Caregiver intervention in elder crises
by Isabel Fawcett
When basic life activities that were once automatic suddenly become confusing, a crisis is brewing. Crises are no respecter of age and sometimes present as health shifts.
Consider these circumstances.
- An elder independently balanced checkbooks for years. Suddenly he is confused by bills, reconciling his checkbook, or check-writing.
- After parking directly in front of a store, an elder walks away from the store entrance ahead. He enters another store and is confused thinking the store he came to shop in has moved. He looks inside another store not knowing what to do. He doesn't think of retracing his steps. He just stares straight ahead blocking the entrance to another store.
Once-familiar places, routines and ways of thinking have been disrupted. Underlying causes may be related to medication side effects, cognitive impairment, dementia, onset of Alzheimer's symptoms, extreme or rapid blood sugar fluctuations, high blood pressure disorientation, and other issues.
Loved ones may be the last to know or first to deny elder crises. If a loved one witnesses more than one crisis, he or she may seek medical advice, research elder health issues, express concerns to the elder and take it from there. If only there were elder care and crisis intervention formulas.
There is a point where elder intervention becomes the handwriting on the wall.
Handling Elder Care Crises: Doctor Visit Required
I remember the first time I accompanied my mother back to the patient room on her doctor's appointment. Left to her, she would not have scheduled the appointment with her doctor. Medical appointments make her nervous. I strongly encouraged her to keep the appointment I scheduled for her. While it is rare for me to tell her when to go to the doctor, the appointment was a preventive measure that might preclude an emergency department visit in the near future. Been there, done that. No longer want to do that.
Multiple visits to an emergency department is one visit too many. If within my control as a caregiver, as I perceived this health crisis to be, I will not spend hours in an emergency department. Pulmonary symptoms are best managed proactively.
Elder Care Crises: Deer-in-Headlights
Although I walked back to the patient room with my mother when her name was called, I thought I would be invisible and have nothing to say. My caregiving job was done. The appointment would be routine. It was anything but routine.
The doctor asked her what brought her to the office that day. She lowered her head, looked sideways at me, smiled, looked sideways at the doctor and said nothing. I smiled--until I noticed the doctor looking back and forth at my mother and me as if we had just gotten off a spaceship.
The doctor looked like a deer-in-headlights. Why had I not thought of explaining my presence in the patient room with his mentally competent patient? I'd never been in a patient room with her on any prior medical visit--ever. I had some explaining to do.
I wiped the smile off my face and admitted that I, not my mother, had scheduled the appointment. I explained that preventive care is better than emergency care for escalating wheezing symptoms. I told the doctor that two days of wheezing was one day too many for her based on her body's history with respiratory symptoms. Her symptoms had been successfully managed for years by skilled doctors.
Elder Care Crises and Chronic Health
In a 2006 publication, the U.S. Census Bureau reported that approximately 80 percent of older adults have at least one chronic health condition and 50 percent have at least two. Arthritis, hypertension, heart disease, diabetes, and respiratory disorders are leading causes of elders' reduced functioning.
Deciding when, whether and how to intervene in elder care remains a challenge. It helps to remember:
- We all have off-days regardless of age. Occasional memory lapses, episodic or rare mental confusion may not be cause for alarm. Stress, poor nutrition, the reversible onset of dehydration, and physical exhaustion might be culprits.
- Careful caregiver observation is essential, preferably over a period of time, to determine symptoms requiring possible intervention.
- There can be other triggers to mild confusion, including time of day, lack of adequate sleep, and prescription drug interactions.
- Non-verbal clues such as anxiety or anger are important to note.
- Adversarial interventions by loved ones are non-productive. Choose the time, place, and manner to express yourself with respect and dignity for the elder.
By working compassionately with loved ones and medical providers caregivers may facilitate seamless interventions and support elder life transitions.