Depression in Older Adults and the Elderly

Article: Depression in Older Adults and the Elderly

Depression is a very common occurrence in seniors for numerous reasons.  They have lost friends and loved ones; they become isolated due to physical losses; some suffer from health issues.  There are many factors that can lead to depression in older adults.  Anti-depressants are not always the best treatment for this problem.  As we age, our body is not able to metabolize medications as well and because of this the side effects of these medications are more commonly noted, which can do more harm than good.  Also medication alone, at any age, will not alleviate depression.  The reasons that are causing the sadness must also be addressed.  Click the image to read a very informative article regarding this issue.

Knowing the signs of depression in older adults improves your chances of Aging with Ease!

Navigating a Hospital Stay, Are You Getting the Help You Need?

Are you getting the help you need?  Navigating our health care system is, let's just say, nearly impossible.   Many people, especially older adults, don't even know if they are getting all the help they need or is available before, during or after a hospitalization.  Why is this such a well kept secret in our health care system?

Seems to me that the more knowledge and assistance you give someone the more likely it will be that they do not end up right back in the emergency room, constantly repeating the near same scenario over and over again.  It does not take a degree in economics to see that the system would be able to keep costs down considerably by giving more priority to this very simple element of health care.  Instead this system leads you to think that it is complete ignorance on our part that keeps costs so high when it appears to me that there is just entirely too many special interests involved in the treatment of sick people.

Every time that I experience, first hand, just how difficult moving through the labyrinth of our health care system is, I am left to wonder how in the world do families that do not have a medical professional as part of their family ever get anywhere.  The education of people should be of top priority, especially during a hospitalization, yet it always feels like the patient and family are left in the dark.   WHY?

As I write, my father lies in a hospital slowly recovering from a bowel obstruction. This is the 4th, yeah that is right, the 4th hospital that he has been over the last month.   Due to preexisting difficulties with advanced chronic obstructive pulmonary disease (COPD), the proper treatment for the bowel obstruction was delayed for far too long.  We started the first week at a local community hospital that either was not permitted to refer us to a larger hospital or just simply did not consider it.  Had it not been because of persistence of the family and a family member with a medical education, my father probably would not be with us at all.  After requesting that he be transferred to a larger teaching hospital with the ability to give him the help he needed we were told by the physician that he feels that would be the best plan and my father was moved within hours and just hours after being admitted to that larger facility with more advanced technology he received the surgery he needed.  He remained at this hospital for three weeks making slow improvements everyday with a few set backs.  He was finally strong enough to be transferred to a rehabilitation hospital at which he stayed for all of 12 hours before they sent him to yet another local community hospital because his oxygen levels were low.

The frustration the I feel about the systems within healthcare are mind blowing.  Many things run through my mind in the care of my father.

1. Why did the rehabilitation hospital not call a family member when his oxygen levels became low? To at least give us the option to say: "Please send him back to the facility he just came from".
2. Why did the current hospital that he is in right now not contact the previous hospital that he just spent 3 weeks at to obtain his records?
3. Did my father miss doses of his medications when he transferred from one facility to the next?  This very fact alone may have been what caused his oxygen levels to drop...
4. Where is he going to go from here?

The common denominator in every question that goes through my head is communication and why is it so poor in our healthcare system?  In this day and age there is no excuse for it!  If I can know with in seconds what my cousin on the other side of the country is eating for dinner right now and even see pictures of it through social media then we should be able to send communications just as quickly about things that truly matter in the care of a persons life.

Not only would some real attention to this aspect of healthcare improve the continuity of a patients' care but it would also help to keep the cost of health care down.  Blood test results, x-ray reports, CT scan reports, MRI reports, medication records, patient allergies, assessments, therapy notes, specialists reports, etc. all at your fingertips thus preventing unnecessary repeat testing.

I spend a portion of each day talking to someone at the hospital, whichever one he may be in, about the care of my father.  Whether it be his social worker, care coordinator, nurse, surgeon or physician I am constantly seeking information about what they are doing to help my father,  what the next steps are going to be and what he needs to be doing to get there.  If I would not be pursuing the information, we would be in the dark.  I hate the dark, don't you!

Learning how to navigate our health care system is essential to Aging with Ease!

Geriatric Care Management

So today I learned about a service that I have not had any experience with.  It is called Geriatric Care Management.  Some of you may already be familiar with this service, but it intrigued me because of my lack of knowledge about it.  So I did some research about it. This service offers support for families caring for older adults.  Many of people who are faced with caring for a spouse or parent who is declining in their health really have no idea where to begin to look for help.  Those difficulties are escalated when you are a child of an older adult and live miles away.   The day-to-day care that is needed can leave you exhausted and feeling depleted to even have the energy to look for help.

Geriatric Care Management offers care managers that specialize in social services. They assist in finding the help you need based on your individual situation.  Their goal is to help older adults find the best quality of life physically, mentally and socially.   If you are looking for help finding the right long-term care or assisted living facility, they can help you with that process.  If you need someone locally to check in regularly on a loved one, they can provide that service.  They will advocate for any needs that will assist in achieving an improved quality of life for the older adult as well as for the caregiver.

Geriatric Care Managers charge clients in a variety of ways, but typically their hourly rates are between $50-$200 an hour.   Medicare, Medicaid and private health insurance very rarely pay for these costs; long term care insurance might, but most often this is an out-of-pocket cost.  I know that sounds expensive, but when you consider the convenience and security they provide, the cost can seem worth it.  Actually, Care Managers usually save families money despite being an out-of-pocket cost because their needs assessments align an individual’s present condition with only those services that are necessary at that point in time.  This prevents unnecessary fees from home care providers and assisted living residences.

This service is worth checking out if you are struggling to decide the best way to provide care for an aging adult.  The first step is to locate one and simply have a phone conversation with them about different ways that they might be able to help your situation.  A simple Google search for Geriatric Care Management will help you easily locate one near you.  If you decide it is worth the investment, they will come to meet you and your loved one to perform a complete assessment; physically, mentally, financially and socially.  Together you create a plan to manage care.

Like I said before, I do not have any first hand experience with this service but it appears to be a very useful resource in assisting caregivers to manage care.  If you have ever used this service or know of someone who did, I would be very interested to hear what the experience was like.  Did they own up to what they offer?

Finding the right kind of help that is available for you is vital to Aging with Ease!

Fulfilling Activities in Adult Day Centers

Creating fulfilling activities for seniors can be challenging at times, especially if they are suffering from memory loss or physical ailments that limit their abilities to participate the way that others can.  I am blessed to work with some of the most creative people I have ever met.   They are constantly meeting this need for the seniors in our Adult Day Center.  They never cease to amaze me and I am constantly learning from them.

There are two main things that I have learned the most from my co-workers:
1. Try anything, no matter how odd it may seem;  you never know what might work.
2. If it failed once, that does not mean that it will fail again.

We offer a variety of different activities every month.  Sometimes certain activities are scheduled on specific days of the week with certain clients in mind.  For instance, for the lawyer who only comes in on Tuesdays and Thursdays, we schedule a game called "You Be The Judge."  This game engages this client extremely well and brings back to his life a chance to share his knowledge.   Then there is the retired English Professor who misses leading lectures in his classroom; he is given an opportunity to present a different topic each month to the other clients and staff.  By providing this activity for him, we are giving him a sense of purpose and a chance to perform.  There also is a client that spent her life raising her nine children - yes that is right 9 children -  she spent much of her time after her children were grown making quilts but because of memory loss she had stopped doing this.  My staff was able to find a way for her to continue this joy in her life.  It took several different approaches to find the best way for her to be successful at it, but she now comes into the center and gets right into it without hesitation.  I could go on and on with examples of these types of great things that happen in our Adult Day Center.

As clients remain at our center over time, their level of functioning will change.   Activities they once were successful at become difficult and frustrating for them.  Again, my staff observes this and quickly adapts to these changes. An example of this would be to remind you of the client that is a lawyer, that I spoke of in the paragraph above.  Since he started at our center, his condition has progressed and he no longer finds fulfillment in that game.  So the activity for this client was changed.  We looked for another opportunity for him to feel useful.  What we found was that he needed to be responsible for something in the center that made him feel useful.  So we gave him the task of helping with setup for activities and clean up when they are over.  He takes this responsibility very seriously and it is a huge help to our staff.  A win, win situation.

These activities are a direct product of my staff - by them constantly looking for ways for our clients to feel important and useful again.   There are also many activities that, in general, can be easily managed no matter what their losses may be.   We do use these activities regularly as well.  But who wants to do the same thing every day?  We all need variety in our lives no matter what age we are.

Adult Day Services can provide useful, fulfilling and satisfying activities for seniors.  They are designed to provide stimulation and socialization, which in the long run will keep older adults more active physically and mentally.  With all that to offer, it seems kind of silly not to check them out.  This kind of structure to a person's day will keep them living independently longer and can provide comfort to families that their loved one is being productive in a safe environment. 

Aging with Ease can be obtained by feeling useful as older adults!

A Visit With My Grandmother

This weekend I was visiting my grandmother who now, at the age of 95, has recently moved into a skilled care setting.  I was sitting there talking with her and bringing her up to date on the happenings in our family as I frequently have to do when I go see her and it occurred to me that my grandmother is the essence of Aging with Ease.  She is the true inspiration for why I began writing and trying to help others.  She is the reason that I care and respect older adults the way that I do.  I have watched her progress from the vibrant person who would always be ready for play to the old woman who now mostly sits in her chair, content with her life and herself the whole way through.  It is her attitude toward life that has aided her the most in gracefully going through the aging process.

I can remember when I was 12 years old and my grandfather became ill with cancer.  I can clearly recall the way in which my grandmother cared for him with respect, love and laughter.  Never changing the way she loved him or how they communicated with each other.  It always stayed with me how she faced the reality of the situation head on, would tell you what she thought about it and then just simply do what needed to be done.  There was never a doubt in her mind, at least not that I saw, of what she should do, care for and love him.  Of course, she would be sad sometimes, but it never held her back; she seemed, to me, to gain strength from the hard times.

Not long after my grandfather passed away is when she decided it was time to sell her house and move to a retirement community, there was no changing her mind.  She knew she could no longer care for the house any longer and the memories that she shared with grandfather in the house that he built for her was just too much.  It was time to move on!  Our family would discuss with her other possible options besides living in a retirement community but her mind was set.  She would say: "This is what I want to do, I don't want to live with my children."  So everything was packed up and the house was sold.

My grandmother transitioned through every level of care within this retirement community over a span of about 18 years.  With every move, she accepted it with ease and trust that she would be taken of even though with every move she was slowly losing her sight, her hearing and eventually her mobility.  She never once doubted her faith or her family.  She would find laughter in the situation and was always so very grateful that we were there for her.   So thankful we were there to make sure that everything would be done the way she would want it and that the things that were most important to her stayed with her.

Now, as she sits in her favorite recliner, unable to see anymore and hardly able to move with out help, all she prays for is a peaceful end to her life.  Not because she is sad or depressed.  If you would meet my grandmother, you would know that she certainly is none of those things.  My grandmother even at the age of 95 could still be the life of a party.  She hopes for the end because she has lived her life to the fullest.  She has no regrets.  She has lead a happy and full life by having fun and helping others.  She is simply just tired, her body aches and she cannot do the things that she once did.

She has gone through the aging process with grace.  I can only hope to follow in her footsteps, even just a little.  In my work I have seen the direct result of negative attitudes on a person's health.  The mind is the most powerful tool you have in overcoming challenges in your life.  She showed me how to always look for something to laugh about, especially if it is about yourself.  She showed me to just let it go.  She showed me that if you can't change what is happening, then find a way to handle it but keep moving forward.

I am truly blessed to have had a person like this in my life.  I think there are probably many people that don't.  All you can do is be responsible for yourself and your own attitude.  You cannot change the way other people think or behave.  The most you can do is maybe make them laugh, which sometimes is all that they may need to improve their attitude, at least for a while...

Finding joy in your life is the essence of Aging with Ease!

• When I originally made this post in November 2011, little did I know at the time that a few short months later my grandmother would get exactly what she was praying for.  She passed away on May 1, 2012.  Thanks to the wonderful nursing staff where she lived she died peacefully with a photo of my grandfather right beside her and her music playing, just the way she wanted it.  I miss her everyday!

It Might Be Time to Step In...

As a child of aging parents, it can be difficult to know when your parents can no longer manage on their own.  Your mother or father will become very adept at keeping it looking good.  You will become very good at looking the other way.  It is not easy to look at your parent as someone who needs help with their activities of daily living.  Parents are the people you turn to for support, advice and strength - not the other way around.  On top of that, your parent will most likely become upset with you if you even suggest that they cannot manage on their own anymore.  No one enjoys confrontation, especially with our parents.

Some of the sure signs that someone may need to step in are easy to spot, if you are looking for them.

• Things in the house are out of order from the normal (laundry piling up, dirty dishes, messy floors, etc.)

• Mail piling up and bills not being paid

• Body odor/ Poor hygiene

• Frequently losing or misplacing things

• Forgetting to go to appointments

• Spoiled foods in the refrigerator

If you notice some of these signs, you need to take a closer look.  There are numerous reason that these things could be occurring.  Pain, fatigue, or memory loss just to name a few.   As uncomfortable as this discussion may be, it needs to be done.  Avoiding it until the situation becomes a crisis will decrease your family's control of the decisions that need to be made.

If you have siblings, you need to involve them in these discussions.  This is a family matter; it should not completely fall on the shoulders of one child.  Typically one child will become the primary care taker for your parents but that does not mean that all the decisions fall to you. 

If you are an only child, seek advice and guidance from other family members.  If you feel like you have no one to help you with this problem, you can look for support online, your parent's physician, your pastor or your local Area Office of Aging. 

Expect confrontation when you approach your parent about these concerns.  Try to keep your cool.  Continue to talk with them calmly and respectfully.  It may need to be brought up more than once until you are able to have on honest conversation with them about the changes that you are seeing.

Knowing when to step in aides older adults' ability to experience Aging with Ease!

Time to Hang Up the Keys?

What do you do when your parent or spouse is unsafe to drive a car any longer?  This is a delicate problem.  Of all the things that you lose as you age, not being able to drive a vehicle any more can be one of the most difficult to face.  It is one of the biggest losses of independence an older adult can encounter.

Some signs that it may be time to stop driving:
1. Slowed motor reflexes
2. Decline in vision
3. Impaired hearing
4. Decline in attention span
5. Physical limitations (neck, arms and/or legs)
6. A few "Close Calls"- almost hitting someone, dents or scratches on your car

If your loved one is experiencing one or more of these difficulties, it may mean that it is time to look at their driving safety.  Being forthcoming about these limitations can help to understand the risk that they may be taking by driving a vehicle.  It would be horrible for them to be responsible for a terrible accident by avoiding these questions.  The last thing anyone wants is to hurt themselves or somebody else.  The risk for fatal motor accidents rises significantly after the age of 70.

Another important point is for them to know their limitations.  If they don't see well at night, then don't drive at night.  If they get nervous driving to certain areas because of traffic congestion, then don't drive to those areas.  If they have pain in their neck when they try to look back over their shoulder, have it checked by a physician.

Tips to staying healthy behind the wheel:
1. Stay active
2. Have regular eye and hearing exams
3. Manage any chronic conditions
4. Know your limitations
5. Plan ahead for trips
6. Drive when weather is good

If you feel that it is time to hang up the keys, you do not have to face this obstacle alone.  Ask your physician for support in this and ask that he recommend this for your loved one. You can request to discuss it with him at an appointment.  There are driving courses available for older adults that you can enroll in to have them evaluated by a professional.

Click Here to visit the AARP link to their Driver Safety Program.

Being safe behind the wheel contributes to Aging with Ease!