mind when planning a trip include is to not over schedule your days. It will take at least an extra half hour for every hour others might spend at a site or event. Remember that handicapped persons will tire more easily than those without mobility issues, schedule rest periods. You and your traveling companions will not cover quite so much territory but you will find that you will enjoy what you do see much more.

Be sure that you ask for a handicapped accessible room when you make your reservations. Include specifics concerning what accommodations you need; grab bars, a walk in shower, a larger room, rooms on the first floor, etc. Hotels in the US will have this type of room available but they will not be in every room so book early.

If you need to travel with a great deal of equipment, it may be reasonable to include extra people to help wrangle the baggage. There are sky caps and porters available most places if you are only two traveling together.

One last suggestion; cruise ships are well equipped to assist those travelers with mobility issues and will know which of the shore excursions are equipped to accommodate travelers with mobility challenges.