Homebound aging parents need mini field trips

What seems to happen way too often is that aging parents would rather sit in the kitchen or living room at home instead of going out… almost anywhere.

Yet getting them out is good for them. Homebound aging parents need mini field trips. It’s movement, it’s new sights and sounds, it’s a diversion to their otherwise often limited lifestyle. But not too much! Homebound elderly parents will tire more easily; they’ll feel out of sorts, even threatened by too many stimulants.

The trick is to take them for short trips. To a park. To a mall. To a movie. For a visit. To… well, whatever will engage them. Whether half an hour or two hours, it’s time well spent.

Have you tried to get your aging parents on mini field trips? How did it go? What worked? What didn’t? 

The challenges of senior travel (part 2): the discomforts of traveling for seniors

Italian poet Cesar Pavese may well have had seniors in mind when he wrote,

“Traveling is a brutality. It forces you to trust strangers and to lose sight of all that familiar comfort of home and friends. You are constantly off balance. Nothing is yours except the essential things – air, sleep, dreams, the sea, the sky – all things tending towards the eternal or what we imagine of it.”

It may be that air travel, with all its attendant aggravations, would be too gruelling for elderly and frail individuals. Some possible issues:

·      The very long waits at airports due to heightened security

·      Access to washrooms and problems with continence

·      Problems with behavior or potential agitation may be difficult to deal with in flight, and unpleasant for staff and other passengers

·      Those with severe urinary urgency or incontinence should probably not to fly at all since the washroom wait on an airplane can be very long

Depending on trip length, driving might be an easier alternative for the older person.  For example, problems with urinary frequency or continence can be contained by planning to make frequent stops at service areas instead of waiting until the person says, “I have to go, now!!” Whatever the mode of travel, make sure that all necessary supplies, for example medications, absorbent pads and changes of underwear are easily accessible. The challenges of senior travel are many, thus the need to plan.

Keys to successful travel

Despite the challenges, travel may be worthwhile when previous experiences have always brought an improvement in the person’s sense of well-being. If the trip will really be a vacation, is safe, relieves the discomfort of a bad winter and/or offers a reunion with loved ones, it may well be worth the trouble.

The keys to a successful trip are:

·      Planning to ensure enough support and supervision to decrease potential danger during the trip and the actual travel

·      Providing any special considerations needed for comfort during the trip

·      Ensuring that travel insurance will cover any needed medical services, return travel costs and cancellation penalties

·      Defining beforehand how to obtain any necessary medical services, who to contact in an emergency, and how to return home early if necessary

Traveling with wings and roots

            Despite the enormous growth in destinations that cater to older people, travel is not as easy as it once was and the challenges of aging can magnify the difficulties.  But communication tools like cell phones, computers and Skype mean that seniors can be far way and still remain in contact with people who can help if an urgent need arises.

            With the right planning, many older people can travel in relative safety to enjoy those warmer climates and loving reunions.

The challenges of senior travel (part 1)

A patient of mine, whom I’ll call Juan, was in my office with his wife and daughter for a six-month check-up.  Juan suffered from progressive dementia and we had previously adjusted his medications to try to improve his mood and mental function and decrease his periods of agitation.

Originally from the Caribbean, Juan and his wife and children had made their home in Canada for many years. They still had lots of family and connections ‘back home,’ and travelled there often. With his increasing level of dementia, Juan began talking a lot about going home to the islands even though Canada was now his real home.

 “We used to take dad south to the islands every year to avoid the harsh winter,” said his daughter. “But now I am not sure if we can. What do you think, doctor?”

It was not the first time that family members or patients had asked about whether they should travel south as they had for the past 30 or 40 years. Some, like Juan, develop an almost ‘romantic’ association with their past and younger years in their former ‘homes.’ Unfortunately, with the past so vivid in their minds, these patients may have unrealistic views as to what awaits them should they be allowed to visit. Others seniors have second homes in a southern clime and feel something missing from their lives if they cannot escape the worst of the winter months.  In Juan’s case, I advised that a trip such as he is contemplating he and his family must clearly understand the implications, the potential risk and possible benefits that must be considered before a final decision to travel is made. It is not so simple as buying a ticket and getting on a plane. There are lots of challenges of senior travel.

When to stay home

 Do not travel if an existing medical condition requires frequent monitoring and has resulted in repeated, unexpected or serious or urgent admissions to hospitals or emergency rooms. Most travel insurance policies will not cover faraway treatment of such medical conditions especially if the cause of them is from what is called a “pre-existing” medical condition because of the potentially dangerous clinical uncertainty and extreme costs they entail.

Think Before You Go

When a disability has developed, the benefits of traveling don’t always outweigh the risks.  Here are some factors to consider when your older family member is contemplating travel—especially, but not exclusively, out of the country:

·      The medical condition

·      The medical implications of the actual traveling

·      Being far away from your normal professional caregivers

·      The need for reliable and adequate insurance to cover expected illness

·      The costs and other implications of getting needed care and /or having to return home in the event of sudden illness or injury

Check Travel Insurance Carefully

This means you could end up with potentially huge medical bills, especially but not exclusively from illness that occurs while outside the country. Insurance companies consider any medications changes that have occurred during a previously defined period (often 90 days) – may invalidate medical insurance coverage.

Clarify any such stipulations before the trip, as stopping or reducing a medication because of better outcomes of already-established treatment does not make the person a greater insurance risk for travelling. If medication changes do occur in the months prior to a planned trip, inform your doctors and ask for a note attesting that the reason for the change was for good and positive reasons that would not increase the risk of travel or illness.

Note:  This is not legal advice. The value of such a note prior really depends on the insurance company and on the traveler’s willingness to confront the insurance company if they reject the claim. Physicians who have written such a letter may be required to be called as witnesses should there be a claim that is denied and not every physician is willing to get involved in such complex and often contentious legal conflicts.

Part two of travelling with seniors to follow in next blog

Checking remotely on elderly loved ones: technology helps

This article is worth a read:

www.cbc.ca/news/technology/use-of-surveillance-tech-to-monitor-seniors-at-home-on-rise-1.2535677

New technology is allowing for myriad remote monitoring of elderly loved ones. It's a mixed but good blessing for all, once aging parents understand the vlaue and benefits and their children know how to use it respectfully. 

Making sure your parents are prepared for a safe winter

In the same way that a car owner makes sure a vehicle used in winter is prepared for the challenges of cold, snow, ice and other aspects of inclement weather, so should seniors make sure that they have had a similar winter check up. This includes doing everything for their “medical” safety but assuring also that their environment is also safe. And this so far sever winter seems to be especially a threat for many seniors.

Medical safety

Medical safety includes making sure that  the risk of illness that are more common in winter are taken care of in anticipation of winter’s special challenges. On top of the list is vaccination against influenza which is necessary every year, as the strains of virus changes from year to year. Even though sometimes the yearly outbreak is mild you will never know in advance what kind of outbreak might occur. For seniors who may have  an array of chronic illness affecting their cardiac and respiratory systems or have impairments of their immune responses, a bout of influenza, can cause a very serious and debilitating illness  and at times can be fatal. As a child of an aging parent it might be your role to make sure that your parent and the treating physician are aware of the importance of such vaccination.

Other safety check-points

Other safety check points include reviewing all necessary medications that are taken by your parent and review them with your parents’ physician. Make sure that there are refill orders already available so that there isn’t a chance that your parent may run out of necessary medications during inclement weather. If your parent(s) are fortunate enough to vacation in the south for part of the winter make sure that they have the necessary supply of medications.

If travelling

Check with any travel insurance provider that travel insurance is in place and that you have determined that there is no risk that should something medically happen to you while traveling that you will not discover that your insurance did not cover that eventuality: the general rule is that you must reveal to the insurance company all your illnesses and any changes in your medical status and medications prior to your trip.

What about the cold of winter?

If you will be staying put in the Northern United States or Canada the important steps for winter home safety should be taken. Whoever it is that takes care of your parents heating system should make sure that maintenance servicing is done well in advance of winter  to avoid the risk of a breakdown during a cold spell that could potentially put your parent(s) at risk. Determine what the network of family supports is and if there will be an periods of absence and what steps might be taken to fill in which could be very important should something unanticipated happen. Having access to help and if necessary a place to go while repairs take place is very important.

With the risk of power outages, be sure to have flashlights positioned around the house and purchase a few units that sit in outlets as “nightlights” which double as emergency lighting if there is a power failure. Get some flashlights that will last a few hours with sealed batteries so that your parent(s) do not have to be concerned about batteries going dead. Avoid depending on candles for blackouts because of the risk of fire and make sure that smoke and carbon monoxide alarms are installed in the proper places.

Safety inside and outside

Make sure that safety is a priority around inside and outside your parent(s) home especially if it is a private home and not an apartment where someone is responsible for assuring walkways and stairs are safe. Make sure your parent(s) have a means (usually through another person) to clear snow and ice from walkways and steps and that there are secure handrails on steps, that salt or sand are available for slippery surfaces and that places that might become covered with snow or ice are well illuminated.

Having an automatic light that goes on at dusk is one way of assuring that the walkways will always be lit when darkness falls. This will help you navigate walkways and steps.

Preparing for a safe winter takes little time; not preparing can result in injuries that can take a long 

Prepare parents for a safe winter

In the same way that a car owner makes sure a vehicle is prepared for winter use, so to should we prepare parents for a safe winter. This includes doing everything for their “medical” safety while assuring that their environment is also safe.

Medical safety

Medical safety includes making sure that the risk of illness that are more common in winter are taken care of in anticipation of winter’s special challenges. On top of the list is vaccination against influenza which is necessary every year, as the strains of virus changes from year to year. Even though sometimes the yearly outbreak is mild you will never know in advance what kind of outbreak might occur. For seniors who may have  an array of chronic illness affecting their cardiac and respiratory systems or have impairments of their immune responses, a bout of influenza, can cause a very serious and debilitating illness  and at times can be fatal. As a child of an aging parent it might be your role to make sure that your parent and the treating physician are aware of the importance of such vaccination.

Other safety check points

Other safety check points include reviewing all necessary medications that are taken by your parents and review them with your parents’ physician. Make sure that there are refill orders already available so that there isn’t a chance that your parent may run out of necessary medications during inclement weather. If your parent are fortunate enough to vacation in the south for part of the winter make sure that they have the necessary supply of medications.

If travelling

Ensure travel insurance is in place; determine that should something medically happen while traveling that your parents are covered for that medical need. The general rule is that you must reveal to the insurance company all illnesses and any changes in medical status and medications prior to their trip.

What about the cold of winter?

If your parents will be staying put in the Northern United States or Canada the important steps for winter home safety should be taken. Whoever it is that takes care of your parent’s heating system should make sure that maintenance servicing is done well in advance of winter to avoid the risk of a breakdown during a cold spell that could potentially put them at risk. Determine what the network of family supports is and if there will be an periods of absence and what steps might be taken to fill in which could be very important should something unanticipated happen. Having access to help and if necessary a place to go while repairs take place is very important.

With the risk of power outages, be sure to have flashlights positioned around their house and purchase a few units that sit in outlets as nightlights that double as emergency lighting if there is a power failure. Get some flashlights that will last a few hours with sealed batteries so that your parents do not have to be concerned about batteries going dead. Avoid depending on candles for blackouts because of the risk of fire and make sure that smoke and carbon monoxide alarms are installed in the proper places.

Safety inside and outside

Make sure that safety is a priority around inside and outside your parent’s home especially if it is a private home and not an apartment where someone is responsible for assuring walkways and stairs are safe. Ensure they have a means (usually through another person) to clear snow and ice from walkways and steps and that there are secure handrails on steps, that salt or sand are available for slippery surfaces and that places that might become covered with snow or ice are well illuminated. Having an automatic light that goes on at dusk is one way of assuring that the walkways will always be lit when darkness falls. This will help you navigate walkways and steps.           

Preparing for a safe winter takes little time; not preparing can result in injuries that can take a long time to heal. So be prepared and prepare for your parent’s safe winter—wherever they are.

 

Flu shots important for aging parents, yourself

 

            “I never get the “flu”. I often hear that from patients, colleagues and friends. After awhile the public seems to ignore news about the “flu”. When reports first came out of Mexico about the “swine flu” in 2012 (more accurately called H1N1) and the number of cases mounted and the World Health Organization issued reports about the potential for a world-wide outbreak (pandemic), the media issued reports every day which caused a great deal of concern in the US and Canada.

            However, as it became clear that for most people who contracted H1N1 infections, the cases were mild, there seemed to be a sense of boredom on the part of the public about the risks entailed in this “flu” outbreak. The excessive media focus on the outbreak may have done an inadvertent disservice to public health officials who were trying to prepare the public for the upcoming “flu” season. The fact is, it’s important to get a flu shot each year to ward off illness for aging parents and yourself and family.

Personal History of “Asian Flu”

            As a teenager growing up in Brooklyn I contracted the Asian “flu”. I recall how terribly ill I was, being bed bound for a week with high fevers and excruciating muscle pains. The Asian influenza outbreak of 1957-1958 was followed years later by the Hong Kong outbreak of 1968-69. In both outbreaks it is estimated that hundreds of thousands if not more people succumbed to the illness directly or indirectly due to underlying chronic illnesses worsened by the infection. This was especially the case in the senior population.

            One problem with the public’s recognition of the potential seriousness of such outbreaks is that we have tended to use the term “flu” for a disease which rightfully should be called influenza. The term “flu” is used almost dismissively for almost any type of viral infections, many of which are minor in nature and have nothing to do with influenza. Sometimes health care professionals will describe non-specific illnesses with fever and respiratory symptoms as the “flu”. Since these illnesses are usually not serious, the whole idea about the potential catastrophic nature of true influenza is lost. Telling people to get the “flu shot” even when used by public health officials may be perpetuating the false sense of security about influenza being relatively innocuous.

            People who refuse the vaccine often justify their decision with, “I never get ‘the flu’ or last year I got the ‘needle’ and got ‘the flu’ anyway so what good did it do?” Then there is always the story about someone they knew or heard about who got the ‘flu shot’ and got sick or died or was paralyzed or some other perceived and often unsubstantiated disaster. Most of these stories are erroneous and part of the well-known tendency to propagate myth as if it is fact, especially when it is self- serving.

What to do?

            The first and most important point for you, your parents and health care professionals to understand is that characterizing influenza as “the flu”, especially when it is preceded by the phrase “it’s just” is very misleading. Influenza can be a very serious and potentially lethal disease. The influenza outbreak of 1918 following the First World War killed more people than that terrible war itself. According to the website of the CDC (Centers for Disease Control and Prevention in the US): For everyone, getting vaccinated each year provides the best protection against influenza throughout flu season. It’s important to get a flu vaccine every year, even if you got vaccinated the season before and the viruses in the vaccine have not changed for the current season.

Historical Perspective Should Inform Us

            The development of influenza vaccine during the Second World War and its improvements subsequently has been one of the great advances in medicine. We have been very fortunate in the United States and Canada in that the vaccine is readily available to the population and in some jurisdictions it is available without cost to everyone. Manufactures are trying to include a fourth strain of influenza into the 2013-2014 vaccine repertoire so that we can decrease its risk on our population. So remember, “it’s not the ‘flu’ – it’s influenza’- get the ‘shot’ and encourage everyone in your family, especially aging parents to do the same.

Taking to bed: an undercover problem

 

            Staying in bed is not a “normal” aspect of aging, other than for the occasional day or two which may occur as part of an underlying short-term illness. Most people want get out of bed and greet the day as soon as they can. So if an elderly loved one ‘takes to the bed’ and stays there, a full health evaluation and possibly intervention for depression, should be done.

Proper Assessment Is Essential

            The most important aspect of an in-home assessment is discovering any underlying medical problems that could cause someone to ‘take to bed.’ Clearly, any distinctive physical symptoms—such as pain or shortness of breath— that are relieved by staying in bed will need to be addressed.  In the absence of such fairly obvious physical symptoms, major depression ought to be considered.  Older men in particular have a significant risk of late onset depression, a condition that is easily overlooked, especially when the person denies feeling depressed.  Not every depressed person expresses negative or ‘blue’ thoughts, or mentions feelings of hopelessness or helplessness. Fortunately, treatment for depression, which might include medications or other therapies, is usually effective. 

What’s Wrong with Staying In Bed?

            When older people start taking to bed and refuse to get up, it makes perfect sense to them.  “I don’t have the energy or interest to get out of bed,” or “I just feel better being in bed,” are common explanations. But bed rest of more than a day or two very quickly becomes problematic, causing muscle tone and functional ability to deteriorate so that after a short period of being in bed, the person may indeed have difficulty performing everyday activities. Sometimes, physical condition can deteriorate seriously, leading to the need for hospitalization and urgent medical intervention. Family members often have a difficult time persuading their loved ones that staying in bed is bad for them. 

A Return to Meaningful Mornings and Engaging Days

            ‘Remaining in bed’ may not sound serious, but it can be symbolic of an important underlying condition which needs to be addressed and treated quickly and properly by the whole team of those who care for the older person. Sometimes, especially for the person who is living alone, moving to the more engaging and supportive environment of an assisted living facility may be worth considering. Ultimately, the ‘best decision’ is whatever helps the person look forward to getting out of bed and participating in the world around them. 

Elder care living choices: decisions are not easy

    It is a fairly common scenario: the daughter who was the primary care giver of her 84 year old mother was sitting together with her in my office. “I feel a lot better since that visit to the emergency room in the summer when they changed my medications. I have not had any more dizzy spells or falls.”  The daughter concurred and I confirmed from the discharge summary of the finding following a fall that was found to have blood pressure levels that fell when she stood up as well as a slow heartbeat.  It was believed to be the result of a combination of medications for her high blood pressure which were producing an excessive effect, leading to “postural hypotension” (an excessive fall in blood pressure when standing) 

The real issue beyond the medical care

    I was told that since the fall the mother was living in her daughter’s home; the mother’s apartment had suffered water damage during a rainstorm that required repairs. It was not yet certain if she would feel secure enough to return and live on her own, even though that was what she was appeared to prefer. The mother had mild cognitive impairment; but her every day and basic functioning was normal. She was able to care for herself in most ways despite being a bit repetitive. She expressed herself quite clearly and made reasonable sense about what was happening to her.

    The daughter asked quite bluntly after the assessment, “Do you think my mother should move into a retirement home rather than living with me? During the day she is alone in the house but we have checked it all for safety and she has an emergency call system which she knows how to use” I asked the patient and asked her how she felt about living in her daughter’s house. Other than musing that returning to her own home would be her preference she stated that she felt quite comfortable living with her daughter. The house was arranged in such a way that she could do everything she wanted to do and be comfortable on the modified ground floor.

Conflict between siblings

     The daughter continued, “My sister who lives in Toronto and brother (who lives in New York) feel she should in a retirement home for safety reasons. On their urging our mother tried one that seemed very nice and suitable but after three days she called and begged to be taken back to my house. They are now looking at others but my mother insists on staying at my house if she cannot return to her own apartment.”  

How such living decisions should be made

    Making elder care living choices is not easy. I explained to mother and daughter the principles according to ethics and the law, by which such living decisions should be made. The important point was the apparent ability of the mother to participate in such decisions.  I explained to the daughter and patient, “I think you and your siblings need a good discussion with someone who understands the process of personal decisions and how alternative housing arrangements should be made. Arrangements were therefore made for a family meeting with a social worker. The mother seemed very pleased that her wishes were being listened to and respected—that step and process is key to any such discussions. Being the daughter who in this case was the proverbial “It” in the middle of family discord is not easy.