Pick you fights

I was speaking with a neighbor the other day about her frustration with her husband and his memory loss. You see, this gentleman has been diagnosed with Alzheimer's and has reached that stage in the process where he is argumentative and suspicious. She is finding it harder and harder to hold things together.
My suggestion to her and to anyone else with the same challenge is to choose your battles. Ask yourself if the issue is going to be important in 5 years. Is it a matter of safety? How about economic health? Also, allow some space for a topic to cool off to avoid a major conflict.
Some times you also need to agree at the moment and then do what needs to be done when the person forgets the topic ever came up. This will take a delicate touch but it is worth it to develop the ability to tread lightly when needed and take charge when you can.

Keep it Clean

Just the other day, I was in a client's home for the first time and it comes to me that his situation is not all that unusual. There were plenty of informal care givers, children, friends etc but the house itself is in poor repair, cluttered and not clean. As we age our ability to keep things around us clean may be impaired due to medical or emotional issues. We need to step in to help when this begins to happen. Look around your relative's home and really take note of clutter that needs to be organized and trash that needs to be thrown away. Check the kitchen for proper food storage and get rid of spoiled food. Clean the counters, refrigerator and floor. Maybe clean the walls or paint them. Be sure that the bathrooms are clean and that the plumbing is in working order. This is all preparatory to brightening things up with a new coat of paint.
Another problem that pops up occurs when people move to small homes or apartments. The furniture that they own was made for larger rooms and now over fills the space. People will often hold onto things for memory's sake that are now only gathering dust. Sitting with your loved one to sort through the collected mound of stuff from a life time will take time but is worth the effort. You will be able to get them to toss or organize what they have elected to keep. You will also have the chance to reminisce about the good times.

Good locks equal safety, mostly

As things have changed since I was a girl (back in the Dark Ages) we are finding that we lock our doors when we leave the house and at night. This is instead of locking the front door so folks know you are not home but leaving the back door unlocked in case they need to get in. Images in movies include apartment doors with three, four and sometimes more deadbolt locks as well as chains. There is a perceived need for locks that is probably accurate. In order to be effective, the door jamb needs to be sturdy, the throw of the dead bolt (how far it goes into the door jamb) needs to be at least 1 1/2 inches and the door itself needs to be sturdy. A good locksmith will be able to set this up for a reasonable fee. It is also the law in many states that at least one door can be unlocked from the inside without a key. Just be sure that this door does not have a window that is easily broken to allow someone to reach through to turn the lock.
One thing we need to be aware of is that we cannot lock to house up so tightly that getting out in an emergency is a problem. If you have a family member who wanders, consider installing an alarm system to warn you if they leave the house. There are also pendants to be worn around the neck that are GPS equipped. These can be programmed to alert someone if the person goes beyond the perimeter that has been set up and to locate someone by pinpointing their location.

Safety on Your Feet

As we get older, our sense of balance can diminish. Our ability to catch ourselves if we start to fall also declines. In order to prevent a fall, we need to be sure that we are wearing the proper footwear. I am seeing some really attractive and cute slippers being offered in the catalogs we get this time of the year. If you intend to order these, take the time to check the soles. If they do not indicate that they are slip resistant, don't buy them. If you have them in hand, return them.

Flexibility: the Key to Mobility

Thanks to the Americans with Disabilities Act (ADA) it has become easier for mobility challenged folks to get around but it is not yet perfect. There are some public spaces that have been grandfathered into the act that have not been adapted for wheelchair accessibility. As facilities are remodeled, more and more are making the adaptation for access. Unfortunately, non-challenged people may not be able to spot subtle barriers. A 2" step may be too much for a small powered wheelchair or the rest rooms may be on another level without an elevator. Some places are just too narrow or otherwise cramped for someone to get through using a wheelchair or a walker.

Being adaptable and thinking creatively will go a long way to overcoming these challenges. Restaurants need to get supplies in somehow, you may find yourself coming in through the kitchen. If you can transfer or stand briefly, you maybe able to shift to a chair at the slightly higher level while someone lifts the wheelchair up one set of wheels at a time.

This is also the "teachable moment" for the manager or owner of a facility. Point out the barriers as pleasantly as  possible and if you can, suggest a solution for future reference. It has been our experience that most facilities are more than eager to help and happy to have the feedback.

Medication Safety: Keep it Bright

As we age, our eyes change. We may need glasses to read, cataracts may form or other issues arise. We are also more likely to be taking medication for a long term health issue. It is not uncommon for someone to be taking several medications several times a day. In order to be sure that we are taking the correct medication at the correct time we need to be able to identify the bottles when we go to take our medications. One of the best things to be done is to be sure that the area is well lit. If the medications are moved from the bottles from the pharmacy to a pill case, be sure to fill the pill case in a well lit location.

Medications and the Granny effect

There has been a recent rise in the number of children being seen the Emergency Room for accidental poisoning. Children have been known to take prescription pills, thinking that they are candy. They come in such an array of pretty colors after all. One of the reasons that children find medications and take them inappropriately is the "Granny effect."
When grandparents come to visit they will naturally bring their medications. Often there will not be a particular place to store the medications out of the reach of children and the medications may be in a pill dispenser case and not in a child proof container. Older adults often receive their medications in non-child proof containers because child proof can also mean senior proof as well.
Remember to find a place for visiting grandparents to store their medications safely out of the reach of little hands.

Family dynamics in crisis

As we are growing up we have the role that we play in the family and these will not change just because we are all grown up. In fact, the roles even become more rigid over time if nothing is done to change the dynamics. We also need to be aware that if one person changes everything else becomes unstable. When a family finds itself in a crisis situation, each person will usually act and react in a well established pattern.
There is the person who is "in charge" who takes care of everyone else and makes sure that what needs to get done gets done. The flaw here is that there is no one to step up if the person needing help is the one who has always been the organizer. This also interferes with other family members learning how to cope for themselves. This person is also less likely to ask for help or to accept help when it it offered.
The person who always finds humor in things can relieve pressure but can also keep folks from taking things as seriously as they should be. This person distracts everyone from the problem because they do not want to face the issue. This family member will find it hard to accept that Mother or Father needs help and may sabotage the efforts of the organizer.
There is also a behavior pattern that distracts from a problem by being a more "urgent" problem. This pattern will pull energy and resources from an aging relative who needs help. If this person has managed to grow out of this pattern it is hard for the family to trust that help offered will be there if it is accepted. Take the time to ask for help from this family member based on recent behavior rather than historic behavior.

Pets and the Aging - Part II

Having a pet is often a very good thing for us as we age. This is especially true for those of us who live alone. The companionship is comforting and being responsible for an animal is a reason to get up in the morning. Unfortunately, there can be too much of a good thing. In the last two weeks there have been at least three separate hoarding events in the news that involved animals.
The most common types of animals involved in these cases are cats or dogs. They are easy to collect and if they are not spayed or neutered they will produce new litters regularly. Many towns and cities have ordinances that limit the number of pets someone can own. There is a very good reason for this. Both the animals and the people will soon find themselves in an unsanitary and unhealthy situation if there are more than the home and grounds can reasonably handle. Cats and dogs need room to move around, a suitable place for them to "do their business" and a clean place for food and water. Cramming large numbers of animals in a small space is not fair to the animals or the people involved.
If your family member is hoarding animals, give them the opportunity to find homes for the excess animals. If this is not going to happen without intervention, call the animal control office. They will come and remove the animals and provide you with information regarding the next steps to take.d

Listening to Our Aging Relatives

Listening is something we all think we are doing all the time. Multitasking by texting while we are also in a conversation or playing a game on the computer while we are on the phone may lead to incomplete understanding of what was said. This can be especially a problem if we are having a conversation with our aging relatives.
We need to be present in mind as well as in body when we are talking with our relatives, friends and acquaintances. Listening is an active process. Paying attention to what is being said, noting non-verbal clues and knowing what has already been said in the conversation are all ways to listen actively. Do not think of your reply before the other person stops speaking. Ask for clarification of a statement that was made. Restate something or paraphrase it to be sure that you understood. All of these practices will improved communication.
Another thing we need to keep in mind while we are talking with our aging relatives is that they do usually have something to say. They have many years of experience and may provide a new point of view to enliven the discussion. They may also be giving you an opening to discuss uncomfortable issues such as money concerns, safety concerns or end of life issues. How they feel about the last days of a friend or relative can give you a hint about how they want to be treated.
We also need to allow them to be happy, sad, fearful, angry or any other emotion that presents itself. Nodding and making "listening noises" (I see, and then what happened, really!?) will encourage them to share what is really going on. You need to acknowledge how your relative is feeling about an issue, do not assume that they want you to fix whatever is wrong and do not try to minimize what they are feeling.

Supporting New Hobbies and Pursuits

As we age many of us find that old hobbies and activities are not so pleasurable as we once thought. Our abilities change, the activity becomes associated with a negative memory or we simply lose interest. Those of us who are intellectually lively will usually seek out a new interest. Meeting a new friend or beginning to date someone may also stimulate the desire to learn new things. The same situation holds true for our aging relatives.
Just because someone decides to become involved with new pursuits does not mean that they have taken leave of their senses. Learning about new things or starting a new career are clear indications of being an active participant in life. Your loved ones deserve your support in the new activity.
One thing you need to do when this new activity breaks out is to be sure that your loved one has the physical capability of participating safely. Be sure that they have checked with the doctor and are taking appropriate safety precautions.

Fall Risks for the Aging

Just this past weekend we had two risky events. I stumbled in the parking lot of the local big box store and my husband slipped in the bathroom. Of the two, the bathroom slip was the more dangerous. The stumble was only potentially embarrassing.
As we age the risk of serious injury from falls increases. Bones become more brittle and the risk of a break secondary to a fall increases. Our loss of muscle mass leads to greater challenges as we try to catch ourselves to stop a fall or weakness that may lead to a fall. We are also more likely to have challenges to our sense of balance.
These are only the reasons that we may fall, where we fall also effects the outcome. In the parking lot I had visions of scrapes on hands and knees from the blacktop while I moved forward to regain my balance. The risk of a break is there as it is with any fall but scrapes and bruises are more likely.
The concerns in the bathroom were greater for a couple of reasons, the first being the hard surfaces in most bathrooms and the fact that my husband uses a blood thinner per his doctor's orders. We have grab bars well placed around the toilet and the shower which came in handy to help my husband to guide himself to a sitting position and a softer landing. We have added slip resistant tape to the bottom of the shower rug (it slipped to cause the incident) and will be adding another grab bar in the shower to accommodate his increasing difficulties with balance.
When there are changes in status, always move to change the responses as quickly as possible. The changes we have made and will make in the bathroom will allow us to continue in our home with safety.

Hot, hot, hot

Even if you think that global climate change is not real, you cannot ignore the heat that is baking the US at present. There is also a drought in Africa that is resulting in famine. The rains and run off from snow melt combined to create flooding in the Midwest this past spring and the evaporating waters drive the humidity to raise the heat index to record levels.
Throughout all of this we need to keep in touch with our aging relatives and neighbors. The power grid is being stressed and we are beginning to hear about brown outs and other power interruptions. This raises the risk of heat related injury and death, especially for the very young and the very old.
One of the problems for the aging population is that they do not notice that they are becoming dehydrated. By the time they are thirsty they are already at risk. Be sure that they stay out of the heat in an air conditioned area and that they drink at least a quart of water or non-alcoholic beverage an hour if they are not in air conditioning. Preventing heat stress is easier than treating it.
If your family member or friend is in distress, call 911. They will send help and will provide guidance for what you can do while waiting for the Emergency Services to get to you.s

Living Arrangements for the Aging -What's out there

I have recently been posting about my friend's search for a new and more suitable living arrangement. We have been looking at Assisted Living facilities and tomorrow we will tour a Continuous Care facility. Many of the services that each of these offer are similar but there are specific differences between them.
Assisted Living facilities will usually charge a one time community fee and a monthly rental on the space to be occupied. This will be a room and bath at the least but will often also include a kitchenette with a space for a microwave and a small refrigerator. Some larger units will also have a small second room as well. Meals are supplied in a communal dining room and there will be support services to keep things clean, get the laundry done and support your loved one with taking medications. Depending on the facility, these services will be included in the rent or may be additional cost as needed. Nursing care will be available 24 hours a day when needed.
Continuous Care facilities have more options and a resident can move through the facility depending on the amount of care they need at any time. It is possible to move from independent living with meals and access to medical support all the way to a nursing home placement if it were to become necessary. There is generally a larger buy in fee than for Assisted Living along with the monthly rental fee but this will allow you to be sure that your loved one will be well cared for with a minimum of disruption as they age. There will also be an age restriction for the youngest age at entry to the facility.
Either option is worth considering if you can take your time and work through the process before there is an urgent need for a new place to live.

Protecting the Aging from Excessive Heat

Here we go again! We just posted several days of 90 + degrees and summer is still three weeks away. Now is the time to pay close attention to our aging friends and relatives. They are more prone to become dehydrated and will often forget to drink enough to prevent problems. Of course, it is not uncommon for them to restrict water because they don't want to need the bathroom all that frequently. They are also at risk to not notice the signs of dehydration until they are really in trouble.
My best trick for getting them to drink enough liquid is to find a particular glass and give them specific instructions to drink 3 or 4 glasses full from that glass. The number of times that they should fill the glass each day is calculated to give them at least 32 ounces of water each day. This water in addition to the liquid in their food and taken with meals will help them to stay hydrated.
Notice that you need to keep hydrated yourself. Drink water, juice, milk or soda to keep up your hydration. Avoid caffeine because it pushes your kidneys to put out more liquid and you will be defeating your purpose. Alcoholic beverages should also be avoided because they will also interfere with staying hydrated.

Wild Weather and our Aging Family and Friends

Every time we turn on the news lately, it seems that there is a new story, complete with distressing pictures, regarding damage to lives and homes by the forces of nature. The flooding in the Midwest has been horrendous but there was plenty of warning, particularly for towns downstream. There is some warning regarding tornadoes but not nearly as much as we would all like. This year the storms seem to be more violent than usual as well.
Every area has its own dangers from nature. Humans find themselves in the path of everything the planet can throw at us but we can also be prepared for what can be expected.
Take the time to sit down with your aging loved ones, maybe even all of your family and make a plan to meet the challenges you can reasonably expect where you live. Set up an emergency pack with items you can expect to need that can be grabbed in a hurry if you need to evacuate. Include a list of medications and contact information in a water proof bag in the back pack or other bag along with a couple of days worth of clean clothing and a small quantity of high energy food (energy bars, trail mix, etc) When the time comes to leave the home it will be easy enough to toss all your medication into a large storage bag and add it to the larger emergency bag.
Take the time to store irreplaceable items in a manner that will reduce the likelihood that they will be destroyed by a flood, fire or storm. It may even be worthwhile to store them in a safety deposit box at the bank.

Medication Safety for the Aging

The older we get the more likely we are to need some sort of medication on a regular basis. I have talked about storing medications safely but there is so much more to keep in mind. You may have heard it before but it bears repeating; store medications in the containers in which they come. These containers will be labeled with the name of the medication, the strength of the pills (milligrams) and how often it is to be taken. There may also be additional important information. It is perfectly fine to set out a week’s worth of pills in a pill case that is labeled for the day of the week and possibly the time of day that the medications are to be taken. If you are traveling, be sure that you have a list of the medications you are taking and if any of them are narcotics, keep them in the original prescription bottle.

Be sure that you understand why your physician wants you to take each medication, how you are to take the medication and what side effects can be expected. You may need to take a medication with or without food, avoid certain foods while taking the medication or you may need a certain amount of fluid with each pill. You may also need to sit upright for at least an hour after taking the medication. Side effects may need to be reported right away or only when you next see the doctor. You should also know any symptoms that would require a trip to the Emergency Room due to an allergic reaction. Never hesitate to ask for clear instructions and plenty of time to ask questions.

Driving, withdrawing gradually

Beyond a doubt, when to hang up the car keys is arguably one of the most stressful decisions a family needs to make. Sometimes we are lucky enough to have our aging loved ones voluntarily stop driving, more often there is stiff resistance to the idea. Driving represents independence as no other issue except maybe control of money. Recognizing the need is hard enough for the family, the aging driver is unlikely to acknowledge the increased challenges unless there is a significant or dramatic incident that is unmistakable.

It is possible to start the conversation related to events in the news. The current high gasoline prices represent a wonderful opportunity to talk about decreasing time behind the wheel. Offer to take your aging loved one to the market when you go as a cost saving measure. Suggest that you will drive them to religious services, to the doctor or wherever else they need to go and you can complete an errand of your own at the same time. Any news item regarding an aging individual who got into trouble driving will also present an opportunity to open the topic for discussion. It also is possible to start the discussion if there is a change in a person’s medical condition that will make it less safe for them to drive.

If you can get the conversation started, consider suggesting a gradual decrease in driving. Limiting driving to daylight hours, close to home and/or familiar destinations is a way to ease into the change.

Storing Medications Safely

As we and our loved ones age, it becomes increasingly likely that we will need to take medications for chronic conditions. We also usually keep over the counter medications in our homes for pain management, symptoms of the common cold or other simple occasional problems. The most common places to store medications are the bathroom and the kitchen. There are issues with both places.

The bathroom may be a convenient place to store medication but there is a great deal of humidity due to bathing activities we complete in the bathroom. The medicine chest is often placed over the sink which increases the rate at which medication is affected by moisture. Medications will often lose potency from the exposure.

The kitchen is the other place that people store medications. This keeps them convenient to remind us to take them as we should but will often put them in easy reach of children. We should always take care to teach children to leave medicines alone but the teaching isn’t always effective. There is less chance of humidity becoming a problem in the kitchen.

The safest place to store medications is in a sealed container (Rubbermaid, Tupperware or such) in an upper level cabinet.

Gun safety in the home

You only need to open the newspaper or turn on the television to see that there is a great deal of gun violence. The response to this violence is to either get rid of any firearms or to get and keep a gun in the house. Whichever choice you make, you have every right to decide for yourself. One thing you need to be sure of if you choose to own a gun you must take gun safety into consideration. There is nothing more unsafe than having a gun in the house that you do not know how to handle.

If your aging relative has a weapon in the house, take the time to be sure that they can still use it properly. Take them to the firing range to have them checked by an expert. It is a good idea to verify with them that they know how to load, unload, clean and where the safety is and when it is on or off. Be sure that they have the gun and the ammunition stored safely.

If your relative has changes in their mental status or physical condition that result in them being no longer able to use a gun safely, ask them to give up the weapon. If they wish to keep the gun, do what you can to remove all of the ammunition from the house.