Minimize emotional pain among the elderly and aging

 

One always hopes that as medical practitioners, we will be able to focus our attention on the medical issues faced by seniors and help families cope with the fears, disappointments and tragedies that are faced by loved ones in the midst of what are often life-altering illnesses. In short, as physicians, we want to minimize emotional pain among the elderly and aging.

Throughout our initial medical training, and most often during post-graduate training programs, the primary focus in general is: what is the “best of medicine” and what does “evidence-based medicine” tell us about treatment decisions and their ultimate impact on health, well-being and, often, the likelihood of death? 

This is particularly the case in the care of the older adult – whether in geriatric medicine or eldercare.

What is often surprising and baffling, especially to younger physicians, is the situation where the core of what appears to be the challenge in care provision is negatively tinged by what might be called family “strife.” 

At times, however, a more appropriate term would be venomous, hateful actions—actions that ultimately will be destructive to the family fabric. This should not be 
surprising to anyone who has even a modest understanding and familiarity with the world of literature—whether limited to English works, or more broadly including European or other literature.

Those medical trainees who have worked with me have in all likelihood heard me either seriously or humorously say, “If I were king, all first degrees would be in English literature.” Or when there is a complex family dynamic playing out, I might say, “It’s King Lear—if you have not read it ever or lately, read it or read it again—it’s all there.”

Sometimes I feel like that great American comic Jimmy Durante, who was quoted as saying, “I have a million of them, a million of them,” referring to his often delectable jokes. According to an online biographical history, it has been said that “I’ve got a million of ’em” is what Durante (1893-1980) often said after telling a corny joke. Durante was credited with “I’ve got a million of ’em” in a 1929 newspaper story.

I say this when referring to complex family situations in which what appears to be the worst in human interactions seems to be playing out. Often the issue is related to money (or property), and if one is in a position to hear the story from all the parties, it often becomes clear that, for whatever reason, the pot has come to a boil at this juncture of life.

This is usually because the flame heating the water that’s not boiling has been on for what appears to have been many years. Most of us know of such stories, hopefully not in our own families, but it is unlikely that there is a family who is not familiar with a “Lear-like” scenario in someone close to them. 

Greed, jealousy, hurtful memories, mean-spirited personalities, events that occurred—sometimes decades earlier— that were never resolved or that left indelible scars are often the reasons cited for the enmity I have had the good fortune to observe that, on some occasions, especially when a parent, in particular, is dying, though it could be another relative, there is the possibility of repairing long held animosities and bringing long-estranged family members back together. 

It does not always succeed, but I have witnessed the monumental efforts of health-care staff—especially those in social work, nursing and medicine, although any and all of the health-care staff can be key—in bridging the emotional moat that often separates family members. It may not always work, but I believe it is always worth the effort.

Living with the result of lifelong family strife is often disabling, and the scars that occur and that are left can have long-lasting negative effects on people’s lives and their own abilities to have meaningful and binding relationships with their siblings and offspring.

Are we ignoring immunization needs of the elderly?

Are we ignoring the immunization needs of the elderly? The recent New York Times opinion piece by Louise Aronson, a professor of geriatrics at the University of California, San Francisco, offers an interesting proposition. about the needs of those in their 70s and up. Read it by clicking here:

https://www.nytimes.com/2017/08/11/opinion/sunday/vaccinations-elderly.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region®ion=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region&_r=0

Don’t let spring cleaning become spring falling for the elderly

It just happened to my wife, an avid early morning walker. She does everything ‘right’ in terms of the ‘right’ shoes, coat, scarf, hat—you name it –she does it. The only thing she does not do is make sure the weather is perfect and receptive to activities of middle, later age, and elderly individuals. 

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We must protect the elderly and aging when crossing streets

The Mayor of the City of Toronto recently called to safety islands to be created for the elderly and aging to use when crossing busy and large intersections. This is has been an issue on my mind for a long time. The piece below I wrote last year precisely about this all too common threat. 

Bottom line: We must protect the elderly and aging when crossing streets.


Watching the ribbon of news on roll across the bottom of my television is often very disturbing. 

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Caring for a parent afflicted with Alzheimers

Caring for a parent afflicated with Alzheimers is challenging.

Listen here https://soundcloud.com/680cjob/parenting-our-parents​ as Dr. Michael Gordan discusses key considerations in a CJOB 680 interivew with host Jeff Currier in Winnipeg.

Nursing home drama: wrong treatment

This is an email from a long time friend on the west coast. 

Her point is simple and poignent… a nursing home drama: wrong treatment.

Her challenge: how to help her failing fahter.

It's not pretty, and so many of us experience the same trauma. 

Please read on.

On Thursday, dad's geriatric psychiatrist contacted me to discuss his treatment. The facility is saying he is being aggressive, so they are looking at his meds to adjust. Less than a half hour later the doctor called me back asking if the facility had contacted me because they are indicating they will send him to emergency where he will essentially be sedated. The doctor doesn't agree with this and has him on the waiting list to get into the geriatric floor at the hospital. 

Dad is physically fine, he gets around and is busy. He tends to get into other people's rooms and moves everything around and tries to fix things. His eyesight is really bad, so he feels for things. One care aide at the home is calling this aggressive behaviour. He has had a couple of incidents, but they were because he was alone and could have been redirected, no one was hurt or even close to being hurt. Dad jokingly does a one two jab action, then laughs. It is a jest, not aggressive whatsoever. His main care aides say he is the least aggressive person, but busy and gets into things. The facility have told us we have to be there from the time he wakes until he goes to sleep or they will send him to emergency here he will be sedated and returned to the facility or he may not have anywhere to go. 

The home has a lack of staff and often there is often no LPN on his floor. If they are on breaks there is no one there. This is a dementia unit for high needs patients. They will move in temporary replacement staff that do not have dementia training, nor read the patients charts and make comments such as why are we even feeding these people.

They have lost his shoes, his dentures, his glasses, they don't shave him and I have to ask for him to be changed. They are supposed to contact us when incidents occur and they haven't.

It is appalling. I am putting in a formal complaint to the health authority, licensing board, and ministry. The disease is hard enough on its own without having to deal with the system. Not sure why I am sharing, except that I know you went through the disease part. This is not the norm as far as care, is it? I am working with the doctor and hopefully we can get him into a place that has adequate care. 

Maybe you need a follow up book on how to ensure your parent is being cared for?

Clearly, her father needs the right kind of care. 

He seems to need regular attention and care. And a way to vent his interets and energy.  It seems he's not violent or dangerous. But ongoing stimulation may be needed.

Bottom line: the system needs stronger checks and balances. It needs to be able to effectively understand and manage the needs to those who are suffering from various stages of dementia. 

 

Plan now to plan ahead for the right substitute decision maker

Choose the right substitute decision makers (SDM) now.

With all the recent focus on what is now called advance care planning (ACP) in the medical and social work literature, it is important for people especially middle-aged and older people to understand what is at stake.

Using the old terminology of a "living well" there has been a transformation from what used to be a few words in a document somewhere or as a conversation with the family member likely to be the SDM that for example the parent "would not want any heroics" if they develop a terminal illness. The reality is that is no longer enough to help those empowered to make such decisions on your behalf. The new world of medicine has many things that can be done that are no longer considered "heroics" but just part of contemporary every day medicine.

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Summer safety for our elder parents and even us!

Most of us look forward to summer. Those who can often take vacation during this season, and many families use it for opportunities to visit their loved ones especially if they are far away from where we live year round.


For those who can, summer is often a time of recreational outdoor activities which may include long walks, swimming, going to beaches and such activities as cycling. Of interest is the fact that with the expansion of the older population many what have been referred to as seniors or elders are now actively involved in physical activities including those outdoors.

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Childless, unmarried baby boomers warned to prepare for future

Childless, unmarried baby boomers warned to prepare for future.
Dr. Mireille Norris says elder orphans are a growing problem across the country.
    
A new study is raising awareness about the problem of "elder orphans" — seniors who have no children, spouse or any other family member to care for them as they age.
The research comes on the heels of an incident earlier this week in North Carolina in which an 81-year-old cancer patient with no caregiver called 911 to ask someone to buy him some food.
Dr. Maria Torroella Carney, the chief of geriatric and palliative medicine at North Shore-LIJ Health System, recently completed a case study and literature review that she will be presenting to The American Geriatrics Society's Annual Scientific Meeting this weekend.

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Planning an elderly parent’s long trip

Planning an elderly parent's long trip requires thought and caution.

Your 80 year old mother wants to visit her sister who is older than she is and still lives in their small village in Scotland.

She says, "it is her 85th birthday coming up and if I do not visit her now I may never see her again". She is right and has a point; but the question is whether it is a good idea to go and if so alone or with someone? Flying has become a real chore and for elders it has many challenging components.

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