KEEPING TRACK OF THE CONFUSED ELDER’S HEALTH RECORDS

(PART I)

It is going to become more and more important for the family member of the elderly to keep accurate and current health records. This will require the family not only to keep written documentation but also to ask the right questions about a disease process, signs and symptoms of problems and have a full understanding of the medications for that disease process or diagnosis.

What is a current diagnosis?

If the elder fell and broke their right arm 5 years ago, it healed as expected and is as “good as ever.” That fractured right arm is not a current diagnosis. Cancer that has been in remission and is now considered cured, is also not a current diagnosis.

Diagnosis are recognized by disease categories:

  • Cancer
  • Heart/Circulation
  • Gastrointestinal
  • Genitourinary
  • Infections
  • Metabolic
  • Musculoskeletal
  • Neurological
  • Nutritional
  • Psychiatric/Mood Disorder
  • Pulmonary
  • Vision

Hypothyroidism is a condition in the disease category of metabolic diseases. Heart failure is a condition in the disease category of Heart/Circulation. For the elder’s current list of diagnosis you want to write down any diagnosis they are taking medication for. Once a person has been diagnosed as a Diabetic (Metabolic diagnosis) and using insulin – as long as they are on insulin this is a current diagnosis. If the elder is taking a medication for high blood pressure – than they have a current diagnosis of Hypertension.

In any emergency situation; paramedics, emergency room personnel, new specialist, hospital admission any of these healthcare situations require the most current information you can produce. Having all the pertinent information at your finger tips makes the situation easier on everyone, especially the elder.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

BRACE YOURSELF – NOT FOR THE FLU, BUT FOR YET ANOTHER OPPORTUNITY FOR THE MEDIA CARNIVAL

Summer isn’t even over and it seems that many apparently can’t wait to scare the pants off the population with words like “pandemic.”

This comes under the heading of:

Fool me once, shame on you! Fool me twice, shame on me!

The real flu pandemic – 1918

Yes, the so called “Spanish Flu” killed millions of people world wide. They still haven’t found where that flu originated, yet they call it “the Spanish Flu.”  It circled the globe several times from 1918 through the middle of 1920. Some say 20 million died, some say as many as 100 million. The interesting thing was, it wasn’t the very young or old who died it was the young, healthy adult.

They now blame it on an over reaction of the immune system in healthy people called, a cytokine storm. If you weren’t that robust or healthy, your body didn’t have such a strong reaction when you got the flu and it followed a normal course.  Although many deaths were the direct result of the flu, as usually is the case, it was the resulting bout of pneumonia that was actually the killer.

Again with the pandemic.

The signs are still out in front of the corner drugstore “H1N1 Shots Available” from the last pandemic forecast. And now the news is out that new vaccines coming out will protect against 3 influenza strains including the 2009 pandemic flu.

Every time I hear this kind of “news”, I have a mental picture of men in suits giving each other a high “5” – someone will be making big money. I will do the same thing I do every flu season – wash my hands, avoid people who are obviously sick and should have stayed at home and up the amount of D3 I take. (I have a reputation for never being sick, go figure)

Virginia Garberding, R.N.

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

WHEN THE ELDERLY PARENT SHOULD NO LONGER DRIVE – TAKING AWAY THE CAR KEYS

(Part III)

No matter how difficult the conversation, when it is the family who observes the changes in the elder’s ability to drive, it becomes the family’s responsibility to face the situation. Waiting for the State to pass a law mandating regular testing of elders is not an option. Not when the family knows the elder should no longer be granted the privilege of driving a car. A very effective way is to gather people who are significant and considered credible by the elder. This could be family members, friends, clergy, physicians, any one who has a close relationship to the elder and is valued by the.

Holding a family intervention.

  1. Set the rules for the intervention – if someone in the group doesn’t know when to let someone else talk – set time limits
  2. Give facts about the elder’s driving – Identify driving behaviors that members of the family have witnessed:
  • Crossing over the lane lines
  • Going off the road
  • Getting lost going to a familiar place
  • Other drivers honking at the elder
  • Asking passengers to read signs
  • Not yielding to other cars
  • All driving behaviors that are contrary to “Rules of the Road” conduct.

(See part II of this series for bad driving behaviors)

  1. Don’t become distracted with other issues – stick to the subject of driving
  2. Give driving facts:
  • In accidents that involve an elderly driver – the elder is most likely to be injured
  • Describe how the elder’s life would change following an injury; pain, disability and increased dependence
  • How upset the elder would be if their actions driving would cause injury to someone else, especially a child
  1. Offer solutions:
  • Identify who will now take the elder to; doctor, dentist, pharmacy, barber/beauty parlor, dry cleaner, Church, clubs, hardware store, grocery, visit friends, etc.
  • Avoid saying things like “Someone from the Church will be glad to come and get you,” or “I’m sure we will all help out driving you.” These statements are way to general – this situation calls for specifics, so the elder does not worry.
  • If appropriate – suggest the elder take a driver’s course developed just for seniors.
  • If appropriate – suggest an eye exam and have the elder’s physician check reflexes.
  • If the problem might be the car – suggest someone take a good look at the car – is it easy to drive, are the controls easy to use, does the elder have a good field of vision when sitting in the car.
  1. Re-state what everyone learned in this intervention and most important what everyone promised to do including the elder.

If the elder will not cooperate with a family intervention or discussion of the driving issue – a last resort can always be to disable the car – especially in the case of a very confused elder who is dangerous on the road.

Virginia Garberding R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me-Aging with Dignity and Relevance

www.pleasegettoknowme.com

WHEN THE ELDERLY SHOULD NO LONGER DRIVE, HOW TO TAKE AWAY THE CAR KEYS

(Part II)

As people age they start to change their driving habits. The elderly start driving slower, drive during daylight hours while most people are working, and try to avoid left hand turns and crossing traffic. (Even so statistics tell us that 28% of accidents involving elderly drivers were due to left-hand turns) Taking these self imposed adjustments into consideration, when you study statistics it is surprising that there is such a high amount of accidents involving the elderly.

The reported statistics could also be skewed by the under reporting of accidents by the elderly. One need only drive around an area like Boca Raton, Florida, to see the many fender benders on cars driven by an elderly person, that haven’t been fixed. Crash statistics are generated from reports by the DMV as well as insurance companies. Many people can attest to the elderly person who has hit their car and begged them not to report it, so it won’t go against the elder’s insurance.  And, the elder who decided to pay for the damage on the other person’s car then forgoes having their own car fixed.

Added to this is the fact that when the elderly driver is in an accident they are three times more likely to be the one hit, then the one to hit someone else.  This of course due to incorrect turns, changing lanes inappropriately or just weaving back and forth in their own lane, slow reflexes and generally doing something unsafe in front of another moving auto, causing the elder to be hit.

Why is it so difficult for family members to stop their elder from driving? Giving up the privilege of driving represents a very hurtful change for both the elder as well as the family. No one wants to see their parent get old. This is the person who taught you to drive and probably helped you buy your first car.

I read recently where a woman said of her father-in-law. “My father-in-law can hardly walk, has trouble following a conversation, falls asleep at the drop of a hat, has serious reaction time issues and yet he is still driving. Frankly I am afraid he is going to kill himself or someone else.” But as she continues, she seems to be looking to the government to step in with some regulations that will stop him from driving. Some kind of new law mandating driving tests for the elderly. Who should bear this responsibility?

Virginia Garberding R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegetoknowme.com

WHEN THE ELDERLY PARENT SHOULD NO LONGER DRIVE, HOW TO TAKE AWAY THE CAR KEYS

(Part I)

A friend came up to me recently and said her father had failed his drivers test and was so angry. He was now refusing to stop driving, what should they do? Family members have such a difficult time telling their parent they should no longer drive. Driving is such an emotionally charged subject. This is the person who taught you to drive and now you are telling them they are unsafe.

When my Dad needed to stop driving we knew. He had gone into a ditch that winter while driving after dark. When you rode with him as a passenger, you were aware that other drivers were honking their horns at him, and you assumed he wasn’t staying in his lane. We asked his physician to intervene and he notified the state.  Dad was then notified of a need to take a driver’s test. Even though I got him a copy of “Rules of The Road” that he studied, and then I tested him on those “rules” every Sunday when I visited. When the fateful day came Dad, failed the test.

(Book excerpt)

When Dad went through his journey with Alzheimer’s disease, we started where most families start-the awareness that Dad was no longer safe to drive his car. “How can we get him off the road?’ we asked each other.

Mother had already had a stroke and lived in a nursing community. The plan was to move her to a place where Dad could also have an apartment and no longer had to drive. That plan worked out very well, and soon after the move we got rid of the car.

Dad recruited a little band of volunteers on whom he called when he needed transportation. Although the loss of his independence was a serious adjustment for him, he joked that it took a village to get him to church, the Bible class that he still taught at another nursing community, his barber, the grocery store, and the doctor. Dad wasn’t shy about asking for help. (After his death, those volunteers introduced themselves to us at the funeral as Dad’s drivers. Each told us how much he or she had enjoyed the time spent with him.)

(Book excerpt from: Please Get To Know Me- Aging with Dignity and Relevance)


Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

VERBAL ABUSE – WHEN THE FAMILY MEMBER RAISES THEIR VOICE TO AN ELDER

“If you decide to become a zombie, that’s going to be up to you. Go ahead and sit in your room watching court TV all day, that’s on your head.”

“You can’t take care of anything. How old is the oldest chicken in your refrigerator? Nothing in there has a date on it.”

“You don’t need any money. What do you need any money for? Poof, it’s gone, now you don’t have to talk about it anymore.”

“I make all the decisions for you now, stop asking me the same question all the time.”

These statements were all made in anger to an elderly parent, when the child couldn’t take it anymore. Taking care of an elderly parent is certainly not for the faint of heart. It takes so much patience and understanding to answer the same question over and over. Sometimes it takes an outsider to identify for the family that the way they are talking to the elder is abusive.

The first time something inappropriate is said in anger, the child feels just terrible. However as with so many things that are shocking the first time you hear it.  After that first time it becomes easier and easier to vent your frustration verbally at the elder. It’s not only the angry words that are said, it also can be:

  • Tone of voice
  • Volume of speech
  • Body language

When words like “don’t”, “stop”, “no” or “can’t” are said with a negative tone and body language showing disgust, anger, or impatience, it is abusive. It is abusive, when the elder is made to feel like a naughty child that is being scolded. The elder then begins to feel even more fragile, needy and dysfunctional.

A clear sign that the elder may be suffering from verbal abuse is when an elderly person seems to be hesitant to talk openly. Especially, if the caregiver is present and the elder is able to respond but seems fearful to do so.

The elderly still need to be asked their opinion, make some decisions, and be able to voice their concerns.

If you would never stand by and listen to someone berate a child, you realize the need to step in when someone is talking inappropriately to the elderly.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegetoknowme.com

HOW TO REDUCE PHYSICAL AGGRESSION IN THE CONFUSED ELDERLY USING ACTIVITY AND EXERCISE

The confused elderly may strike out at times when they are afraid, or misunderstand what is happening. Doing an activity or exercise that uses large muscles can give the elder an opportunity to use those physical movements in appositive way.

Exercises that can reduce aggressive behavior:

  • Participate in an exercise program – if the elder is especially physically aggressive – they could exercise more than once a day.
  • Encourage loud counting with exercise movements – to get out those aggressive sounds.
  • Encourage using hand held objects, especially large colorful objects during exercise.
  1. Large colorful foam noodles
  2. Thera-band or stretchy cords
  3. Large colorful bean bags
  4. Therapy Balls
  5. Over the door pulleys
  • Encourage throwing exercises/activities
  1. All kinds of large colorful balls (beach, foam, therapy)
  2. Throwing things into something – laundry basket, over nets, through hoops, bean bag toss
  3. Throw plastic horse shoes, plastic air planes,
  • Hitting activities/exercises
  1. Inflatable bouncing figure with weighted bottom (clown)
  2. Drums
  3. Punching bag
  4. Punching ball on elastic band
  5. Hitting balloons or beach balls to each other in a group activity
  • Tearing and ripping activities
  1. Old fabrics into strips
  2. Newspaper
  3. Paper that needs to be shredded
  4. Magazines
  5. Any kind of food item that needs to be torn (lettuce)
  • Kicking Activities/exercises – using a beach ball, large foam balls (make sure the elder has good balance before trying kicking any object)
  • Clapping hands to music with a good beat
  • Dancing
  • Walking

Any activity, exercise or hobby the confused elder enjoyed in the past that used large muscle groups, will give the elder a positive opportunity to be physical.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

NEVER EVENT – WHY JUST FOR HEALTHCARE?

“Never Events” refer to a list of 28 inexcusable outcomes, the result of spending some time in a healthcare setting. Of course the most horrendous of the hospital events are on the list. As horrific and newsworthy as these events are:

  • A foreign object left in a patient after surgery
  • Giving a patient the wrong blood
  • Surgery on the wrong body part
  • Surgery on the wrong patient
  • A patient death due to medication error
  • Patient death due to electric shock in the healthcare facility
  • Patient death due to a fall in the healthcare facility
  • Patient death due to a burn sustained in the healthcare facility

These are considered, and rightly so, events that should never happen in a healthcare setting. Medicare started denying payment for eight never events in October of 2009. Insurance companies usually follow Medicare’s lead and of course we can expect everyone to really run with this. At some point, that original list will really seem like small potatoes. Of course as money is saved refusing payment, I doubt the patients will see any savings.

However, when we get into the area of skin breakdown in the elderly, can we be as sure as to where to place blame?  (In-house acquired wounds and infections are on the list) Or, how about infections acquired in a healthcare setting?

I remember an elderly lady who in her last month of life did start to have “in-house acquired” skin breakdown. She had large, very dark areas of skin, that you just knew were going to open up and be ugly. Because the breakdown was happening from the inside out – not from the outside in, (as happens with poor care) we realized this was just part of her body shutting down.  As this wonderful woman was dying the Director of Nursing wanted her sent out of the building, because she didn’t want one of those “in-house” acquired wounds in her building. Fortunately, common sense prevailed and this elderly woman was allowed to stay, and die being cared for by the staff that had gotten to know her so well for her last six years.

Blame is easy to assign, when a blatant mistake is made. But, sometimes it’s not so easy to designate the blame, and playing the blame game, can take the focus away from patient care.

Here’s an idea. How about coming up with a list of “Never Events” for the Oil Industry?  Maybe some “Never Events” for Congress that makes them stop and think before they allow Wall Street to bet against the country? How about some “Never Events” to prevent the real estate industry from falsifying applications so people can buy what they can’t afford? Just a thought.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

WHEN AN ELDERLY PERSON HAS A SUDDEN CHANGE – IT’S NOT THE TIME TO PLAY DOCTOR, TIME TO GET A DOCTOR

Sudden, suddenly, all of a sudden, unexpected, immediate – when a change in condition is highlighted by an urgent word like “sudden. “ The response needs to reflect that urgent word with action.

Sudden changes:
Confusion
Severe headache
Speech
Vision
Paralysis
Disorientation
Hallucinations
Behavior
Attention
Balance/ability to walk
Incontinence
High fever

When you call the doctor or paramedics what they will want to know.
What is normal for this elderly person and what is unusual for this person.
Confusion – if the elder always knows where they are and now they don’t recognize their home, or anything else they normally know.
All of a sudden got “lost” driving, can’t find their house, lost in their own community.
Hallucinations- they are saying they are “seeing things, that aren’t there.”
Behavior – a person who is normally very calm and thoughtful – without provocation is angry, yelling, aggressive, and this is unusual for this elder.
Attention – especially if the person is going in and out of consciousness, has cloudy not clear thinking
Any recent falls or bumps to the elder’s head – even hours or the day before.

Now is not the time to play doctor.
With the elderly an emergency situation can be caused by an infection, side effects of a
new medication, low blood sugar, neurological problem, head trauma, – so many things.

See also blogs: WHEN THE ELDERLY HAVE A SUDDEN ONSET OF CONFUSION – IS IT DEMENTIA OR DELIRIUM? 3/22/2010 and part II 3/23/2010

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegetoknowme.com