Home Alone and At-Risk for the Holidays
WHAT friends and family?
The statistics vary, but on the average, one in four older Americans is home alone. Not just during the Holidays, of course - but every day. Because of tradition, long-held beliefs and customs, the Holidays put a large percentage of the population at risk for depression, illness and isolation. Let's do a thought exercise: You're taking a walk through your neighborhood. Oddly, every fourth house you pass has the curtains drawn, the mail box is overflowing with junk mail and the house looks almost abandoned. Just imagine for a moment, what's going on inside: maybe a frail man, too proud to ask for meal assistance, trying to read the directions for making some soup, but his glasses are very dirty and his prescription was last filled six years ago, when his wife was still with him.
His two kids, who live in another state, don't call much because they're' busy with their own lives'. Plus, 'Dad is so forgetful, it is frustrating to talk to him'. Do I need to go on? I could paint a very depressing picture, sadly, because I've seen so many in my time as a Geriatric Visiting Nurse.
This imagined person is who 'we in the biz' refer to as 'the unbefriended elderly'. So disheartening that there's even a term for this in our country. But - there is.
This population is quite often hesitant to ask for help in any way and during the Holidays, The old warm feelings of nostalgia may turn to sadness and loss of hope to experience those warm times again. People stop calling after years of turning down an invitation. The well-intentioned may not realize how empty it makes a lonely person feel. This is THE time to reach out: drop by, bake a casserole, make some cookies or bring over some egg nog. Ask to see some family photos of the happier Holiday times. And while you're there, ask if there is anything you might be able to help them with - mow the lawn, clean the kitchen and stock it up...take them to the hairdresser. Your mere presence is a true gift to the spirit of this time.
The Senior Lawyers Division of the American Bar Association also has some very sobering statistics on elder abuse during the Holidays, which you can read below (from their website, linked above).
Elder Abuse and the Holidays
Some older adults may be experiencing feelings of isolation, depression, and pain due to elder abuse. Millions of older adults experience some form of abuse each year. The abuse can take many forms – physical, sexual, emotional, and financial. The holiday season can increase the risks of experiencing elder abuse. The holiday season is also an opportunity to screen for elder abuse.
The risk of elder abuse can increase during the holidays for a number of reasons. Two amplifying factors are increased stress and isolation. Stress. To-do lists are long during the holidays, and with those expectations can come stress. If caregivers and family members are extra stressed, this can lead to abusive behavior with less patience and time. Isolation. Older adults without support systems are more vulnerable to abusive actors preying on their loneliness. Think of romance scams as one example. Isolated individuals are especially vulnerable to financial exploitation.
Holiday celebrations are times when family dynamics are on full display – who is and isn’t invited, who sits by who, who gets along, and who doesn’t. Paying attention to family dynamics, especially as they relate to older adults in the family, is an important way to screen for elder abuse. Isolation and controlling behavior toward an older adult are two red flags of elder abuse. If a family member is isolating an older adult and using that isolation to abuse or exploit the older adult, the holidays offer an excuse to check in. Inviting that family member and older adult to the party or taking the party to them can be an opportunity to talk to the older adult and see if they are okay."
We can do better, perhaps by putting ourselves in their shoes, if only as a thought exercise. Those warm feelings of gratitude come from the giving of self and not the expecting from others. There's an old saying, 'Virtue is its own reward'. Try it out.
More Reading and Resources
What do you need? What is the best? Where do I start?
The ABCs from POLSTs to DNRs...
You get a call that your husband collapsed at work. When you arrive, he's having seizures, is intubated and is on a ventilator. The doctor informs you and your adult children that he had a major brain bleed and he will not recover - he's lost too much brain tissue. You are in shock. The doctor asks what his wishes are - and you have no idea.
POLST, DNR, Health Care Proxy, Power of Attorney: What to do, who to talk to:
This website, Caringinfo.org is my trusted go-to for their easy to understand, clear explanations. Here's a link that walks you through each term, their use, etc...it is a great place to start. Please take the time to become informed.
Useful Information
CaringInfo.org - Free advanced directives and living wills by state.
POLST: what is it and why is it an excellent choice to consider.
DNR - inpatient, outpatient or both?
The ABCs of UTIs in the Elderly Population
Risk Factors, Symptoms, and Complications
As our bodies age, certain systems just don't work as optimally. Our innate drive to eat and drink is controlled by a part of our brain called the Hypothalamus. As we age, the sensing mechanism of this 'control center' begins to feedback to that "I'm thirsty" feeling. That is why we have to remind ourselves to eat and drink. There are other risk factors, such as Receptor malfunction, brain damage, or hormonal dysregulation. In other words, other organs in the brain are malfunctioning. Heat, overexertion, sweating, vomiting and diarrhea deplete our fluids even more. Those prone to bladder or kidney stones, have an enlarged prostate, even chronic constipation become risk factors.
I am willing to wager that most of us know a family member or acquaintance who had a urinary tract infection (UTI). As is true with most illnesses, UTIs can 'present' (symptoms, signs), differently with our older bodies, so we need to be on the lookout for these different presentations.
- Sudden (acute) confusion: Often, this is a first sign that something is wrong. Rarely does acute confusion occur in the normal, healthy older population so this is a major sign. It can be subtle or overt.
Urine output, color, clarity, odor: there are different ways clinicians might describe urine output. These are the things that should set off warning bells. Just one of these is not necessarily a definitive infection, but should be something to discuss with your Provider.
- Dark yellow, brown, cloudy or tinged with or passing bright red blood
- 'Thick' looking, (turbid) particulate matter floating in the urine
- Foul odor (varies from sickeningly sweet to downright gnarly)
- Urinating very little
- Pain or discomfort in pelvic area or back; urgency without the ability to empty your bladder, crampy feeling
- Fever
- No symptoms at all
If you or your loved one has a catheter, recognizing a UTI might be a bit more confusing, so we'll stick to the non-catheterized person.
What can you do?
- Contact your Provider. They may recommend you either come in with a urine sample or go to an Urgent Care Clinic with a urine sample.
- Hydrate! Drink, drink, drink. If you are on a fluid limit, things can get tricky. That's why more severe UTIs in those with fluid retention may need IV hydration under observation, possibly adding a supplemental diuretic. Anything that melts at room temperature is considered liquid, and don't forget low sodium soup and broth. There are lots of hydrating foods, too: cucumbers, tomatoes, watermelon, grapes, other soft fruits, iceberg lettuce. Cranberry juice may have some evidence-based proof that it is effective to prevent infection, however doesn't 'cure' it.
- Check for fever. If it is elevated, again, contact your Doctor's office for advisement. UTIs can easily become very serious. Let's dig into that.
Complications
- Cystitis (Bladder infection)
- Kidney infection
- Acute Kidney Failure
- Sepsis
These and other complications are serious and must be treated quickly and properly. Don't wait until it gets serious! A UTI can equal RIP, so talk to the Doctor PDQ. Any comments or questions? Just ask your Question here. This website has some useful information, too.
Cane, Walker, Rollator, Skateboard?!?!?
No on the drug store hurry cane or walker. No on the Thrift Store rollator. No NOTHING until you have been evaluated and fitted for the correct device by a Professional. Otherwise; you risk injury, muscle or musculoskeletal pain, nerve damage, pressure sores or worse.
If you are feeling unsteady on your feet, talk to your doctor and request a referral to a Physical Therapist. Full stop. Unsure? Reread paragraph one.
Difficulty getting out of the house?
Are you or your loved one medically and/or physically fragile? A Visiting Service* may be the answer. A home health agency can help you get the prescription, answer basic payment questions and evaluate you for Physical Therapy at your home. They will look at your living environment and make suggestions tailored to your specific needs.
Does my insurance cover these services? That is a question to ask your insurance provider, the home health agency receiving your referral, your discharge Social Worker at the Rehab facility, or an accredited outpatient therapy company.
(*Medicare defines 'homebound' as requiring considerable assistance and taxing effort leaving home.) Here's a bit of what Medicare does and doesn't cover.
Breathing problems got you down?
Do you have to stop and catch your breath frequently? A Rollator may be your best option, but what do you do first? Reread paragraph one. You can also visit this site that explains some basics on the topic.
Here's an awesome link with plenty of evidence-based information to get you 'moving' toward safer travels.
Don't Get The Summertime Blues!
Keep Yourself Heat-Safe this Summer!
How much water is enough? Too much?
The National Council on Aging has great advice for those over 50.
Of course, as with anything else, this is a topic to discuss with your Doctor; especially if you have kidney, heart, or other medical conditions requiring limits on fluid intake.
What is the difference between being overheated and heat stroke?
Just a click away: The National Institute on Aging has great information on the various types of heat-related illness, as well as great information on how to beat the heat!
I have COPD - is it ok to go outside when it is hot?
Sounding like a broken record, always have any discussion about your health with your Doctor. The National Emphsema Foundation is chock full of really good, evidence-based advice for those with respiratory problems. The best advice? If it is hot and humid outside, find yourself a cool, air conditioned place to be INSIDE.
The American Geriatric Society is a great resource for all things 'elderly', including this great tip sheet for staying safe in the heat.
Have a Question for Nurse Jane?
10 Signs of Dehydration
Dehydration in the elderly can be serious! Most older people I know get tired of being asked if 'they're drinking enough'. You wouldn't your let your car run out of fluids and still drive it, so why are you not keeping your body engine running on the fluid it needs? Dehydration can cause falls, kidney problems, and even shock or seizures. Here are ten signs of dehydration:
1. Low blood pressure and a fast heart rate
2. Altered mental status - confusion not otherwise present
3. Being ill with diarrhea, vomiting, and not 'making up for' fluid loss
4. Dark, concentrated looking urine
5. Dry mouth, chapped lips
6. Feeling dizzy or faint
7. Headache
8. Heart palpitations
9. Muscle cramps
10. Decreased urination
Significant dehydration should be treated at the Hospital. They'll treat you with IV hydration. Mild to moderate dehydration should be treated with plenty of fluid from hydrating foods and liquids. Normal urine is a light straw color with little to no noticeable odor. This is a good primer on dehydration. The American Geriatric Society has an excellent tool that covers Hot weather safety tips, with information on dehydration.
