Many elderly: I hear you, I hear you, or maybe I don’t

It's the case in many elderly: I hear you, I hear you, or maybe I don’t

The clinical scenario
It was one of those unusual clinics where I saw three similar cases in which the exact same issue surfaced and I was able to demonstrate that in “real time” to residents in training with me in the care of the elderly. The first of the encounters was with a couple accompanied by two family members. The couple lived at home with some personal care help and each had some degree of cognitive impairment, but not enough to completely interfere with reasonably safe functioning when under some supervision. I was interviewing and examining one member of the couple and my resident was doing the same to the other.

Denial or hearing impairment: a common scenario
As I embarked on my interview with the patient it became clear that as noted in previous visits, he was quite hard of hearing and according to the son who was with him, refused to wear his hearing aids because “they bothered him” and he often stated that he had “no problem with hearing”, while each time leaning closer to me to hear my question or answer and turning to the son to repeat the question.  With his wife, the resident also noted that in addition to some degree of cognitive impairment there was a significant degree of hearing impairment. 

Low cost, effective hearing enhancement: very dramatic at times
I retrieved my Pocket Talker® which I keep in the office for such cases. I put the earphones first on him and gradually turned the volume and suddenly his face lit up as I asked if he could hear me and he said, “very well”. We practiced a bit with the device until it was clear that he could engage in a three way conversation with his son and me.  

The resident was now ready to review the wife’s issues with me and the son entered the room with us as did his father. They had already learned from me that during the discussion, while I asked questions the son and husband were to sit quietly despite a desire to “help with answers” unless I asked them specifically to comment on something said to me by the patient. The resident had reiterated the story to me of mild dementia and emphasized that she was quite hard of hearing; she had refused hearing aids although the family was planning on acquiring them. I again retrieved the Pocket Talker® that I had just used with her husband, put on the head phones and as I increased the volume, like her husband’s, her face lit up when she heard my questions and I looked at the son and husband and said to them, “maybe you can get a deal if you get two of these”. 

A hearing augmentation “hat trick” 
Later, a different resident saw another patient. This resident had not been apprised of the earlier experience that we had with the couple. She recounted a history of progressive cognitive decline in the patient and also mentioned an issue with hearing that the patient’s daughter raised. Like the previous couple the daughter said her mother absolutely refused to go for a hearing assessment and said that she did not want “hearing aids” as she “did not need them” and they were “a waste of money”.  

I carried out the same manoeuvre that I had used with the previous couple. Although less dramatic than the previous cases, the way she responded to my repeated questions clearly indicated that she could hear better with the device.  In this particular case,  I was not convinced yet that some of the apparent cognitive impairment may have been perceived as such due to her hearing impairment or at least aggravated by it.  I explained to the daughter I was not yet sure of the degree of cognitive impairment, because “if you can’t hear it, you can’t remember it”. 

Don’t overlook hearing as part of the cognitive assessment
In these three situations during one clinic session the young residents who in their careers would see many elderly people with cognitive impairment or dementia, the message of the importance in hearing was clearly demonstrated.  It can be hard to convince older people to utilize hearing aids or pay for them. For many a simple and inexpensive Pocket Talker® may be a device that can be used as an introduction to the benefits of hearing enhancement or may on its own solve the hearing deficiency problem for the purpose of social communication.

Nursing home warning signs to watch for

There are some nursing home warning signs to watch for.

As those wanting to help and protect our aging parents and other loved ones, we need to be very careful in how we select nusring homes for them.

Here are the first two paragraphs for a Toronto Star article from a few months ago that underscore the reasons for flashing warning signs for us all:

Three troubled Ontario nursing homes — including a Mississauga home — have been ordered to stop accepting new residents due to substandard care.

The crackdown came this week after the Ministry of Health and Long-Term Care ordered each to “cease admissions,” meaning no new residents are allowed to move into the homes.

The message for us: 

Be very thorough and intense about examing any nursing home for your parents or other aging loved ones. Make sure you take the time to look carefully at the facility and what it offers. 

Take the sniff test: can you smell urine in the hallways, common rooms, shared bedrooms?

Talk to staff, residents, and family members of residents. Ask probing questions. 

In fact, if you want to be extra careful, come spot visit at various times of day and night a few times to get a sense of the care giving going on. 

There are lots of optons out there. Take your time, be patient, research. After all, you're making decisons that will impact the lives of your aging parents and perhaps other elderly loved ones.



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:®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. 

Continue reading “Don’t let spring cleaning become spring falling for the elderly”

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. 

Continue reading “We must protect the elderly and aging when crossing streets”

Caring for a parent afflicted with Alzheimers

Caring for a parent afflicated with Alzheimers is challenging.

Listen here​ 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.

Continue reading “Plan now to plan ahead for the right substitute decision maker”

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.

Continue reading “Summer safety for our elder parents and even us!”