What a Super Bowl this one was! The Forty Ninth game was what many are calling the best in history and I have to agree. Of course, as a Patriot’s fan there is much to celebrate.

My viewing of this year’s Super Bowl started from the kitchen where I was just putting the finishing touches on a coffee cake and turning to place it in the pre-heated, 350 degree oven. I could see the pre-game hype going on in the living room from where I worked and I was looking forward to sitting down in a moment for some pre-game chips and dip when my phone rang.

Coffee cake in the oven I picked up the phone to find the nurse from assisted living on the other end reporting that my father was not feeling well. Blood pressure was too high and he was not walking well. Probably best if I took him to the emergency room.

No problem. I charge my husband Randy with taking the coffee cake out in 50 minutes but only after checking for firmness. He panics only slightly as he is not really a baker and this, to him, constitutes baking. He can do this and I pick up my red, white and blue pompoms and cheer him on just before I leave.

In 2011 27% of seniors over 75 visited the emergency room. 40% of those seniors were admitted to the hospital, and 6% of those went to the ICU. http://www.merckmanuals.com/professional/geriatrics/provision_of_care_to_the_elderly/hospital_care_and_the_elderly.html

The reasons for emergency room visits by seniors range from injuries and accidents, chest pain, stroke, urinary tract infections, to pneumonia. And the average emergency room visit will last 5-6 hours. Despite being some of the biggest frequenters of the emergency room, the emergency room is not necessarily set up for seniors. The beds are too high, the rooms too cold, and lighting can be challenging for those with the vision changes of the aging.

Confusion is increased in the emergency room. And for those with any dementia, misleading answers can be given to important questions, leading to more tests or missed information. For this reason, a family member’s presence in the emergency room can save time and tests. If someone familiar with the patient is not available, a quick cognitive test should be performed so that it can be determined if the patient is able to give accurate information.

My father had pneumonia. The emergency room staff knew quickly that they were going to admit him and the respiratory therapists said it would be to ICU given his need for so much oxygen. We arrived in the emergency room right at kick off and 5 hours later we were settling into ICU. Everyone was wearing Patriot’s t-shirts, doctors and nurses included.

My father’s nurse in ICU had a remarkable inner strength. In that I mean that throughout the gathering of her patient’s history she did not turn around to watch the game once. She was reassuring to my father and to me, letting us know that she would help get him out of ICU as quickly as possible because no patient is able to rest in ICU. It wasn’t until the 2 minute warning and my asking her how on earth she was not watching the game that she finally turned around-first stating “I’m trying really hard to be a good nurse.”

As you all know, Malcolm Butler intercepted, all was good in New England. My father’s nurse did as promised and had him quickly on the road to recovery. And the coffee cake turned out perfect.

When my sisters and I were young my parents did what most parents do. They helped pick out clothes for the day, sometimes insisting on a particular dress because we always dressed up for church and because my father was not a big fan of dungarees (old fashioned word for jeans). Mom and dad made dinner and drew our bath at the end of the day. They tucked us in and read to us. And if we were struggling to fall asleep they came back up, rubbed our backs or, finally, told us to cut it out and go to sleep.

At some point we moved out, got married, and took on the role of parent. As our children went through their various stages we gained a much deeper understanding of the challenges of parenting. The joys, sorrows, and the hours of caregiving. Sometimes, and I like to think that this was true more often than not, we carried out our parenting responsibilities with grace and mixed it all in with fun, teachable moments and sage advice. Putting our children to bed, tucking them in, glad for the day the Lord has given.

If this sounds too good to be true I am sure it is because my children are grown, all but one out of the house and the last about to graduate and move on also, and because my mother always says that you only remember the good times. Which is a particularly good way to live.

And then in middle age we meet a new stage-a caregiving stage that we all too often will take us by surprise. Because we approach parenthood with anticipation and in full acknowledgment of the coming responsibility, we imagine it, we gather advice about it, we read about it and we pray about it.

Caring for an aging parent or other family member will frequently bring us face to face with circumstances that we did not envision until the moment we are confronted by the need. Our parents did not envision being needy so we did not envision being needed.

But we are needed and we take on the role of family caregiver. The challenge can be in keeping time with your parent meaningful and not getting lost in the day to day needs of Activities of Daily Living and Instrumental Activities of Daily Living. ADLs and IADLs include bathing, dressing, toileting, eating, shopping, cooking and paying the bills.

These activities can eat up every moment of a day and leave you feeling spent. But, as when raising a child, keeping these times together meaningful is key. If you have to assist with dressing see if you can put on some good oldies and dance a bit. “I’m Looking Over a Four Leaf Clover” could be inspiration for a few good dance moves, if not a couple of shoulder rolls and foot taps.

Put a crossword puzzle book in the bathroom and fill in one or two blanks while supervising. Or use a toilet joke book as a way to share a laugh. The comics in the newspaper are worth a quick read on a quick trip to the john.

Toss the laundry on the couch and fold it together while watching Jeopardy and Family Feud. Both shows have been on forever. The only thing better would be Let’s Make a Deal.

Make dinner together. Together can mean anything from choosing the menu (even macaroni and cheese or spaghetti with butter and peas is choice making and if no one likes it you each can blame the other) to truly cooking together. Old family favorite recipes are easier than ever to find on the internet and a tuna casserole or American Chop Suey is good on a winter night.

If your parent was kind and loving and good to you this is an opportunity to give back. If they were difficult and angry and critical, this is a time to be the person you always wished they would be. And through it all, recognize what your limits are. These ideas are for the best of days but we all know that there will be days where energy runs short. You have to take care of yourself so that you have the long future of which you have dreamed. Get help with the ADLs and IADLs as you can so that you are refreshed and recharged for the demands on your time.

Life comes full circle. As a family caregiver you are given a new chance to be kind, loving and caring and to change the future of someone you love. You won’t regret the time you give especially if you focus on the meaningful, unique moments and not just the task at hand.

The Yankee Candle Flagship Store in South Deerfield Massachusetts is the second most visited tourist attraction in that historic state. Really. A funny fact when you think that Massachusetts is the home of the Boston Tea Party, the Boston Aquarium, the Old South Church and the Freedom Trail. But who doesn’t love the many scents of Yankee Candle? Apple pie baking, mistletoe, lavender, something for every season.

I am taking my mother to the second most visited tourist attraction in a few days. Caring for aging parents is more than attending doctor visits and carrying medication lists in your wallet. It is more than making certain showers are taken once or twice a week and clothes are changed daily.

So often I hear a family caregiver say that they want to return to being the daughter or the son. Senior care can mean losing yourself in the activities of daily living, the essential tasks that are required for independence.

Activities of daily living include feeding oneself, use of the toilet and remaining accident free (continence or incontinence), transfer ability or the ability to move from one place to another, dressing and undressing, and bathing.

A step towards even greater independence for seniors is the management of Instrumental activities of daily living. These include handling personal finances, meal preparation, shopping, traveling, doing housework, using the telephone, and taking medications.

Just reading the list is exhausting and we didn’t even start to talk about meaningful time. Because the truth is that none of the ADLs or IADLs are the things that make us unique, that define who we are, or contribute to quality of life.

Once we begin to share time with the elderly in a meaningful way we begin to find the person behind the tasks. We understand what makes a good day great for both the senior and the family caregiver when we share a story, a joke, a song, a memory.

Caring for seniors is an honor. Often it takes outside help with ADLs and IADLS so that family can spend meaningful time together as they did in times for greater independence. Of course, the best outside caregivers will also look for moments to share meaningful time and I will give thought to these in my next post.

The Yankee Candle Flagship store will be a great and meaningful day for my mother, my sister and I. It is big enough that a map will be handed to us as we enter. We will read the map, make choices together to visit the Bavarian Village, Santa’s Wonderland or Wax Works first. There will be music and good smelling stuff and we will share in a meaningful time that I will never forget.

Concerned about Driving? Caring for Seniors On and Off the Road

As adults in middle age and as adult children providing senior care, it can be easy to forget that our parents have been driving for longer than we have been alive. Some seniors have been driving for more than 70 years and it feels like a fundamental part of their life. At 52 I have been driving for 36 years and I take it for granted that I can go where I want when I want.

Driving can be the dividing line between independence and dependence, between socialization and isolation. And for these reasons this is one area of senior care that can be most difficult to approach. We feel guilty suggesting that our parents are no longer capable and independent. Yet we are awake at night in fear of the phone call reporting an accident.

Further compounding the challenge that this talk presents is that there is no black and white age on paper stating this is the moment in life we give up the car keys. Even the Clinical Dementia Rating(CDR) Scale leaves room for question. This scale goes from severe dementia at rating of 3 to no dementia at 0. For those falling in the 3 and 2 range-no driving. Mild dementia is rated at 0.5 and most of those who fall in this area can still drive. The big question mark comes in at a CDR rating of 1. There are studies to support that 76% of people with mild dementia could pass an on-road driving test however the American Academy of Neurology recommend that those with mild dementia strongly consider discontinuing driving. http://www.johnshopkinshealthalerts.com/alerts/memory/Driving-and-Dementia_7054-1.html?s=W3R_141018_001&st=email

The truth is that this decision may take time to adjust to, not just for the senior but also for adult children who often do not consider the impact to their own life. If you can get your parent onboard, even making the decision to stop driving on their own, the results are better in terms of later arguments and confusion. It can be a topic that is revisited over years as children get accused of taking away car keys and leaving a parent stranded.

Many physical and medical changes come with age and some impact the ability to safely drive. Vision changes can mean limiting the time of day to daylight hours or vision can be poor enough that driving is no longer possible in the event of age related macular degeneration or glaucoma. Medications commonly used can cause fatigue. Loss of fluid in joints means a change in height that could require a change in seat height.

There is no definitive age at which anyone must stop driving. All factors must be considered. Is your parent missing stop signs or red lights? Are you finding new dents and scratches? Is your parent having any trouble finding their way to or from familiar places? The time for your senior parent to stop driving is here.

If you are worried but are not seeing any hard indications that the senior in your life must stop driving now, start the conversation anyway. Talk about some of the accidents you have read about. Ask them to consider not driving after dusk. Ask them to talk to their doctor about all of the challenges that come with driving. Lay the ground work for the future.

Lastly, begin to talk about options for transportation in your area. Is there public transportation or a senior service? Are there agencies that can assist with transportation? Compare costs and value. Flexibility and responsiveness are important factors in the decision. Knowing that there are options for transportation can help ease the pain of giving up driving for seniors.