September 12, 2011 § Leave a comment
At 83 years old, Martha still lived in her own home, and enjoyed working in her garden and canning peaches. It was becoming harder to motivate herself, to get up in the mornings and accomplish the day’s tasks. She confided to her daughter that she felt anxious and tired. Her daughter, who was taking medication for her anxiety, took Martha to her own doctor, not Martha’s and got her a prescription for Valium. In doing so, the daughter’s doctor, who had never seen Martha and who did not have her medical history, was only aware of a few medications they told him she was taking.
Martha, in fact, was taking nine different medications as well as herbal supplements. The addition of Valium to her existing list of prescribed drugs sent her to the emergency room with respiratory distress. If she had gone to her own doctor, he would have found that a dosage adjustment of her current medications would have solved her anxiety.
Medication errors are common in the elderly. Many seniors take on average 6-8 different prescriptions as well as over the counter drugs. Many times the elderly will not go back to their doctor to have their dosage evaluated and changed if necessary. Family members should be aware that elderly parents may tend to take the family’s advice over going to their own doctor. Even though children want to help increase the health and stamina of their parents, they may in fact be causing damage by misdirecting their loved ones.
Where a younger person can benefit from herbal supplements like Ginkgo Biloba, Saw Palmetto and others, in older people, these herbals may cause adverse reactions with their prescription medications. In 2003, a panel of experts put together a list of potential medications that would not be appropriate to give to seniors. This is called the “Beers List” after one of the research professionals.
Dr. Donna M. Fick, R.N., associate professor of nursing at Penn State and one of the panel members for updating the “Beers List,” states in her article on Seniorjournal.com:
Just as our bodies physically slow down as we age, changes occur in the way that older bodies handle pharmaceuticals, and this has motivated experts to develop a list of drugs that may be harmful to elderly patients.
“With age, drugs tend to build up in the body, and the distribution and elimination of drugs from the body changes as well,” says Dr. Fick. “Many drugs, like diazepam (Valium) and other anti-anxiety drugs build up fast.”
An on-line article on HealthSquare.com titled “Drugs and the Elderly,” talks about physical symptoms and medications.
Among the first signs that a drug may not be working properly in an older person is a change in mood, energy, attitude, or memory. Too often, these alterations are overlooked, ignored, or chalked off to “old age” or senility. Older people may themselves feel that their blue mood is caused by something external such as the death of a friend or simply by boredom. Nothing could be further from the truth. Virtually every heart medication, blood pressure drug, sleeping pill, and tranquilizer has been known to trigger depressive symptoms.
When a psychological symptom appears in an older person, examine his or her medication or drug use first. Consider, too, factors like alcohol intake, poor nutrition, and hormone imbalance. And never dismiss the possibility that a real psychological problem has developed and may itself require medication.
There are many things family members can do to help monitor medications for their elderly parents:
- make a list of medicines prescribed and all supplements and vitamins being taken;
- give this list to the doctor and pharmacist and have one on hand for emergencies;
- use the same pharmacy to fill all prescriptions — pharmacies have a record of your prescribed drugs and will verify your doctor’s instructions — they will also tell you if foods or over the counter supplements will interact with a prescription;
- dispense pills in a daily pill organizer box;
- have a family member be responsible to call or physically monitor the taking of medication.
September 3, 2011 § Leave a comment
Living in a different city or state — miles from aging parents — can be very difficult. Keeping in touch by telephone and making long trips to help parents or aging relatives with their needs can be time-consuming and not nearly as effective as being available full time in person.
One of my clients spent two years juggling his restaurant business with multiple daily phone calls to his elderly parents, checking on their needs and answering their questions. Family vacations were spent traveling the 500 miles to his parent’s home to personally take care of home maintenance and provide health care visits to their doctor. During his last visit, Mark noticed his father had difficulty walking and his mother was confused as to which medications she was to take and at what time. This alarming change in his parent’s condition concerned Mark that his parents’ care needs required more than frequent phone calls and vacation visits. Running his business and handling his parent’s long distance care was now becoming very challenging.
According to a report by the Alzheimer’s Association of Los Angeles & Riverside, California, there are approximately 3.3 million long distance caregivers in this country with an average distance of 480 miles from the people they care for. The report also states that 15 million days are missed from work each year because of long distance care giving. Seven million Americans provide 80% of the care to ailing family members and the number of long distance caregivers will DOUBLE over the next 15 years. Long Distance Caregiver Project — Alzheimer’s Association LA & Riverside, Los Angeles, CA (May 15, 2002, National Web Seminar by Judith Delaney, MFT, Clinical Coordinator).
The long distance caregiver is a new role that is thrust upon children and younger family members. Families used to live closer together, with children residing and working near their parents. But nowadays family members are more distant from each other. Society, today, is recognizing this. Some caregiver services have tweaked their programs to work as liaisons between long distance caregivers, senior loved ones and local medical professionals.
At my firm, we do Life Care Planning. What this means is that, in addition to legal and financial advice on how to pay for long-term care, I have an Elder Care Coordinator on staff. Elder Care Coordinators are care managers who assist caregivers, friends, or family members provide care for loved ones. They evaluate and recommend care for the aged. Care manager professionals are becoming extremely popular as the caretaker liaison between long distance family members and their aging elder loved ones.
Jacqueline Marcell — author of “Elder Rage, or Take My Father…Please! How to Survive Caring for Aging Parents” (Impressive, 2000) — says, “The most important thing to do is to find a geriatric care manager in the area where your loved one lives. She will have knowledge of all the services in the area and can be your eyes.”
Below is a partial list of what an Elder Care Coordinator might do for our clients:
- Assess the level and type of care needed and develop a care plan
- Take steps to start the care plan and keep it functioning
- Make sure care is in a safe and disability-friendly environment
- Resolve family conflicts and other issues with long-term care
- Become an advocate for the care recipient and the caregiver
- Manage care for a loved one for the out-of-town families
- Conduct ongoing assessments to implement changes in care
- Oversee and direct care provided at home
- Coordinate the efforts of key support systems
- Provide personal counseling
- Help with Medicaid or VA benefit qualification and application
- Provide placement in assisted living facilities or nursing homes
- Monitor the care received in a nursing home or in assisted living
- Assist with the monitoring of medications
- Find appropriate solutions to avoid a crisis
- Coordinate medical appointments and medical information
- Assist families in positive decision making
- Develop care plans for older loved ones not now needing care