Hand Hygeine

Hand hygeine is an important health preventative for everyone to remember, but is especially important in the elderly.  With a decline in +mental processing or +physical decline in health, toileting can present challenges that were not there before.  Because of this, hand hygeine can also be a problem.  With failing vision or memory, hand hygeine can be forgotten, hands not washed long enough to remove germs, or under nails improperly cleaned.  Improper hand washing can spread germs easily, but this can be especially problematic among the elderly.  +Norovirus, +flu virus, +staph infection, and +ecoli are all easily spread but improper handwashing and can all be potentially fatal among those with weakened immune systems.  Norovirus can cause fatal electrolyte imbalance and dehydration or even aspiration.  Staph infection can be threatening with thinning skin and poor skin integrity, where a skin abrasion or tear could lead to staph contamination from scratching. Ecoli can cause severe gastric illness and flu can be difficult to overcome in the elderly. Ensuring that your loved one keeps their nails trimmed and has a nail brush to clean under nails is also helpful when emphasizing hygeine.  +Hand Sanitizers are helpful in reducing the spread of germs, but should not replace the importance of hand washing with antibacterial soaps. 

Avoiding Pressure Sores on the Rear

Pressure sores in the sacral region are especially concerning.  This is the region of the body where the spine meets the top of the rear end.  This condition can be caused or aggravated by several things.  Here is a list of causes/reasons for these sores: a) Prolonged sitting. b)Incontinence and soiled briefs. c)Decrease in hygeine and perineal care.

To remember first and foremost, encourage toileting and/or repositioning every 2 hours.  This will force the body to move about. 2nd, encourage fluids for hydrated skin. 3rd, change brief and shower daily, and last but not least, get a good barrier cream such as +Lantiseptic.

Hearing Loss or Slowed Processing?

Family and friends often recognize when a change occurs with their loved one, but sometimes are unsure what they are noticing.  One way to decipher if there is a hearing problem or a slowed processing problem is to get in front of your loved one a speak clearly where they can see your mouth and be close enough to hopefully hear you.  If they can give you an quick response when they can see what you are saying and hear you, then you are dealing with a hearing loss.  If they seem to be able to hear but take a while to respond (more than 30 seconds), then a neurologist should be consulted and testing done.  Also, many hearing aide retailers will give free preliminary hearing tests to advise if a trip to the audiologist is needed.

Evacuation and Emergency Plans

With all of the fiascos in the news as of late, I am reminded of the importance of disaster planning for the elderly and disabled.  The recent explosion in West, Texas that devastated that little town left me in complete awe of their emergency response team.  Those wonderful folks were successful in evacuating an entire nursing home before it burned to the ground, among everything else they had going on.  Just within the past week we have had a devastating tornado go through Oklahoma and floods now occurring in San Antonio.  It is important to be sure your loved one has an emergency plan in place, even if they are living in a facility.  If they are in a facility, have the management go over what the protocol is for each state of emergency.  It is always best to keep important documents and family heirlooms in a safe deposit box if it is possible, but if that is not possible, I would advise investing in a coded fire safe box.  Also, in this box it is important that you keep a list of all current doctors, medications, and pertinent medical information, especially documents such as a living will, DNR, or power of attorney.

If your elderly loved one lives alone, please check all smoke and carbon minoxide alarms monthly.  Ensure that there is always more than one usable exit to the outside and that there are no trip hazards or fall risks in the pathway.  If your loved one is having difficulty with mobility and is still living at home, please be sure that a wheelchair could get out the door and away from the house.  You may need to look into a wheelchair ramp.  Many companies such as +Allumed and other mobility companies have removable handicap ramps that do not have to remain a permanent fixture to the home.  Make sure your loved one has easy access to a phone, hopefully with large lighted buttons, so during an emergency they can see to dial.  It may seem like overkill on a normal day, but in a smoky dark room it can be the difference between life and death.  

Aging Couples and Independent Living Options

One of the problems that may be encountered with aging couples is the decline of one spouse.  As an aging spouse begins to take on the role of caregiver for the ailing spouse, caregiving can become overwhelming.  We have discussed many options, but I would like to touch on Independent Living centers today.  The independent living option is more for the sanity and success of the caregiving spouse.  A community I have worked with in +Cedar Park, TX is +Lakeline Oaks, a subsidiary of the +Steve Mueller Lifestyle Resort Communities.  In this community residents have individual apartments with internal hallways, weekly maid service, three cooked meals served in the facility dining hall, planned daily activities, a privately contracted home health agency such as +Capitol Home Health on site, bank on site, gym, theater, privately contracted personal care services (such as my employer +ComForcare Home Care of Austin) available, bus transportation, and a doctor that provide weekly visits to the facility and has an office on site.  With all of these listed ammenities, the caregiver is relieved of much of the stress and isolation that occurs with caring for an ailing spouse.  Meals and meal planning are taken care of, basic housekeeping, having to get the spouse to appointments in town frequently, and the ability for both spouses to socialize is critically important.  In these type of facilities, the caregiving spouse is surrounded by a tightly knit community and support network.  As I have addressed in previous posts, isolation and depression for caregivers can be crippling and cause significant decline for the "well" spouse.

Signs an Elderly Loved One May Need More Help

Here are a few things to look for that may indicate your loved one may need a caregiver or new living arrangement.

1. Changes in grooming habits.  Hair frequently unkempt, wearing the same clothes day after day, body odor.

2. Abnormal financial issues such as unpaid bills, bounced checks, overspending, or abnormal charitable gifts he or she cannot afford.

3. Confining him or herself to a certain section of the house.  If he or she seems to avoid the kitchen or everything seems clustered into one area.

4. Decrease in mobility, avoidance of stairs, frequent falls, unexplained bruising that looks like it is from a fall.

Recognizing Grief and Loss

As I sit here tonight, it has been a tough week for the nation.  We had the bombing in Boston. Tonight in Texas, an entire town was evacuated due to a fertilizer plant fire, which has been catastrophic for the elderly and disabled there, and children have been harmed and died from senseless cruelty.  Today, many of us are likely to be feeling a sense of loss and bewilderment.  However, if I might call attention to that feeling for one moment I think you will understand why.

It is vitally important that once someone receives a diagnosis of a health crisis or deterioration that they be allowed to be angry.  Naturally, it is important to also remind them not to lash out at their support system.  That said, anger is an important stage for grief.  Imagine your sense of loss over the above issues, and then imagine that you are slapped in the face by your own body every morning you try to get up and carry on because a health condition is stealing your abilities and your independence.  How did you feel when you passed that 30 mark and then snowballed to 40, 50, and 60 years old?  Some days the sense of a lost youth creep in. Our loved ones with chronic illness and health problems have to try to make peace with loss every day, and sometimes many times a day.  It is good to acknowledge the sense of loss and give that emotion a name.  That way your loved one can verbalize that it is not the caregiver they are mad at as much as it is the illness and be relieved from a feeling of guilt.