being made, caregivers should discuss the matter openly with the
doctor.
 
31.  Keeping Records and Managing Medications.
 
Caregivers can help older people maintain medical records for
use by the doctor.  Arrangements can be made through the
doctor's office to send for previous records that could be
helpful in treatment.  This may require getting Releases of
Medical Information signed by the care-receiver.  You also
should keep a list of all medications (both prescribed and
over-the-counter) being used.  The same medications that are
helpful in easing pain, stopping infection, controlling heart
rate and keeping people healthy can also cause serious problems.
 
Because many older adults take several medications at one time,
it is possible that these drugs can interact with one another
and be a danger.  If more than one doctor is prescribing
medications, it is important to keep each doctor aware of the
drugs that are being taken.  You can keep them informed by
taking all your drugs in a paper sack or a list of all your
drugs to each doctor.  Having one pharmacist that fills all of
your prescriptions is a way to prevent taking drugs that
interact and cause problems.  Over-the-counter or
non-prescription drugs also can cause problems.  Talk with your
pharmacist before using them.
 
If you find the medicine schedule confusing or difficult to
follow, ask your pharmacist about preparing all medicines in
blister packs.
 
Below is a sample of "current medication list" which includes
the essentials:  name of medication, sample of the medication
taped beside its name, the reason for the medication, the dosage
and the time the medication is taken:
 
Table 7     Current Medications List
 
(This table shows the above essentials in a line across the page and each
line
separated from the others by a solid line.  Mike)
 
Medication Name///Tape Pill Here/// Reason...///Dosage///Take at...
 
If your care-receiver is taking several medications at different
times throughout the day, it may be helpful to develop a second
list to assist you with daily medication set-ups;  this list may
be color coded, or may have the names of the medications grouped
in the times to be taken each day.  For medications taken
several times a day, their names will appear several times on
your list as in the example below:
 
Table 8   Daily Medication Set-up
 
- Time of Day Medication is given, AM + PM
                                          - List all Medications for Each
Time
 
Morning
 
Noon
 
Evening
 
Bed Time
 
32.  Choosing a Doctor
 
If you don't have a doctor, choose one carefully.  There are
several referral sources you can utilize:  1) a friend who is
satisfied with his/her physician for a referral;  2) your County
Medical Society;  3) Physician Referral Service;  4) A
neighborhood hospital (some offer a physician referral service.)
 
The doctor is a valuable resource.  If you are having a
difficult time managing your care-receiver at home, or an acute
illness occurs, the doctor may assist with related health care
concerns.  Your care-receiver may have to be hospitalized.  The
doctor may assist by making a home health care referral.  Once
hospitalized, the doctor can assist in placement issues or home
health care upon discharge.  If he/she doesn't offer it, you may
request it.
 
If you are dissatisfied with your doctor, consider:
 
1.  What do you want from your doctor?
2.  Are these wants realistic (e.g., cure of an incurable disease)?
3.  Have you discussed them with your doctor and/or staff?
4.  Do you have a primary physician (usually internist or family
practitioner) who oversees your overall medical care?  (Often,
sub-specialists such as cardiologists or orthopedists focus on
one organ system, and do not try to coordinate the patient
care.)
5.  Do you keep your appointments?
6.  Do you take medications as prescribed, contact the doctor if
you change, and discuss your concerns with him/her?
 
Remember, physicians are human beings, with individual
personalities, enormous responsibilities, and only 24 hours in
one day.  No doctor will be right for all patients.  Find a
doctor whose skills and style of practice suits your current
needs.  All patients should have one physician to coordinate
their care.  Frequently changing doctors is likely to result in
poor quality care of chronic or complex problems.
 
Older individuals with multiple medical problems or difficulties
with memory or intellectual functions may benefit from a
comprehensive geriatric assessment program.  (This guide
identified one program in the San Diego area as the UCSD Seniors
Only Care Program (SOCARE).  Your physician or local Area Agency
on Aging may have information on comparable programs in your
community.)
 
Arranging the Doctor Appointment.   Some questions to ask when
you make a first appointment:
 
--  What are the office hours?
--  How are the bills handled?
--  Who will answer my questions if the doctor is unavailable?
--  How does the office handle emergencies?
--  How is co-payment handled?
--  What hospitals does he/she go to?
 
On the first visit to the doctor, the patient's list of current
medications (Table 4) and previous medical records should be
given to the doctor.  If the visit is for a specific problem,
have the following information for the doctor:
 
1)  the symptoms,
2)  how long they have been present,
3)  how often they happen, how bad they are.
 
Reviewing this information before the visit will help.  And
remember, it is important that the patient have a chance to
visit with the doctor privately to discuss confidential
information.  Before leaving the doctor's office, meet with the
doctor or the nurse to find out how you can help with treatment
and what your role as caregiver should be.
 
It is useful to look at the following three areas:
 
1)  What can be done now to help in the treatment of current medical
problems,
2)  How to recognize problems that may arise,
3)  What to do in emergencies.
 
Planning For Emergencies       Having an emergency plan is
important, especially when a substitute caregiver occasionally
takes your place in the home.  (Post phone numbers for the
following agencies next to your telephone or a conspicuous place
where they can easily be seen by anyone.  This sentence modified
for readers outside San Diego County.)
 
1)  The 911 number for emergencies (Medical, Fire or Police),
2)  The physician's number (emergency and office number),
3)  The name and number of the hospital the physician and the patient
prefer,
4)  The number of the home health agency, if one is currently
making visits to the home,
5)  The Poison Center phone number,
6)  The 24-hour number of the medical or oxygen supplier, if one is being
used,
7)  The telephone number where you (caregiver) can be reached.
 
Remember, observe changes and signs of illness in the
care-receiver.  They can help detect a medical problem.  But if
any doubts about health arise, CALL THE DOCTOR FOR ADVICE;  DO
NOT PROCRATINATE!
 
************************
 
J.  Emotional and Intellectual Well-being
 
Each human being is a combination of body, mind, and spirit;  we
should be aware of how these parts interact.  For example,
people may have powerful emotional responses while facing the
many challenges which life presents.  Thus, some may often
appear cheerful and optimistic while others are anxious and
unhappy.  In later years, we usually continue our basic moods,
but the ways we express our feelings often become more obvious.
 
33.  Depression:  Signs and Causes            In the midst of
losses, such as physical changes, death of friends or loved ones
and reduction of income, older people may begin showing signs of
depression.  Some things to look for are:
 
--  inability to concentrate or make decisions,
--  lack of feelings of enjoyment, or enthusiasm even for doing
those things that were favorites,
--  little interest in eating (causing weight loss) or changes
in eating habits (overeating causing weight gain),
--  lack of interest in being with other people, or loss of sex
drive (libido),
--  feeling unwanted and worthless, sometimes leading to the
thought that life is not worth living,
--  sadness or crying spells for no apparent reason,
--  problems with sleeping (sleeplessness during the night or excessive
sleep
during most of the day),
--  feeling tired most of the time, regardless of adequate rest.
 
If older people brood about their unhappiness, much of their
energy is focused on worry.  Part of that worry may relate to
the fear that they will become forgetful and unable to manage
their affairs.  This worry can lead down the path to more
depression, which may cause physical problems.
 
In exploring the cause of depression, the following questions
should be asked:
 
1.  Is there a physical or medical problem causing the depression?
2.  Have there been changes in hearing, seeing, moving, or other
body functions?
3.  What social contact does the care-receiver have?
4.  What are the opportunities for usefulness?
5.  What kind of personal losses (death of friends, relatives,
or pets) have there been?
6.  Is the older person getting proper nutrition?
7.  What kind of mental stimulation is the person getting?
8.  Has there been a difficult adjustment following retirement?
9.  Is the focus entirely on the past or is there some
enthusiasm about coming events?
10. Is there a possibility of reaction to medications?
11. Is there a dependency on alcohol or drugs?
 
Once these questions have been answered, steps can be taken to
relieve the depression.  It will take some work from both the
caregiver and the care-receiver to change habits and routines.
Prolonged depression causes biochemical changes in the brain,
usually requiring treatment with medication.  The doctor is a
good person the contact to find help for treatment of
depression.  Other resources are County Mental Health Centers,
psychologists, counselors or clergy.
 
34.  Suicide Prevention
 
Suicide among the elderly is a significant and ever increasing
problem.  Statistics show that 27 percent of all suicides in San
Diego county (1985-87) were committed by people 60 years of age
and older.  Nationally, elderly (65+ years) made up 12.3 percent
of 1987 population and committed 21.0 percent of suicides.
Elderly complete one suicide every 1 hour and 21 minutes, or
each day 17.7 seniors committed suicide.
 
Unlike other segments of the population, the elderly do not
often make threats or mention suicidal thoughts to others.
Therefore, it is important that caregivers also know other
warning signs:
 
--  Depression - feelings of sadness, hopelessness, a sense of
loss and statements as "Life isn't worth living" are common
before a suicide.
--  Chronic or terminal illness.
--  Withdrawal and isolation - suicidal people may pull away
from family, friends and others close to them.
--  Behavior changes - sudden changes such as irritability,
aggressiveness or changes in eating and sleeping habits can
signal problems.
-- Making final arrangements - a suicidal person may give away
valued possessions, making out a will, make a plan for suicide,
or write a suicidal note in preparation.  They may purchase
weapons or stockpile medications.
 
Suicide can be prevented.  If the person you care for shows any
of the warning signs, you can:
 
--  Ask - don't be afraid to ask directly if the person is
thinking about suicide.  It is not a taboo subject.  You will
not be putting ideas into the person's head.  It can be a relief
to the suicidal         person to talk openly about their
feelings.
 
--  Listen - let the person express his/her feelings and
concerns.  Don't worry about saying the right things - just
listen.
 
--  Show you care - tell the person you care and want to help.
Take active steps to make sure the person is safe;  remove
weapons, pills, etc., and stay with him/her.
 
--  Get help - make sure the suicidal person gets in contact
with a professional counselor or other helpful person who will
know what to do.  Or have the suicidal person call (suicide
prevention/crisis intervention Hotline in your community.
Telephone numbers for such local resources should be at the
front of your telephone directory.)  A crisis counselor can help
figure out the best way to handle the situation and give
referrals to other resources.
 
Death and Dying Interventions        Elderly terminally ill
encounter anxiety and fear regarding death:
 
--  fear of the process of dying;  will there be pain?
--  fear of losing control;  will I be at another's mercy?
--  fear of letting go;  I can not leave family and friends to
an uncertain future.
--  fear of seeing how others will avoid me.
--  fear of losing my caregiver;  will he/she be turned off emotionally
to me?
--  fear of the unknown after death.
--  fear that my "life's script" has been meaningless, unfulfilled, a
waste.
 
You may wish to ease these fears through an open discussion of
these fears and intervening:
 
--  Regarding the death process, a "faith system" may be of
great help;  if you can get the person involved in his/her
religious faith, the subject of death is well covered.
 
--  Regarding fear of letting go and isolation, assist then
person to get his/her "house in order."  This entails a will,
funeral arrangements, burial plot, etc.  Also attempt to have
the person and family involved discuss the situation.
 
--  Regarding meaninglessness of one's life, have the person do
a "Life Script," whereby he/she writes all the good things done
for others, all accomplishments, etc.  Then discuss with the
person that had he/she not been there to do what he/she did at
that time, no one else would have, and society would have been
the worse for it.  So he/she did make a difference.  Truly, no
person is an island!
 
35.  Promoting Emotional Well-being         It is important to
help the elderly remain involved in decision-making as long as
possible.  You must stress that needing help with everyday
activities does not mean that they cannot make decisions for
themselves.  Also, granting others the right to decide does not
mean you are ignoring or abandoning them.  Caregivers need to be
sensitive to the right combination of giving just the right
amount of assistance and no more.
 
Ways to promote good mental health in the elderly:
 
--  encourage socializing with friends and relatives through
visits, phone calls or letters.
--  arrange fun times such as parties or outings.
--  help start new hobbies or revive old ones.
--  listen, talk, and share feelings.
--  assure privacy.
--  treat with respect, not as little children unable to think for
themselves.
--  encourage movement and exercise.
--  help find ways to be as useful as possible.
--  strive to keep the lines of communication open.
 
36.  The Importance of Lifetime Learning
 
Research shows that reaction time may be slower in older people
but they can still learn.  Families and friends may need to be
patient in waiting for responses.  It is also important to
remember that short-term memory may not be as good as it was.
 
The brain helps link people to the world.  If we are able to
process and understand what we see, hear and absorb from our
senses, our experiences will become more meaningful.
 
Sometimes older people are incorrectly labeled as "senile"; the
misconception is that they are no longer able to think for
themselves.  However, for the most part, older people continue
to make good use of their creative powers, and as is true for
all parts of the body, the brain usually will function better if
it is used regularly.
 
Lifetime learning means exploring new ideas, whether this is
from reading, listening to radio or television, trying a new
hobby, or trying a new recipe.  It can include lively
conversation with friends and family.  What it boils down to is
a willingness to keep exploring the many adventures that life
has to offer.  The benefits of lifetime learning include more
enthusiasm for life, less boredom and depression, increased
feeling of self-esteem and self-respect, more interest in the
surrounding world, and new ideas to share with family and
friends.
 
37.  Memory Problems             Memory loss can be one of the
hardest problems for both the care-receiver and the caregiver.
Some memory problems are treatable, some are not.  Therefore, it
is important for the doctor to determine the causes of memory
loss in the individual.  Forgetfulness, even inability to
recognize familiar faces and places, might result from such
treatable causes such as malnutrition related to improper eating
habits, alcohol, side effects of medications, loneliness,
isolation, few chances to socialize with others, sensory
impairment (decreased vision, decreased hearing), surgery or
accident resulting in injury to body, viral infections or other
illness, or depression or other mental illness.
 
38.  Sensory Problems            People who have losses in
hearing and vision may have trouble understanding things
consequently negatively affecting their emotional well-being.
Basic aids to hear and see are vital.  At times an older person
may be cut off from the world because of wax in the ears or worn
out hearing-aid batteries.  Glasses may need to be adjusted or
perhaps just cleaned.  Good lighting, without glare, is
important.  Magnifying glasses or large print can make reading
easier.
 
39.  Confusion          For people who are confused, the
following tips can be useful: --  Make changes in routines
gradually, --  Be clear about reminders for appointments or
meetings, --  Write simple directions in large, clear print, --
Use large labels (words or pictures) on drawers and shelves to
identify contents, --  have clocks and calendars clearly visible
and mark off passing days, --  Make certain that medicine is
being taken regularly, --  Confused or forgetful patients must
have assistance with their medications, --  Encourage
consumption of nutritious foods, --  Encourage movement and/or
exercise as this will increase circulation         of the blood and
help improve bodily functions, including the ability to think.
 
40.  Behavioral Problems           For people who are acting
out, being disruptive, or have other undesirable behaviors, it
is best to not antagonize or confront but to temporarily remove
your presence from the person, giving the message that "I
love/care for you but not this behavior."  Below are some
suggestions to minimize undesirable behaviors:
 
1.  Avoid confrontation.  If the behavior deals with disrobing,
offer brightly clothes which make the person feel good.  2.
Don't argue.  If the person becomes too agitated, change the
subject/object to something completely different.  3.  Reduce
stimulation.  Lower lighting, reduce noise (radio, TV) to
soothing music, minimize items in the area to a few possessions
known to the person, and avoid clutter.  4.  Promote familiar
objects, pictures.  5.  Walk slowly with the person to reduce
anxiety and stress the muscle tension.
 
41.  Mental Stimulation            Because many older people
enjoy recalling events from past years, families and friends
should encourage the sharing of stories.  Activities which
stimulate the brain (visiting with others) can contribute to the
goal of continued lifetime learning.
 
Often, older people can become happier, more productive
 
 
John Cottingham         NEW ADDRESS:          [log in to unmask]