Stories

Caring for an Aging Family Member and Trying to Work Too?

Date: June 17, 2013
Author: Judy
Categories: Stories, Stories & Tips

If you are one of the millions of working caregivers in the US then you can likely relate to the following scenario.

Imagine getting up in the morning at 5:00 am and hopping in the shower, running to get the coffee going and then to wake up a sleeping 15 year old who has to catch the bus to school. While he showers you knock on the extra bedroom door and wake up your 85 year old mother. She has Dementia, Diabetes, and a heart condition. You help her out of bed, into any clean clothes you can get your hands on, and into the kitchen to begin taking her daily regimen of medications. Your son can’t find his homework so you attempt to help him recall where he was sitting when he presumably completed it last night. Oh-a printer problem, you quickly fix that connection with a reset and he grabs the homework and a few dollars because he is out of lunch money at school, and runs out to get the bus. Your mother is ready for her breakfast so a piece of toast with jelly is what you can manage while you hop into something suitable for the office and take a look at the clock. It is 7 am, you help your mother into the rest room, then set another cup of coffee by her chair in the TV room. You turn on Good Morning America, give her a kiss and tell her you will call her at lunch to remind her to eat. A sandwich is on the counter (don’t’ ask how you had time for that).

At work you do not discuss your home challenges with anyone but you feel ready to fall apart. The co-worker in the cubicle next to you is on maternity leave. Everyone had a baby shower for her and is filling in for her responsibilities while she is home adjusting to life with a new baby. You want to cry but hold it together. Exhaustion is too long a word for your brain to come up with—you are pooped.

According to the National Alliance of Caregivers, 43.5 million of adult family caregivers care for someone 50+ years of age and 14.9 million care for someone who has Alzheimer’s disease or other dementia. The average age of caregiver is 48.0 years; about 51% of caregivers are between the ages of 18 and 49. Forty-one percent of caregivers have children, too. Part of the “sandwich generation,” many women will spend more years caring for a parent than they do raising a child. (National Alliance for Care giving and AARP, 1997) http://www.theseniorsource.org/pages/StatInfo_CAREGIVER.html

Caregiver depression is real. Sure, for those of us who are parents we can harken back to the early days of care giving. But even on those days where we “hit the wall of fatigue” because we have been up 3 nights in a row with a sick child, in our minds we know this ends. Our children grow up. They grow out of the house. They grow independent. And we have joy in our role of helping them accomplish that independence.

But what happens when the reverse is true. Like in The Curious Case of Benjamin Button where Brad Pitt’s character is born old and his life moves backwards. In the eyes of a child, aren’t our parents very old when we meet them? I mean, thinking back to your first days of awareness of your parents as your parents. Didn’t they seem old? Yes, they get older but eventually if we become caregivers doesn’t it seem like there is a childish quality that emerges? A dependence that we often don’t see coming and for which we have not planned.

We think about our parents at night and during the day. We wonder if they will fall, wander, or be happy today. Will they take their medications, will they eat enough and drink enough. Have they gained more than 5 pounds this week, indicating congestive heart failure? How could I forget to take their blood sugar before giving them that cup of coffee? At home we can find we are increasingly in demand. Let me tell you, a two hour toilet schedule eats up a lot of your day.

Unlike going to work and sharing pictures of your children, most caregivers keep the worry and fatigue to themselves. A sense of isolation increases and depression can be the result. Symptoms of caregiver depression are:

• Feelings of hopelessness, agitation and/or restlessness

• Loss of interest in activities

• Irritability or frustration over small things

•Either  Insomnia or Excessive sleeping

• Changes in appetite

•Sense of  Fatigue, decreased energy

• Feelings of worthlessness or guilt, blaming yourself when things don’t go right

• Frequent thoughts of death, dying or suicide

• Unexplained physical problems like back pain or headaches

What can you do to prevent caregiver depression? Ask for help! Reassess your commitments. Take time for other relationships and for yourself, (and this will likely mean asking for help). Stay positive. A recent study found that it is not the care giving itself that will lead to illness for the caregiver but the stress of care giving. In fact, in those caregivers who found healthy ways to manage the stress and who report satisfaction through care giving, little impact to health and wellness was noted.

Truly, there is a blessing in being a caregiver. An opportunity to slow down and really know someone. Because things take longer, the pace is slower. Less, and yet more is accomplished. More stories are told, more memories are shared. A sense of making a difference in a true manner emerges.

Not surprisingly, many of those caregivers that we have hired at Seniors Helping Seniors In Home Care of New Hampshire are the very people who cared for an aging parent and found deep satisfaction and fulfillment. They come to us missing that role in their lives and with an understanding and caring that knows no bounds. They relieve the stress for a family caregiver, and acknowledge the blessing of giving as a senior care provider.

 

Do Not Resuscitate

Date: June 9, 2013
Author: Judy
Categories: Stories, Stories & Tips

My mother had a heart atta ck on my birthday. Well, maybe a few hours before my birthday but it was picked up on my birthday and my father took her in to the Milford Medical Center where they determined she needed to go by ambulance to St Joseph’s Hospital. She is on the cardiac unit there and so far we are thrilled with the care she is receiving throughout this significant “event.”

In addition to the medical care that seems outstanding, the caring itself is remarkable. In particular, the care the doctor took in walking my father and mother through a “do not resuscitate” order is noteworthy.

We all have a tendency to avoid thinking of the circumstances of death. My grandmother died at 80 a very healthy woman who was blessed to just close her eyes and not wake up in the morning. No suffering. No limping along with one organ after another slowly quitting. I was 22 years old and I know that I decided right then that was how I would die. Neat and clean and no decisions to make. But this is not how it always works.

My parents have approached being seniors and aging with a fair amount of planning. They arrived in New Hampshire from Florida with a beautiful binder from their attorney labeled “Estate Planning Portfolio.” The majority of Americans do not make end-of life plans, in fact about 80% of people do not preplan and prepare advanced directives.

When questioned about whether they should do CPR if my mother’s heart stops, my father said “We have a living will. We do not want to live hooked up to tubes. Judy would you bring the doctor a copy?” As his child and as a Certified Senior Advisor, I thought great, this discussion has happened and we are all set. But did it really happen? Is there really an understanding?

Maybe not.

An advanced directive has 2 parts, a durable power of attorney for health care and a living will. A 3rd part that may be necessary is called a Do Not Resuscitate order or DNR. This portion lets medical personnel know if a patient does not want action taken to resuscitate them in the event that their heart stops. A living will speaks to the care desired when a person is considered terminal.

In my parents case they had designated me as their durable power of attorney for health care but this was the first I was hearing of their actual wishes. In addition, when questioned, although they have a statement about not wanting to live hooked up to tubes and everything, and I heard both my father and mother say this to the doctor, when further questioned, they said yes, they did want CPR started. It suddenly became clear that they did not understand DNR.

AS their durable power of attorney it is essential that I understand their wishes as they approach the end of life. But even more important is that they understand this stage of life, the circumstances that bring us to the end of life and how decisions today will change the face of our last days, months or years. Given medical advances, once CPR is started we may be able to live a prolonged but difficult life that we never intended.

The doctor gently described to my parents the likelihood of broken ribs and decreased oxygen to the brain during CPR. That my mother may live but may not be the same person she is today. Neither she nor my father want that and as difficult as it was, they were able to state this clearly to the doctor, the nurse and to me. My mother is now wearing a purple bracelet that also tells everyone else her wishes. She will not be resuscitated if her heart stops.

It is important for me to be clear. My mother has had 40 plus years of rheumatoid arthritis, 2 strokes, removal of ½ of her right lung, confusion (not yet diagnosed dementia but with all of the characteristics) and a heart attack. She is not the oldest of old but she is old at 80. She is a wonderful woman who is loved by everyone who meets her. She is nicknamed “Sweet Priscilla.” We love her so much we want to honor her wishes about how she wants to live out her life.

This is her decision. You will have yours, your parents will have theirs. Talk about it. Sooner rather tan later. Be clear. Be supportive. We have been grateful to have a doctor hold our hands through this before it was too late.

My Lesson on Fear of Falling in Seniors and Senior Care Providers

Date: May 22, 2013
Author: Judy
Categories: Stories, Stories & Tips

My mother started to express a fear of falling 10 years before she had her first fall.  She and my father were active people, playing golf 3 times a week right up until she was 79 and he was 81.  They have lots of friends and were always out doing things; popcorn night, Elks Club dinners, a cruise to the islands once a year, evening rides on their pontoon boat at our summer home in Maine.  But her steps started to look different.   Her gait pattern was changing and before my eyes, her daughter and  also a physical therapist saw that the future could easily be a fractured hip.

Fear of falling in seniors is the number one risk factor leading to a fall.  As we begin to worry about falling and all of the complications that go along with a fall in our 70s and 80s, we change the way we move.  People with a high level of anxiety about falling are most likely to suffer a fall, as noted in a 2010 study conducted in Sydney Australia.  http://health.usnews.com/health-news/family-health/bones-joints-and-muscles/articles/2010/08/20/in-seniors-fear-of-falling-risky-in-itself

About one third of the elder population over the age of 65 falls each year, and the risk of falls increases proportionately with age. At 80 years, over half of seniors fall annually. Those who fall are two to three times more likely to fall again.  Fear of falling leads to a restriction in activity which leads to weakness, which leads to a justifiable reason to be afraid of falling.  The cycle has to be stopped early.

My mother continued with her social activities but took the golf cart more often.  She shortened her steps and changed the way she went up and down stairs.  In essence she created what she feared.  Talking to her about her fear did not help much.  What she heard when we talked about fear of falling leading to falls was a prophecy of her future.  She heard “you are afraid of falling so you are going to fall.” What was meant was “you are afraid of falling so let’s change the way you move to better prevent a fall.”

To be fair, my mother has had rheumatoid arthritis for 35 years, she had back surgery, a laminectomy at 69 followed by a small stroke from both of which she had an excellent recovery.  My mother did begin a home exercise program that I taught her, modified somewhat for her arthritis, but once up and about for the day she stopped pushing herself physically.  Walks were shortened and then became absent.  Her gait pattern changed with her feet closer together and her stride length shorter.  And then the fall came.

My mother had a larger stroke at 79, leaving her slightly weak on the left side.  8 months later she dropped her toothbrush on the floor and bent to pick it up and just kept going forward until her face and hands hit, followed by the rest of her.  An ambulance ride, x-rays, and consultation with orthopedics revealed broken fingers and very bruised facial bones.  No fractured hip.  One blessing.  Once home the response? Increased use of the wheelchair, decreased walking, increased immobility, increased muscle weakness.  All out of fear that now was a reality for both my mother and my father.  He was happy to have her in the wheelchair.  It broke his heart to see her bruised and hurting.

In retrospect I should have done more education earlier.  I should have been a meddling daughter after the back surgery and called her doctor, insisted on physical therapy for her then.  I should have recommended regular exercise class.  She needed more than the 10 minutes a day of exercises I gave her.  Granted 10 minutes of targeted exercises are better than nothing but they need to be combined with the consistency of  walking, swimming, tai chi, or any other senior modified exercise program.  I lived too far away in New Hampshire so each year that summer arrived and my parents traveled north from Florida for a summer in Maine I grew more and more alarmed.   I made gentle recommendations but now I wish I had raised a loud red flag of concern and asserted myself as a physical therapist first and daughter second.

What does this mean to you?  Learn from our journey.  Start early and do not let up.  Recognize that you have to stay mobile to stay mobile.  Yes, do some home exercises, a good start was recommended in earlier blogs.  Look for a class conducted by a professional with experience with seniors.  This could be a physical therapist, an athletic trainer, a tai chi expert, a yoga instructor but be sure that the professional knows how to safely modify each exercise for seniors or for an underlying condition like arthritis.  If you have a fear of falling ask your doctor for a referral to physical therapy.  Chances are you have some underlying weakness and in 4 to 6 visits you will have greater confidence and an individualized home exercise program to keep you going.  They may also know of a good group program to continue with once discharged from PT.  Even finding a walking partner in your community helps as you will both keep each other motivated even in cold New England winters.    Overcome your fear of falling and decrease your risk; step out in confidence.

 

Essential Exercises for Senior Care Providers

Date: May 9, 2013
Author: Judy
Categories: Stories, Stories & Tips

As we age we stop performing many activities that came naturally at a younger age.  Think about it, when we were in elementary school we ran on the playground, climbed up the ladder of the slide, crawled through play tunnels, hid in bushes during hide and seek.  We played on the floor, on the grass, and in trees.  I like to say that we were “multi-level players.”  Add 20 years and we were multi-level parents.  We bent down to pick up our child after a fall and a skinned knee, we bent down to get a hug, to pick up our child and carry them up to bed.  Maybe we knelt by the side of the bed to say prayers.  We definitely bent down to pull a favorite stuffed animal out from under the bed, or at least a sock.

Then our children grew, we stopped picking them up.  We approach retirement and we rarely live our life on multiple levels anymore.  This seems convenient; we sit on chairs and not the floor.  We arrange our kitchens and work room so that everything we need on a daily basis is somewhere between our belly button and our ears.  We are so smart.   And so efficient.

But we could be too efficient.  We are limiting our movement each day and the old adage “use it or lose it” applies to muscle strength and range of motion.  Range of motion describes that amount of movement we have around a joint.  As we age our muscles begin to lose mass because of a decrease in the number and size of muscle fibers.  As senior care service providers we will only maintain or gain strength through the range that we use.  So over time the muscles that we use to reach for needed items weaken, the muscles that we use to squat and return to standing weaken.  And what we don’t know is that these large muscles of our legs are muscles that are essential to balance and mobility.   Strength in these muscles helps us right ourselves quickly when we have had a misstep and begin tripping.  They help us to get up and down stairs and curbs safely.  They help to prevent back strain when lifting.

The last exercises helped us to prepare for the day, to wake our muscles up, increase circulation, and to lengthen what is likely getting shortened.  In addition to these, in caring for ourselves as we prepare to care for seniors,  throughout the day it is important to incorporate a few exercises that will maintain our strength, and in particular to maintain the strength in our antigravity muscles since we have determined that gravity is working against us.

Start facing a chair or counter.

March in place, placing a hand on the counter or chair only if you need to in order to feel safe. March for a minute, take a break and march for another minute.  If that is too much, march for a count of 10, take a break and march for another count of 10.

Keeping your knees aligned over your second toe, slowly sit back as if you are going to sit in a chair. Lower only as far as you can go and still feel control, making certain that you do not become “knock kneed” that is, your knees do not move towards each other but stay centered over your toes.

If the exercise above, sitting back towards a pretend chair, is difficult, reverse the exercise.  Sit in a chair and slowly come towards standing.  Then slowly lower back to sitting.  Again, keep those knees over your toes and do not let them come towards the middle.

Keeping your knees aligned over your toes is important for the health of your knees.

Facing the counter or chair, rise up on your toes, hold for a count of 3 and lower.  Repeat 10 times.  Work up to 3 sets of 10.

Now in standing, pull your toes up towards your legs, lifting the toes and forefoot off of the floor.  Hold for a count of 3, repeat 10 times.  Build up to 3 sets of 10.

These chair or counter exercises are going to go a long way in keeping you strong for the day as a care provider for seniors or in caring for yourself.  In a perfect world we do all of the exercise together, starting with those I described for you to do at the start of the day before getting out of bed.  But I have yet to find a perfect world here on family-raising, chore filled, work laden, gravity pulling  earth.  Do them as you have time.  One exercise in 30 seconds to a minute is better than no exercise at all.  We tend to feel if we cannot do everything we will not start at all.  Not true with a home exercise program.  Do what you can when you can and your life will begin to feel easier, pain will be reduced and endurance will increase as you move more efficiently.

How to Stay Limber as a Senior Care Service Provider

Date: April 2, 2013
Author: Judy
Categories: Stories, Stories & Tips

As a senior care service provider, you won’t be able to take care of others if you don’t take care of yourself! Developing some good stretching habits will go a long way toward keeping you more mobile.

Randy is 6 feet tall and I did not know him as a child but he must have grown quickly. He got Osgood Schlatter’s Disease, a knee problem, as a teenage and limped for a year – not uncommon when you grow fast and are trying to play hockey. Randy does like to point out that he was the worst player on the 2nd string of the worst team in Maine. What he had for 40 years of his life was tight hamstrings, which led to back pain, knee pain, neck pain, shoulder pain. You get the idea.

And then a brilliant physical therapist (not me because I am his wife and not his physical therapist) taught him to stretch his hamstrings. So for the past year at 6:45 am he has taken our dog Moses to the field down the street. As all of the neighborhood kids wait at the bus stop, Randy chucks the tennis ball for Moses, throws a foot up on a boulder, and carefully leans forward, keeping his knee and back straight.

Holding, holding, holding.

Foot down, pick up the ball, chuck it, repeat other side.

Repeat 3-4 times a day.

Happy that his 15 year old step son is unaffected by how strange he may look on the field across from the bus stop, Randy’s pain is gone. He is convinced that he has found a cure for all afflictions, including hair loss.

Stay Limber in Your Hamstrings

In my first blog I taught you how to do 7 simple exercises to start your day and maintain strength to combat the effects of gravity on the aging spine. But I also mentioned that stretching your hamstrings is another key. As your hamstrings shorten, your pelvis is pulled under, creating tension up your spine. All of the way up the chain you will compensate for this tension. So you should and you can stretch your hamstrings and this will help your mobility and counteract gravity pulling you down every day.

The exercise below is different than the one Randy does in the field but it is easy, and most importantly it is difficult to do this one with poor alignment as the bed or floor will serve to stabilize your spine:

  • Lying on your back, bring your right knee towards your chest. Keep left leg straight on the bed.
  • Place both hands behind your right knee and slowly straighten your knee, bringing your foot towards the ceiling.
  • Hold for 3, bend your knee.
  • Repeat 10 times both legs.

For some other tips on how to stay limber as a senior, visit this link.

7 Steps to Fitness for Senior Care Service Providers

Date: March 24, 2013
Author: Judy
Categories: Stories, Stories & Tips

"Boulder Pushing" courtesy of MGChan on Flickr

At 27, when I was pregnant for the first time, I was working as a physical therapist with infants and young children and my entire world perspective was one of disabilities at birth. In my 40’s, with 3 children and 3 step-children – all except 1 being a teenager – I was working with young adults with traumatic brain injury. All I knew was that drinking, drugs and driving result in injuries too overwhelming to describe here.

And then I moved into the world of geriatrics and I have begun to realize that if other stages I was looking at through my physical therapist’s eyes were out of my control, this might be a stage I could do something about. And there is still time, this is my future. This is your future. We will likely all reach a place in our lives when we are providing care of some type to a senior. Our parents, our grandparents, a neighbor, a member of our church; with 10,000 to 11,000 people reaching 65 every day and with so many living beyond 80, we will know and love a senior who needs our assistance. As a senior, as someone approaching the age of seniority, or as a senior care provider staying fit is vital.

Gravity is mean to the aging. We shrink, we curve over and forward, and our decreased muscle mass struggles to keep us up. But I believe the secret to counteract gravity is extension. Randy, my husband believes the secret is stretching your hamstrings.

Either way, and probably in combination, we have to move.

Start at the beginning of the day. Everyday. Before getting out of bed is a great time to begin to warm up our muscles and increase circulation. This will help to lubricate our tendons which attach our muscles to the bones. As we age these tendons lose water content, making us stiffer and less able to tolerate stress.

The following exercises will help to decrease stiffness and increase joint mobility before we even get out of bed:

  1. Stretch out long and tighten all of your muscles, relax, tighten, relax.
  2. Windshield wiper your feet 10 times
  3. Bend your knees and with your feet on the bed, gently draw your belly button towards the bed, still breathing. Lift your buttocks hold for 3, lower. Repeat 10 times.
  4. Drop your knees gently to one side and then the other. Look in the opposite direction.
  5. Roll to your side and rise to sitting at the edge of the bed.
  6. Squeeze your shoulder blades down and back. Hold for 3. Your breastbone should tilt up when you do this. Repeat 30 times
  7. If your ears are forward of your shoulders, tuck your chin but do not tilt your head, bringing your ears over your shoulders. Hold, relax, hold relax.

Senior care service providers–Now get up and get your coffee. And no, we did not stretch your hamstrings. We will add that next time.