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Is it Time for Assisted Living?
October 5, 2011 By Leave a Comment
You’ve come to this blog for a reason. More than likely, you’ve seen changes in your loved one that have you concerned. They are likely changes that worry you, but have not fully convinced you that your loved one may need additional care. Whether a spouse, or a parent – even an aging sibling, this person has come to an impasse in life’s journey. And it’s at that impasse that you wish to help them overcome.
The first step is getting clarity about what’s going on today, and to temper that clarity with loving compassion and an understanding of what the future may hold. This assessment process can be emotionally challenging. It’s something I’ve learned firsthand.
Take a deep breath, and let’s move on to step one: the assessment of your loved one’s current capabilities and needs.
How is Your Loved One Feeling Today?
Regardless of our age, our bodies are in a continuous state of decline. Whether it is reading glasses, arthritis or a doctor’s warning about your lifestyle, our bodies emit warnings about its decline.
It’s no different with our loved ones, except that while it can be an inconvenience for us, it is a matter of independence for them. Since you are concerned about your loved one, you’ll want to do an assessment.
An assessment looks at four areas where change may have taken a toll on your loved one’s independence: the physical, perceptual, cognitive and psychological manifestations of aging. We’re going to explore those areas with one overriding premise: ensuring their safety, and the safety of those around them.
Physical changes and loss of abilities (to some degree) are natural in the aging process. Your loved one is not the same as they were 10 years ago, or even 5 years ago – any more than you are the same as you were then. With that said, the essential key in the assessment process is to recognize symptoms and actions which fall outside the range of expected and acceptable changes. What defines “acceptable changes”? I would say they are those changes that don’t significantly interfere with the way they’ve lived their daily life.
Many changes are subtle and inconsistent; and many don’t put their lives, or the lives of others, at risk. Truly then, the focus should be on risk management. Continually ask yourself this question: Is my loved one a risk to themselves or others?
The criterion most often used by doctors, social workers, and geriatric care managers is a list of activities of daily living, or ADLs. These are those most common activities, divided into two categories: basic and complex.
The early warning signs are often losses in the realm of complex skills. Usually (but not always) loss of basic ADLs comes later on in the decline in the quality of your loved one’s life. As every person is an individual, so is his or her aging; assessment can only be done on a case-by-case basis.
Basic Skills
- Ability to feed oneself
- Ability to use the bathroom appropriately
- Ability to maintain good personal hygiene
- Ability to dress appropriately for the season
Complex Skills
- Cooking
- Shopping
- Effective communication
- Following directions
- Taking medications appropriately
- Money management
This list of activities appears rather brief; however you can see that each element listed, whether ‘basic’ or ‘complex’ is essential. Everyone should be able to use the bathroom appropriately, or follow directions.
If your loved one is having difficulties with one or more of these tasks, then they are in a state of functional decline and you should more thoroughly asses the state of their decline and possible solutions. In my next post I will discuss common signs of functional decline in greater detail.
Photo Credit: Flickr user Titoy.
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3 More Signs of Functional Decline
October 4, 2011 By Leave a Comment
In the last blog, I discussed some of the warning signs that your loved one could be experiencing functional decline, including difficulty communicating and the disturbance of everyday functions and tasks. These kinds of hardships may be symptoms of a more serious functional decline, in which your loved one is losing the skills needed to maintain basic independence.
In the previous blog, I gave a detailed account of physical, perceptual and cognitive changes that can indicate a functional decline. Now here are three more areas to monitor if you believe your loved one may be experiencing functional decline.
1. Hearing and Vision Loss
Hearing loss is hard to hide; it’s often one of the first indications your loved one is in need of assistance. Here’s a list of things to note:
- Saying “What?” over and over again during conversations, or repeating what you just said, as if to confirm what they heard.
- Turning the volume up on the television repeatedly, until the neighbors may be able to hear it – while your loved one still complains it’s ‘too low.’
- An inability to distinguish certain sounds, such as f, t, and z, resulting in misunderstandings and miscommunication.
- Nodding frequently during conversations, as if to confirm that they are participating fully in the dialogue.
And then there is eyesight – often the first of the senses to be noticeably affected by age. Focusing on small details becomes difficult; self-grooming becomes challenging – and who can write out the checks to pay bills when you can’t see the numbers?
As with hearing loss, compromised vision is also a safety issue. What are some of the signs of decreased visual acumen? Just ask yourself these questions:
- Has your loved one lost interest in reading, playing cards, or other hobbies where clear vision is required (embroidery or television viewing, for example)?
- Are their clothes, shoes or socks frequently mismatched?
- If they still drive a car, are they getting lost more often (because they can’t see the street signs)?
- Has your loved one started to fall, trip or bump into things more frequently?
Once again, a primary concern here is one of safety. How safe can your loved one be, if they can’t clearly hear or see the world around them? And if they’re driving, it can be catastrophic.
3. Frequent Falling
Certainly, frequent falling may not be related simply to poor eyesight; it could be the result of medical conditions related to poor physical health. Or repeated falling in the home environment could be the result of poor safety habits: loose throw rugs, a cluttered living space, exposed wiring, no handrails or poor lighting. There are also those elderly who refuse to use their assistive devices such as canes, walkers and wheelchairs – even refusing to wear their eyeglasses!
Whatever the causes, the consequences are serious – and should be addressed by your family or geriatric physician. Here are some things to watch out for:
- Unexplained cuts and bruises, or explanations for these injuries that seem far-fetched or implausible.
- Hesitancy when walking or climbing stairs.
- Reticence to leave the familiarity and relative safety of their home.
4. Psychological Changes
May Lamberton Becker – the journalist and literary critic once said, “We grow neither better nor worse as we get old, but more like ourselves.” What she’s describing is the process called disinhibition, where those personality traits that may have once been charming or quirky slowly become exaggerated as we age. Aunt Rosemary used to be rather bossy, but now she’s dictatorial; your father, who used to simply be self-reliant, is now completely resistive and argumentative.
It seems that the natural process of disinhibition is magnified when aging is coupled with fear and unhappiness. If it is complicated even further by depression or anxiety, your loved one will completely cling to those coping strategies that served them so well in their younger days – to the point they completely interfere with an independent life.
So, whatever you do, don’t delay in taking action. Start actively assessing all six areas of your loved one’s strengths and abilities as soon as possible. If there are signs of a serious functional decline, then you may want to consider a transition to assisted living.
Photo Credit: Flickr user One From RM.
More: 3 More Signs of Functional Decline
