What is elder care?
Elder care is the fulfillment of the special needs and requirements that are unique to older adults. This can include services such as assisted living, adult day care, long term care, nursing homes (or residential care), hospice care, and home care.
The stages of aging
The stages of aging based on physical abilities looks like this:
- Crisis management and
- End of life
Transitioning from stage 1 to stage 2 is not quite as dramatic for older adults as from stage 2 to stage 3. This is the stage where you may want to start discussing long-term care plans and preferences with your parents. The earlier the better! Short, casual conversations may be a good way to start. For example, “Have you ever thought about…?” or “How do you feel about having help in the house?” What is important is to keep the lines of communication open and transparent.
Stage 1 to 2 includes transitioning from total independence to some assistance in housecleaning, meals, shopping. Stage 2 to 3 usually means having to have full time caregivers at home, or transfer into a continuing care home facility. This is a total loss of independence. This can be very hard for older adults to accept.
Challenges facing the elderly Part 2 of 3
As we age, new challenges are faced. These include biological, emotional, intellectual, social, and spiritual changes. Sometimes these changes can be more frightening than the thought of dying. Loss of independence for example may leave an older adult frightened and vulnerable, and thus resistant to care. Understanding these changes from the older adult perspective can lead to smoother communication about the need for care. More details on what to expect when aging can be found here https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/aging/art-20046070.
When to Step In
Ideally, conversations about care start long before any issues arise. There are some things to look out for that should raise a red flag and indicate a more urgent need to assess the family member and place of residence. These include:
- Falls – falls are a leading cause of seniors’ injury anywhere. One in three elderly people in Canada will have a fall in any given year.
- Signs of neglect (poor personal hygiene, difficulty shaving, soiled clothing, weight loss)
- Difficulty walking; or climbing stairs
- Difficulties with medications (taking them too often, or not at all)
- Changes in eating habits
- Unpaid bills
- Irritability or sudden mood changes
- Concerns about driving
- Recovery from surgery, or the parent has a sudden, temporary illness and wants to stay at home
- More serious illness has been diagnosed – for example, Alzheimer’s, Parkinson’s
- Difficulty recovering from a hospitalization, especially if they experienced delirium
- Sudden disability after a fall, stroke, or other health emergency
- Increasing forgetfulness
- They may live in a neighborhood where they are vulnerable to crime, or have been scammed online
- Indications of loneliness and/or social isolation
- Financial vulnerability (or exploitation) – you may feel a loved ones’ “friend” or neighbor seems to have unprecedented access to your parents’ bank account
- Legal or other financial issues
What Can You Do? Part 3 of 3
Early signs of Dementia:
Knowing the early signs of dementia versus typical age-related change is important (https://www.alz.org/alzheimers-dementia/10_signs).
Here are ten common symptoms:
Common signs of dementia
Typical age-related change
1. Memory loss that disrupts daily life
- forgets recently learned information
- asks the same questions over and over
- increasingly relies on memory aids (notes, or electronic devices)
- increasingly relies on family for things they used to do on their own
Sometimes forgetting names or appointments, but remembering them later
2. Challenges in planning or solving problems
- changes in ability to develop and follow a plan, or work with numbers
- may have trouble following a familiar recipe or keeping track of monthly bills
- may have difficulty concentrating and take much longer to do things than they did before
Making occasional errors when managing finances or household bills
3. Difficulty completing familiar tasks
- often find it hard to complete daily tasks
- sometimes have trouble driving to a familiar location, organizing a grocery list, or remembering the rules of a favourite game
Occasionally needing help to use microwave settings or to record a TV show
4. Confusion with time or place
- lose track of dates, seasons, and the passage of time
- may have trouble understanding something if it is not happening immediately
- sometimes forget where they are or how they got there
Getting confused about the day of the week but figuring it out later
5. Trouble understanding visual images and spatial relationships
- for some, vision problems are a sign of dementia
- may lead to difficulty with balance or trouble reading
- may have problems judging distance and determining colour or contrast, causing issues with driving
Vision changes related to cataracts
6. New problems with words in speaking or writing
- may have trouble following or joining a conversation
- may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves
- may struggle with vocabulary, have trouble naming a familiar object or use the wrong name (for example, calling a watch a hand-clock)
Sometimes having trouble finding the right word
7. Misplacing things and losing the ability to retrace steps
- may put things in unusual places
- may lose things and be unable to go back over their steps to find them again
- may accuse others of stealing, especially as the disease progresses
Misplacing things from time to time and retracing steps to find them
8. Decreased or poor judgment
- may experience changes in judgment or decision-making
- for example, may use poor judgment when dealing with money, or pay less attention to grooming or keeping themselves clean
Making a bad decision once in a while, such as neglecting to change the oil in the car
9. Withdrawal from work or social activities
- may experience changes in the ability to hold or follow a conversation
- as a result, may withdraw from hobbies, social activities, or other engagements
- may have trouble keeping up with a favourite team or activity
Sometimes feeling uninterested in family or social obligations
10. Changes in mood and personality
- may experience mood and personality changes
- may become confused, suspicious, depressed, fearful, or anxious
- may be easily upset at home, with friends, or when out of their comfort zone
Developing very specific ways of doing things and becoming irritable when a routine is disrupted
These 10 signs are listed on a worksheet at: https://www.alz.org/media/Documents/10-signs-worksheet.pdf. Take action if you are concerned that you, or someone you know is displaying any of these signs.
More resources can be found at: https://alzheimer.ca/en/Home/About-dementia/What-is-dementia/Normal-aging-vs-dementia.
A doctors appointment checklist (that includes questions to ask) is available to download at this link: https://www.alz.org/media/documents/alzheimers-dementia-communicating-doctor-health-care-pro-ts.pdf.
Another helpful tool offers suggestions on what to do when you notice changes in others:
"Falls" - an excellent source of information on fall prevention is at this link https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/disease-and-injury-care-and-prevention/fall-prevention. A number of strategies are listed as effective for reducing the number and frequency of falls. In Alberta, a similar guide can be found here https://myhealth.alberta.ca/health/pages/conditions.aspx?hwid=ug2329spec&.
The strategies to reduce falls include:
Exercise programs, environmental modifications (rails, grab bars, removing rugs, clutter); education (informing older adults about risks); medication modification; the correct use of walkers/canes scooters and other devices, and the use of hip protectors to cushion the hip from the impact of a fall.
Signs of neglect:
Signs of neglect could be an early sign of dementia (see above), or of depression. Ask your loved one for permission to speak with their doctor, and raise your concerns with them. If your loved one already has some level of homecare and signs of neglect persist, other resources include https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/protection-from-elder-abuse-and-neglect; and https://www.alberta.ca/get-help-elder-abuse.aspx.
Difficulty walking or climbing stairs:
Assistive devices for walking can range from walkers (with wheels) to motorized wheelchairs or scooters. For climbing stairs, options range from “stair elevators” (such as Acorn Stairlifts) to installing a residential elevator in the home (such as Stiltz home lifts). When looking at any of these options, ask the supplier if any of the items are covered by provincial plans. Other options might be March of Dimes (www.marchofdimes.ca) or Veterans’ Affairs (www.vac-acc.gc.ca). Short term loans of equipment can be secured through The Canadian Red Cross (www.redcross.ca). Finally, check if your loved one has any private health insurance policies regarding coverage or subsidies.
Difficulties with medications:
Pharmacists can help with medication control. Blister packs are now fairly common through most pharmacies. These control the day, time and amount of medication as well as having the option for differnt medications on a timed schedule throught the day. This makes it easier to keep track of which medication is to be taken and when, as well as knowing if a dose has been taken, not been taken yet or skipped.
Changes in eating habits:
People tend to eat less as they age and this is normal. However, sometimes, as with the loss of a loved one, it becomes very difficult to cook for one person rather than two. Programs such as Meals-On-Wheels can help provide nutritious meals one to three times daily as required. Or, if you are cooking for family and your loved one lives nearby, freeze extra for them so that they just need to pull it out and reheat.
Today it is easy to set up online banking and automatic bill payments. If you notice your loved one has overdue bills, then this option is a good one to keep bills paid on time. Ask your family member how they feel about either setting up online bill payments, or having you check their bills have been paid.
Legal and financial issues:
These issues are best discussed before any illness or mental deterioration. A way to introduce the topic is to say something like “hey mom, if you became ill suddenly and were not able to talk or communicate, who would you want making healthcare decisions for you?” An excellent resource to understand the difference between Representation Agreements and Power of Attorney can be found at http://seniorsfirstbc.ca/resources/legal-research-articles/representative-agreement-article Representation agreements can be drawn up for personal care only, for personal care and property, or for property only. Generally, a Section 7 Agreement is enough to cover routine, day-to-day care needs. Make sure they understand these are being drawn up only for use in emergency or sudden deterioration in mental health. Advanced directives resources can be found at https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/advance-care-planning.
Sudden illness or recovery from surgery:
Hiring a private caregiver is a great option for these circumstances. Look for reviews, ask exactly what their care will be, speak with people and find the right fit for your loved one.
Concerns about driving:
This is probably the most sensitive issue to raise in a discussion. Many older adults cling to the independence that driving affords. It does not matter than taking a cab everywhere is often still cheaper than maintaining a vehicle – the sense of independence that owning and driving a car brings, is priceless. In most provinces, once you reach 80 years you are required to take your test every two years and pass a test of cognitive abilities. But what if you have concerns before then? The best strategy is to discuss this with your parent first, if it can be done calmly. Then next step is to discuss your concerns with their doctor. The doctor (if they agree problems are serious) can notify the Provincial licensing authority that your loved one is no longer safe to drive, and have their licence revoked. This is obviously a last resort as it is likely to cause great anger and resentment. However, better this than a tragedy with your loved one behind the wheel.
Other excellent resources can be found in both British Columbia and Alberta through these links:
The British Columbia Seniors Guide:https://www2.gov.bc.ca/assets/gov/people/seniors/about-seniorsbc/guide/bc-seniors-guide-11th-edition.pdf
In Alberta, another excellent resource is the Services and Information page through the Alberta Government: https://www.alberta.ca/senior-supports.aspx. There are links for financial assistance for seniors, seniors events, and supports for seniors.
Again in British Columbia: https://www2.gov.bc.ca/gov/content/family-social-supports/seniors (includes Healthy Aging, Financial & Legal matters; Caring for Seniors; Housing; Home & Community; Health & Safety; Transportation).
Supporting the Caregivers
Family Caregivers of British Columbia has an excellent Caregiver Self-Assessment tool that is also downloadable (https://www.familycaregiversbc.ca/caregiver-self-assessment/). Completing this tool gives the caregiver a guide to creating a self-care plan. It can start with just learning about the resources available to caregivers. For caregivers who are struggling, the Employee Assistance Plan (EAP) can help them sort out the mixed feelings often associated with looking after a senior parent or partner.
Family caregivers can use a varitey of self-care strategies to keep their caregiving strain manageable. These include:
- Joing a support group,
- Asking for help,
- Setting Bounaries,
- Alloting time to tend to ones' own health and other needs.
Dealing with resistance
How do you help a loved one who does not want help? It can help the caregiver by understanding the reasons for resistance. If someone is in need of care it is usually because they have lost something – a physical loss, mental loss, loss of a spouse, or loss of independence. To admit to needing help means having to let go of at least some of your privacy, and accept new routines. This can make someone feel frightened and vulnerable, angry that he or she needs help, or guilty about the idea of becoming a burden to family and friends.
Some common reasons for resistance include:
- Guilt about being a burden to the family
- Anger at their situation – perhaps because they cannot do things the same way as before
- Fear of losing independence
- Denial that they actually need help
- Depression from loss of a spouse
- Fear that their lives will not be the same
In all cases, remember – you are dealing with an adult who is used to independence and making their own decisions. Treat them as such and involve them as much as possible in the decision making. And if possible, at least start the conversation early.
Jocelyn C. Herrett DSW RSW