Is there anyone here who works with the elderly?

[Petra]

I think I need your advice. :(

Brief background: Lyn is 78 in a month's time. She is a spinster with no children and no living relatives. We have been her 'family' for the last 35 years or so. She lives alone in Rotorua, but between my mother, my sister and me, we keep an eye on her. I realised she was aging fairly quickly now, but she is still pretty fit. She walks for at least 40 minutes or so, three times everyday. In the last year, though, she has collapsed a couple of times with minor strokes, and is now supposed to wear one of those medical alert bracelets which will summons and ambulance to her as soon as she pushes the little button. She doesn't wear it. She's a subborn old gal, so we don't know if she is not wearing it on purpose, or is just forgetting to put it on. She's getting increasingly senile.

My sister has gone to Auckland, and I'm still here, so I got Lyn over for dinner. Unusually, she arrived without her handbag. Anyway, after dinner, she drove home (she just lives two blocks away), and within minutes she arrived back again, panicked because she couldn't find her handbag, and wondered if she'd left it here. I reminded her that she didn't arrive with her handbag - which earlier in the evening, she acknowledged that she knew she'd left it at home - and I told her I would follow her to her place to make sure everything was alright. It wasn't - she was locked out and didn't know where her key was. Zoe and me managed to break in, and find her handbag, but still no key.

Anyway, cut a long story short, we ended up finding the key about an hour later in the ashtray of her car, and was able to get her inside, make her a cup of tea, and get her tucked up in bed.

Following her to her place, I realised how her driving had gone from bad to worse. Admittedly, it was dark and she is not used to driving after the sun goes down, but this was BAD. She looked like she didn't really know where she was going, and changed her indicator several times on a straight road, well before her place. I don't know if it was because I was behind her or what, but she indicted to turn right into her place about one block ahead of where she was actually going, then must've realised she was too far away, and so indicated left, then right again,. then left again, then right again till we made it to her driveway.

At dinner, we had the same conversation several times. How's your mother and Rita, I don't think I've seen them in months? Lyn, you had lunch at the farm with us on Sunday. What are you girls doing tomorrow; will you be driving back to Hamilton? No, Lyn, we're collecting you to meet Rita at a restaurant for lunch tomorrow. I will be collecting you just before noon. Oh! What day is it today? It's Wednesday, Lyn. So, tell me, Petra, how's your mother and Rita, I don't think I've seen them at all this year? And around and around we go. Fortunately, I have unlimited patience with her, and can manage the repetition. I mean, hell, she's like an aunty to me - I've known her closely since I was a little girl and she totally adores Zoe.

Now, Lyn is stubborn and has always been self-reliant. I know she would not take kindly to being placed in a home, and is not open to the idea of bringing in home help for a few hours a day, a few days a week. As far as she is concerned, she is just fine, thank you very much. But tonight I realised just how much she is NOT fine.

What do I do? How can I help her? I really think putting her into a home would be like signing a death warrant for her, and I don't want to do that. What should I know about the elderly and about senility? What the hell does one do?!

If anyone here can guide me in helping her, I'd be most grateful.

[Legs]

I don't have any answers for you just wanted to say how great it is that you care about this lady, she has no one else in the world. Imagine if you were not her friend?

Hope someone has some good advice for you. I was wondering if there are any community services available for the aged, people that drop in everyday. Do you have meals on wheels in NZ?

[livius drusus]

I'm particularly concerned about the driving. How regularly does she drive, do you know, Petra?

Also, is she a member of any organizations or Church groups or anything like that?

[Petra]

Imagine if you were not her friend?

I shudder to think! If she didn't have us Pa****on's, she'd be screwed! She does still have one or two other old friends, but she is not as close to them as she is to us, and they are also getting on in age. The rest of her old buddies are long gone.

I was wondering if there are any community services available for the aged, people that drop in everyday.

I'm hoping so. I've tried phoning the Senior Citizens club, and I want to get her into a walking group for the elderly, as I hear they do lovely bushwalks and have nice picnics and stuff, but I can't seem to get any reply to the phone numbers in the phone book! :doh:

I think she's also slipping into depression, though she tries to hide it. She was always such a snob, too, and I think she would actually like to join a group to go on walks, but is worried that she'll be a fish out of water with a bunch of old hicks. :giggle: She won't be, of course, and I will try to go on her first walk or two with her and the group to make sure she settles in okay. But first I have to get the buggers to answer their phones so I can get the needed info and register her. I don't even get an answer phone for the Senior Cit's Club! :doh:

Do you have meals on wheels in NZ?

Yes we do, and I didn't even think of them! I know she still cooks - or at least she says she does - but that's scary now that I think about it too.

I'll call them in the morning. Thanks, Legs. :)

[Petra]

I'm particularly concerned about the driving.

No, shit! It was not pretty to watch, and given that when she does drive it's during the day when the roads are busier, I'm VERY concerned - and, like you, for the others on the road, not just her! :eek:

How regularly does she drive, do you know, Petra?

Not often, anymore. She walks everywhere, and buys small amounts of groceries daily from the supermarket, which is about a 20 minute walk away. Later in the day, she walks there to buy the newspaper. I've seen her when driving to town, and she won't accept a lift as she loves the walk. As she says, they are what keep her going.

Also, is she a member of any organizations or Church groups or anything like that?

Nope. She is not religious at all, and can't stand those "bloody god-botherers who bang on her door every other week!" :giggle:

I'll definitely be on the hunt for groups that would suit her, and would help support her over the next few days, though.

I'm kinda lost, though - I've not really had much, if anything, to do with the elderly like this before.

[JoeP]

I'm not sure what to advise. My grandmother has gone through many of those stages except the not being aware of how feeble she was at any stage: she was stubborn for a while but gave up driving voluntarily, and has accepted home-help willingly. Her memory is spot on. Well, pretty good anyway.

She must keep up the walking - I think that is probably very good for her. And I agree that a home wouldn't be right. Somehow you need to work towards a home help. And what about the driving? Is she licensed? In Britain licenses have to be renewed every 3 years after the age of 70. I don't know if there are actual tests, and I don't know if taking a license away actually stops an absent-minded person driving. Maybe you should just hide her keys...

[Godless Dave]

My grandmother slipped into similar dementia after she had congestive heart failure. The cause was never diagnosed, but we think she either lost blood to her brain or had a series of minor strokes. In her case she knew what was happening and did not fight being put in a home. Also in her case, she had enough money socked away that she could go to a very nice home. And she had adult children to make all the arrangements and come visit her.

In short, I have no advice to give you. The only thing I can say is she is very fortunate to have people who love her and will look after her.

[Leesifer]

She does sound like a great person, pepper and she is lucky to have you and your family as friends.

My father-in-law slowly succumbed to senile dementia.

We managed to get him into a warden assisted residential home. Basically, he had his own little flat, but each room had an alarm button or pull rope, so that he could call the warden at anytime he wanted if he got into any trouble. The warden lived onsite.

Do they have this sort of accommodation in NZ? That may be better for her, as she will still have her independence.

[Ari]

Getting her active with other people that can remind her of what she is doing is a good idea. Being active in a safe environment can be a good way to slow any more degredation.

I don't know much about this but my Mom works with many elderly in care homes and a good care place can make a big difference. From what I understand it's common for problems to spiral out of control after a stroke.

[Godwhacker]

Well, Im a geropsychologist...this stuff is sadly, my bread and butter (and nobody will be happier when they have a cure for Alzheimer's, believe me)

I would recommend a couple of things. I live in the US, so I don't know if you have similar resources down under, but here goes.

First, I would get her evaluated by a specialist. A geropsychologist, gerontologist, geriatric psychiatrist, or neuropsychologist. Most universities here in the states have such departments, and many even have clinics specially for dementia evaluation. I would contact the universities there in Auckland and find out. Get her evaluated. Playing the odds, she most likely has a dementia related to either Alzheimer's or cerebralvascular disease, but theres the chance that it may be something else (e.g., a medication effect, normal pressure hydrocephalus, hematoma, even depression can cause memory problems in older people, etc.) that might be reversible.

Second, and people don't like to hear this, but nursing homes have their place. If a person has dementia, and they live long enough and the disease progresses, its not a question of if they need a nursing home, but when. There is a book about caring for demented elderly called "The 36 hour day". Its called this because one person trying to take care of a demented person at home is like having a 36 hour day. Caregiver burnout is rampant. Even in families with good support, eventually, the caregivers can not handle the situation. I have seen many cases where the caregiver dies from trying to care for the demented loved one. One study indicated that caring for a demented loved one increased ones chances of mortality by 40% over a five year period. I had one little elderly lady whose husband had severe Alzheimer's adamantly refuse to place him in a nursing home. "I promised him I'd never put him in one of those places" she would tell us. She broke her back trying to lift him off the floor after he fell. She died from that injury. Once she died, he went into a nursing home anyway, and now without her to help him...

There are two main reasons that nursing home care is eventually necessary. First, as the dementia progresses, bodily functions, such as elimination and eating, get messed up. The person becomes incontinent. The caregiver can't change diapers fast enough, and urinary tract infection (UTI) sets in. This usually leads to a worsening of mental status and hospitalization. Second, houses are dangerous places for demented people. I have seen demented older adults burn themselves severely by turning on the hot water full blast, thinking it was the cold (and dementia often does strange things to hot/cold sensations....this person apparently kept their hands under the burning water, and felt no heat or pain...). I have had numerous patients turn their gas stoves on full blast and leaving them on, or left something cooking (burning) for hours. Older demented people can also, rarely, be dangerous to their loved ones. I have had cases where a spouse has been severely beaten by their husband, who did not know who this stranger was in his home. There have been cases of demented persons killing a loved one.

You friend may not need a formal nursing home now, but she may later on. I would add that, while to you and me nursing homes do not look like great places, often times the more structured, scheduled, "bland" nursing home environment is easier for a demented person to handle than the ruckus of day to day family life.

I would add that many nursing homes in the US have adopted programs to change the way they care for older adults. One program is the Eden Alternative (http://www.edenalt.com/), which seeks to promote changing the nursing home enviroment into a place of growing, living things, emphasizing relationships and community. I am currently actively involved with implementing such a program in the nursing home facility I work in.

The first step, however, is to get her evaluated by a professional who is a specialist in dealing with dementia. If she does have a dementia, they should also be able to provide a listing of what supports are available and organizations (here in the US, we have the Alzheimer's Association) that can help.

I would add that she is very lucky to have a friend like you. Sometimes, a true friend has to make decisions that the other person may not like, or appreciate. This is such a situation. If your friend has dementia, she can not think properly, and she needs your help, even if she can not, because of her condition, appreciate it.

[Dingfod]

My grandmother's mental faculties began to significantly decline after my dad and his brothers took her car away from after she had two accidents in a very short period of time, both related to eyesight and reaction times. Within two years she was in the nursing home. In another year, she was dead at 93. When she was homebound she didn't do anything but watch television game shows and televangelists.

[livius drusus]

She broke her back trying to lift him off the floor after he fell. She died from that injury. Once she died, he went into a nursing home anyway, and now without her to help him...
Your whole post was informative, helpful and sad, but this anecdote stood out for me. What an awful, horrible thing for everyone involved.

Thank you for posting, Godwhacker.

[Clutch Munny]

Pepper, your fondness and respect for Lyn shines through every word you write. But just about the driving for a second: it sounds like at least as great a deficit as driving drunk. Would you let someone consistently drive drunk, on the grounds that it would annoy them to have their behaviour reported and their privileges revoked? I don't want the analogy to seem glib; there are important differences between being old and being drunk! But dangerous is dangerous, and as you point out, it is someone else altogether who may end up dead or injured by Lyn's declining driving skills.

[Godwhacker]

She broke her back trying to lift him off the floor after he fell. She died from that injury. Once she died, he went into a nursing home anyway, and now without her to help him...
Your whole post was informative, helpful and sad, but this anecdote stood out for me. What an awful, horrible thing for everyone involved.

Thank you for posting, Godwhacker.

It occured when I was an intern, and it kind of stuck with me as one of those anecdotes that I often use as an example. Unfortunately, I have plenty more sad stories. I also, however, do have some that have much better endings, at least in terms of the demented person and their caregiver being healthy and happy (or as much as they can be given the illness)

Dementia affects alot of people, but, because they are usually older people, there isn't as much of a push for education going on. You would be surprised how often family members I meet with think Aricept or similar drugs "cure" Alzheimer's. At least in the US, there isn't much education going on, and this is a disease that affects so many people, and those around them.

[Petra]

Thank you for the replies, guys. Sorry I'm so long to respond, but I had a pretty full day yesterday.

Godwhacker, you have my utmost respect - anyone that can work so closely with the elderly and the ill are by far better people than I could ever hope to be. Thank you so much for responding to my plea, I have taken everything you've said onboard - including the tragic tale of warning - and will be acting on all your recommendations over the coming couple of weeks. (I'm still having no joy in getting hold of groups I'd like to get Lyn involved in, but it could be because of Easter and ANZAC. But I'll keep trying. Thank you. :)

Yesterday at lunch, Lyn was quite cogent, and not as forgetful or repetitive as the night before. After lunch I took her for a stroll along the lakefront as it was such a beautiful day, and she thoroughly enjoyed herself.

This makes me wonder if much of her problem in loneliness and depression, perhaps coupled with poor nutrition. She has eaten well in the last week, and as been with people more, as our family have been around to engage her in life a bit more. To me, this makes Meals on Wheels and the walking club/senior cits club all the more important for her. I know her doctor, so I will also speak with him.

As for the driving, I'm back out at the farm for a few days from tomorrow, so I'll discuss it with my mother and see what we can do to stop her from being able to renew her licence.

I'm also wondering whether I should return to Rotorua to live, though I can't say that's what I'd really like to do, but sometimes you have to sacrifice a little, eh.

Gawd, I hope I die before I get old.


Thanks again, guys. Your words of support and the information you share is a HUGE help :bow:

[Godwhacker]

Depression can certainly cause memory problems in older adults. Its a phenomenon called psuedodementia due to depression. Its certainly a possibility. Depression is actually the most common psych problem in older adults, way ahead of dementia even. Nutrition can also play a role. Too little B12 can cause problems, especially if coupled with even moderate alcohol use (I can't explain the biochem, but basically alcohol sucks the B12 out of your brain).

There are lots of things that can cause older adults to become forgetful, and I'm really glad to hear that you are looking for an expert in the area. Im not playing a professional turf game here...Most general practitioners and those clinicians unfamiliar with the psych issues of older adults often misdiagnose problems (or worse yet, think every older adult with a psych issue has Alzheimers). The specialist you seek should do some kind of cognitive testing, after taking a good history and doing a careful interview.

Actually, YOU and people like you have my utmost respect. To help an older adult not even related to you shows incredible compassion and love. Please let me know how it goes. If you have trouble finding a specialist, let me know. I don't have any contacts in geropsych in NZ, but I can probe around on some of the geropsych listservs and try to see if someone knows of one.

[Petra]

Thanks, Godwhacker. I will keep you informed, and return to let you know how I got on with finding the right specialists to diagnose Lyn.

I'll be offline for the next few days, as Mum's uselessly slow rural dial up service tests my patience and wastes my time too much, so I'll get back on to this when I return.

Interesting about the B12 and alcohol. I wouldn't say Lyn is an alcoholic, by any means, but for years and years she has enjoyed a glass of white wine at lunchtime, and a gin and soda or two in the late afternoon/early evening. The gins are weak ones, and she has no more than two. That said, though, she has always been a tiny lady who eats like a bird. Her average weight being around 47kg. (I weighed her just yesterday :D).

Have a lovely weekend, Godwhacker. And thanks again. :kiss: