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Family Caregiver Guide:

Caring for a Senior At Home

If you're a family caregiver, this comprehensive guide provides the tools you need to provide the best care for your loved one — while managing stress and time constraints. It includes videos and hands-on professional advice on topics including dementia and Alzheimer's, mobility, safety, and more.

Contents


Introduction: Your Role As a Caregiver

Am I a Caregiver?

A caregiver is someone who assists with the basic needs and activities of daily living. These activities may include but are not limited to:

  • Bathing
  • Grooming
  • Filling Medication Boxes/Refilling Prescriptions
  • Shopping for and/or Preparing meals
  • Housekeeping
  • Paying Bills
  • Making & Providing Transportation to Medical Appointments

If it’s not in a full-time capacity, you may not consider the time you spend helping a loved one as being a caregiver. You may have said, “That’s what family does for each other.” However, if you are actively handling some or all of the above assistance duties on a regular basis, then you are a caregiver.

You Are Not Alone

The number of caregivers in the U.S. continues to grow every year. According to the National Alliance for Caregiving and AARP, about 34.2 million Americans provided unpaid care to an adult age 50 or older within the last 12 months. Of those, about 15.7 million are caring for someone with Alzheimer’s disease or other dementia. [National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S.]

Caregiver Challenges

For the vast majority of people, caregiving is not a profession. As such, many also work their normal jobs while caring for their own families as well. This can prove to be taxing, and there are some commonly reported issues that may arise, including:

  • Increased Stress 
  • Depression
  • Anxiety
  • Financial Strain
  • Difficulties at Work/Absences

 

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PART 1. Work, Family & Your Caregiving Responsibilities

Striking a Healthy Balance

While caring for a loved one can offer a unique sense of fulfillment, it also comes with many responsibilities and may leave you feeling overwhelmed. Trying to balance caregiving duties with employment obligations is stressful. There are only 24 hours in a day – and with so much to do, it’s common to neglect yourself in order to get everything done.

It’s important to find ways to manage the stress and time constraints involved with caregiving. Don’t be afraid to ask for and, more importantly, accept help from friends and family. Caregivers who feel supported not only have lower stress levels, but they also experience fewer feelings of isolation. Successfully navigating the negative aspects of caregiving will hopefully allow you to embrace the more rewarding aspects.

The Facts on Stress and Caregiving

Family caregivers are at an increased risk for a number of health and wellness issues, ranging from heart disease to depression. Caregiver stress can also compromise your immune system and/or exacerbate pre-existing chronic health problems. Consider this eye-opening statistic: Caregivers are five times more likely to get sick than non-caregivers. They even have a higher risk of premature mortality!

Tangible Ways to Put Yourself — and Your Health — First

Seek Support

While asking for help can be difficult, it's a significant part of overcoming feelings of being overwhelmed. Take advantage of community resources. If you don't have a friend or family member to talk to, look into support groups at your local hospital, community or senior centers. Online forums can also be a valuable outlet.

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Go Guilt-Free

While caregiving abilities are not something that can be accurately measured, many still feel like they're failing because they hold themselves to unattainable standards. Your best is the best you can do. Acknowledging your own efforts and setting clear boundaries can help you avoid feelings of guilt.

Take Time Out

Everyone needs some "me time" now and then, but no one is going to schedule it for you. It’s important to set aside regular time each week to do something that you enjoy. But remember, while it's perfectly fine to want time alone, social interactions are critical in keeping depression at bay – so be sure to stay in touch with friends and family as well.

The Doctor Is In

Many caregivers are so busy keeping up with the appointments of their family members they neglect their own. This can have long-term repercussions for your health. Make sure to schedule your own regular check-ups, and let your doctor know if you are experiencing feelings of isolation or depression.

Understanding the Caregiver’s Role

Love, Respect & Companionship

With the necessary health effect disclaimers out of the way, it’s time to examine how to get the most out of your caregiving experience. Your role may seem straightforward on paper. There are “typical” responsibilities such as preparing meals, assisting with physical needs and a broad range of day-to-day tasks. However, caregiving is also accompanied by many unwritten and unquantifiable tasks, including providing comfort and companionship, demonstrating patience and forgiving others.

Embracing the Gift of Caregiving

If you think asking for help is hard, imagine how difficult it is for your loved one. Imagine the feeling of helplessness when suddenly having to rely on others for tasks you were once able to do for yourself. Showing love and compassion through understanding can improve the lives of the people for whom you care and make the act of caregiving more meaningful for you as well.

>Keep in mind that if an individual in your care is being difficult or obstinate, it’s not necessarily deliberate. Rather, they may be feeling lonely, scared or depressed. Even small acts of love can help struggling seniors feel valued, respected, honored and cared for, which, in turn, can reverse these behaviors.

Small things can make a big difference. Striving to be positive, smiling, listening, laughing, watching television together, praying together, and encouraging seniors to share stories, memories and wisdom are a few simple things you can do to feel more connected with aging loved ones.

Qualities of Successful and Happy Caregivers

Being a caregiver is one of life's most difficult jobs. And while some are called to the path, others are surprised to end up in the role. Regardless of how you come to be the one responsible for the care of another, these six qualities will serve you well in terms of navigating the challenges and finding personal and professional fulfillment:

  • The Ability to Just "Be"
  • Flexiblity
  • Being Detail-Oriented
  • Being Proactive
  • Patience
  • Empathy

Benefits of In-Home Care

Lightening the Load

Your loved one may insist on staying in their home, but this can prove challenging – both for seniors and the family members who care for them. Fortunately, there are some ways to support quality of life while honoring your aging loved one's desire for ongoing independence. Topping the list? Hiring in-home care. Here’s a closer look at four ways this increasingly popular form of senior care can be a vital part of helping to meet the needs of patients and caregivers alike.

Ease Demand on Caregivers

The majority of caregivers spend upwards of 18 hours a week on caregiving-related tasks, according to an AARP report, "Valuing the Invaluable: 2015 Update."

But as previously discussed, most caregivers are also juggling other responsibilities -- from the professional to the personal. Unfortunately, keeping up with these physical and emotional demands can trigger caregiver burnout. The support provided by in-home care can be a vital safety net and defense against burnout.

Bridge Geographical Divides

According to the AARP, 40 percent of people over the age of 50 have children living more than five hours' driving distance from them. While this unprecedented geographical sprawl is leading to new obstacles when it comes to caring for aging loved ones, in-home care can be a mitigating factor. Family members can still stay involved in caring for aging loved ones while simultaneously benefiting from the peace of mind of knowing someone is there when they can't be.

Free Up Caregiver Schedules

Just because many caregivers devote their lives to aging loved ones doesn't mean they don't have commitments of their own. Without the right support mechanisms in place, everything from self-care to "me time" can end up being pushed aside for the more immediate mandates of caregiving. While, in some cases, family members and friends can provide assistance, in other cases their schedules do not allow them to be able to help when needed. In-home caregivers can fill this void and also provide much-needed restorative respite care.

Evolve with Changing Needs

Neither advancing age nor illness is static. As the needs of care recipients change, so do the demands on caregivers. In-home caregivers are flexible in terms of the types of services they provide, meaning that family caregivers aren't overwhelmed by a continually growing list of responsibilities. In-home caregivers provide a range of critical services to aging loved ones and the people who care for them. Resulting in a better ability to meet the changing needs of aging loved ones without compounding family caregiver stress.

PART 2. Living Options for Your Aging Loved One

Deciding Between Continued Home Care & Other Living Options

Just because a person gets older does not mean they are ready to give up the idea of independence; unfortunately, independence does become more difficult to maintain as life progresses. Continued home living requires ample planning for best results. In-home care agencies can bridge some care gaps as previously discussed.

Making a decision about remaining at home or moving to an assisted living or other care facility is not an easy one to make. It’s also a decision that family members will often struggle with, especially if the aging loved one is determined to stay in their home.

Factors Affecting a Senior’s Ability to Stay in Their Home

Physical Factors

Even seniors who stay in the very best physical shape experience natural age-related declines in physical ability.

Older adults who are no longer able to handle basic day-to-day responsibilities may just need an extra set of hands, or it may be time to consider a different living situation.

In some cases, a nearby friend or family member who can stop in regularly to help with anything from opening cans to reaching items on high-up shelves is all an older adult needs to remain safely in their home. Assistive devices can also offer invaluable help for seniors.

In other cases, physical changes that interfere or compromise basic mobility may require something more – not just for the health and safety of seniors, but also for the peace of mind of the people who care for them.

The same applies to routine home maintenance. Changing light bulbs, raking leaves and taking out the garbage can become increasingly challenging for older bodies.

Keeping an eye out for these changes and implementing mechanisms to help seniors in need is a critical part of promoting safe aging in place. Without these mechanisms, aging in place may not be the optimal situation.

Mental Factors

Some cognitive decline is also a common part of the aging process. However, when it begins to interfere with basic self-care, it may be time for caregivers to consider alternate options. Everything from forgetting to turn off the stove to neglecting to take medicine as prescribed can interfere with senior health and wellness.

Again, home health care can help ensure safety for seniors living at home, but when these changes occur with more frequency, the cost of aging in place may simply be too much – not just financially, but also when it comes to the well-being of older adults.

Emotional Factors

Contact with others is an essential part of human health and well-being. When many older adults opt to age in place, they do so with a network of family, friends and neighbors in place. Unfortunately, as time passes, the situation can change, leaving seniors more isolated than initially anticipated.

Decreases in opportunities for socialization can lead to everything from isolation to loss of mobility. Factor in that loneliness and lost connections among seniors living at home have also been linked with increased incidences of depression, and the situation becomes even more critical. Age-related driving limitations further complicate the issue.

Programs like Meals on Wheels and shuttle services for seniors offer regular contact to homebound seniors, but it's not always enough. While physical health may get the lion's share of attention when it comes to assessing the ongoing ability to live alone, the support team must also consider equally important emotional factors.

Regular social contact – whether from a family member, neighbor or home health aide – is an essential part of successful aging in place.

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For seniors who are in good health, active and surrounded by a strong social network, aging in place remains a desirable option. However, when these factors start to change, it may be time to reassess whether aging in place is truly the right choice for your changing needs.

What happens if you discover your loved one is having difficulties living on his or her own?

Although picking the right living option may seem daunting, there are many resources available to guide you. You should always consult your loved one’s doctor, and of course, the senior themselves. Try talking to someone who has experience in the eldercare field, such as a medical social worker, care manager or an agency that specializes in moving seniors at no cost. Social workers and eldercare agencies should also be able to tell you about eligibility requirements for federal or state aid.

Assisted Living vs. Personal Care

Assisted Living

The Administration on Aging (AoA) defines assisted living as “a housing alternative for older adults who may need help with dressing, bathing, eating, and toileting, but do not require the intensive medical and nursing care provided in nursing homes.”

Typically, residents of assisted living facilities reside in their own living spaces with assistance in everything from help with daily living activities and medication reminders to meals and recreation activities. Housekeeping and laundry, security and transportation are also commonly included. These facilities may stand alone or be part of a larger retirement community.

Personal Care Home

Seniors looking for a less “institutional” feel may find their needs better met in a personal care home. Popular for their home-like environments, they provide a sense of community and independence, which some seniors may find lacking in conventional assisted living communities.

They usually cater to a relatively small number of people – from as few as four and capping out at 10 residents, depending on state regulations. While assisted living homes may be configured more as studio apartments, personal care residents occupy rooms in private homes while sharing a common space. They can even exist in residential neighborhoods.

As with assisted living, residents have access to trained and qualified staff members who can help them with both personal needs and medical assistance. However, acute medical care is not available in personal care homes.

Personal Care Home Considerations

If a personal care home sounds right for your aging loved one, there are some factors to consider:

  • Location is essential
    • Being near medical facilities in the event of an emergency
    • Proximity to family and friends
  • Costs cover not only room and board, but also the staff
    • May be priced daily or monthly
  • Comfort with the staff is a must
    • Interview the house manager and/or talk to staff members
      • Get a sense of staff personalities
      • Assess the community culture

One last thing to keep in mind: The state of senior care is constantly changing.

Not only are terms and definitions still evolving, but they can vary from state to state and from community to community. Visiting a community, talking to administrators and staff, and observing residents can help you make the most informed decision when choosing the optimal living environment for your aging loved one.

The Four Most Common Types of Eldercare Options

1. Residential Care

Also called group homes, residential care homes have several advantages over larger facilities. Residential care homes generally serve elderly residents who live together and receive care services from live-in caregivers. The ratio of caregivers to residents is much better than in other types of care homes. Generally non-medical, caregivers offer assistance with activities of daily living such as dressing, bathing, transferring, using the restroom and meal preparation. Many residential care homes offer an intimate, home-like environment that is comfortable for seniors. Depending upon the home, amenities or nursing services will vary. Make sure to take a tour and talk to current residents and staff before making a decision.

2. Assisted Living

Assisted living is a good care option for those who need help with some daily-living tasks, but are still able to live safely on their own some of the time. Maybe help is needed with medications, cooking, or another activity of daily living as described above. Prices fluctuate depending upon the amount of care needed. With assisted living, similar to residential care, caregivers are available around the clock.

Some assisted living facilities contain single-living apartments with kitchenettes; others provide simply rooms; less expensive options sometimes have residents in a shared room, similar to dormitory style living. Assisted living residences have activities, a vibrant social community, and usually group dining, which makes meeting new people easier. Assisted living is a good choice if your loved one needs more personal care than can be given at home or if they need medical supervision, but not the amount of attention supplied by a nursing home.

3. Continuing Care Retirement Communities (CCRC)

Continuing care retirement communities are able to provide multiple types of care, adapting to the needs of the resident. Sometimes, communities even include a nursing home in the same location. If you plan early and have the funds, continued care can be a great option because as your loved one ages, they will not need to move from their already-comfortable area to receive more medical attention. Residents purchase units within the community and pay a monthly fee depending upon the type of care needed. As their needs change, the monthly fee to live in the community increases to match the higher level of care. Added benefit for married couples is that spouses can stay close even if one requires more attention or care than the other.

4. Nursing Homes

A nursing home is intended to offer a high level of care. Outside of a hospital, nursing homes provide the highest level of medical care available. Nursing homes do provide assistance with daily care, but they are generally chosen as a living option because of the high level of medical care. A licensed physician supervises, and a nurse or other medical professional is always available on the property. Occupational and physical therapists should be available on site as well. A nursing home is a good choice if a recent health development has disabled a loved one, such as a fall or a stroke, and there is no way they can receive the level of necessary care through home-health or another living facility. Sometimes, nursing homes are temporary options right after hospitalization or rehab, and residents return home or to another facility after a short amount of time.

Six Tips to Help with a Smooth Transition

Once the decision to move to one of the available eldercare options has been made, moving as seamlessly as possible becomes the next priority. Here are some things you can do to help your loved one have a more positive transition:

1. Find the Right Community

All nursing homes are not created equal. If a facility feels warm and welcoming to you, it will likely feel the same way to your aging loved one. Finding the right environment is a huge factor in helping your loved one adjust to their new home.

2. Give Them a Voice

The information acquired during due diligence not only helps you make the most educated decision but can also be used to help aging loved ones feel more engaged in the process. Seniors who are given a say feel like they are participating rather than powerless.

3. Be Present

One of the biggest fears older adults experience when contemplating a move to a care facility is becoming isolated from the people they love. Frequent visits from the onset is a simple way to alleviate these concerns. Keep in mind that regular visits aren't just for the benefit of residents. They also allow caregivers to monitor their loved one's care and progress.

4. Encourage Involvement

While jumping right into a new community can be intimidating, there's no better way to help aging loved ones feel like themselves again than by encouraging them to get involved. From taking meals in the dining hall to participating in group activities, seniors are most likely to feel like themselves again when they become engaged with the new world around them.

One simple way to help seniors overcome hesitations about getting involved? Accompany them on these initial outings.

5. Schedule Outside Socialization

While making new friends is certainly a huge part of any smooth transition, so is maintaining old contacts. Make sure your aging loved one has plenty of visits to and from relatives and old friends.

If possible, have a family meeting to come up with a schedule aimed at supporting steady reliable contact. This can help mitigate natural feelings of loss and grief which may accompany the move from a long-time home into residential care.

6. Make it Feel Like Home

Home may be where the heart is, but material objects offer comfort while the heart catches up. Bringing along cherished family photos, a favorite blanket, and other decor can help create a pleasantly familiar atmosphere for seniors who might feel out of place without them.

One last thing to keep in mind: While your aging loved one's living situation may change, your relationship shouldn't. Caregivers can and should remain active participants in seniors’ lives after the move to a care facility, and advocate for them, as well.

PART 3. Keeping Your Loved One Safe

While all people would do well to concern themselves with the following safety issues, seniors are especially prone. This heightened risk is made even more apparent with lower functioning seniors. Particularly noteworthy safety concerns include:

  • Falls
  • Driving
  • Medications
  • Depression
  • Scams

Falls

It should first be noted that falling is not a normal part of aging. One doesn’t typically fall just because they are elderly. There are some general causes that may include: conflicting medications, poor vision, or neurological impairments such as vertigo. Slick or wet surfaces, such as those found on a bathroom floor or in a bathtub, area rugs that aren’t slip-resistant, and even the layout of a room can contribute to falls if furniture is impeding clear walking paths.

Four Things to Help Prevent Falls

  1. Begin your loved one on an exercise routine to strengthen their legs and improve balance

  2. Review their medications to identify conflicting combinations

  3. Schedule a vision exam for them to see if glasses are needed or if their current prescription is correct

  4. And finally, make the home safer

The last item seems obvious, but the costs for completely outfitting a home for safety can range from relatively modest figures to being cost prohibitive, depending on the needs. Some cost-effective options include:

  • Backings or double-sided tape under area rugs to prevent slippage
  • Motion-activated night lights
  • Grab bars around the toilet and in the shower
  • Non-skid strips on stairs and in the bathtub
  • Use of a cane or walker

On the issue of stairs, especially at the entryway, ramps may be installed to allow for a gradual incline that’s easier to ascend while also giving accessibility for wheelchairs and/or motorized scooters.

Ramps are certainly on the higher end of cost, depending on the type selected, with the two most common types being modular and custom. In the bathroom, options like a Zero-Step Walk-In Shower are great for seniors but also very expensive. A less costly alternative would be installing a bath bench over an existing soaker tub. Additionally, installing grab bars, a shower stool, and a hand-held shower head are wise investments.

Finally, fear of falling can actually be a factor in increasing falls. Addressing any falling concerns with doctors and active caregivers is an important step for improving safety around the home.

Driving

When you feel it’s no longer safe for your loved one to operate a vehicle, and they insist they are fine, that creates a difficult situation. The loss of independence that comes from not being able to drive can be devastating. And yet you may need to insist that your aging loved one should stop driving — for their safety as well as the safety of others. Geriatric Psychiatrist Dr. Thomas Weiss offers some advice on how to tackle this difficult situation with real-life examples in the video below:

Medication

Medication management is a critical public health concern. Caregivers play a vital role in helping seniors stay healthy by familiarizing themselves with the following five potentially deadly medication mistakes:

1. Ignoring Dosing Requirements

Overdoses are a leading cause of medication fatalities. And although prescription drugs are the most common offenders, it's also possible to overdose on over-the-counter medications. Seniors, in particular, are at risk of overdosing due to declines in memory.

New pill box technology is an an effective way to ensure that seniors are taking their medications in the proper doses and at the proper times. Watch the video below and learn more about the many options available and how they can help manage medications safely.

‘Managing Medications: A Review of the Latest Pill-Box Technology’ Video

Caregivers can also help by watching for signs and symptoms of overuse, such as prematurely running out of medication, mood swings, and over-sedation. If you do notice changes in thinking, feeling or appearance, check in with your aging loved one's doctor.

2. Polypharmacy and Drug Interactions

Not only do most seniors take multiple medications, but many of them are prescribed by different specialists. While each of these prescriptions are likely to be safe when taken on their own, when combined they can lead to unexpected and dangerous drug interactions. Without proper monitoring, a physician may unknowingly add a potentially dangerous medication to the list.

Caregivers can help avoid this problem by maintaining a comprehensive list of all medications and sharing it with a "gatekeeper" healthcare professional whenever a new medication is prescribed. Pharmacists can also play a vital role in catching potential drug interaction issues.

3. Mixing Up Medications

In addition to taking too many medications and/or medications that shouldn't be taken together, many seniors are also taking the wrong medications entirely. This can be caused by similarities in names as well as in appearance.

Sorting medication in advance can help lessen any confusion. Additionally, storing as-needed medications separately can reduce the risk of errors by patients, caregivers and pharmacists alike.

Lastly, the mere act of understanding the purpose of each new medication can help caregivers identify if multiple medications have been prescribed to treat the same condition.

4. Food Interactions

While the dangers of drug interactions may be relatively well known, fewer people are aware that combining certain foods with certain drugs can also lead to life-threatening outcomes. Some foods may render certain drugs ineffective. Others may alter the way a drug metabolizes in the body.

Thoroughly reading medication labels and following directions can help avoid food and drug interactions. Additionally, listening to your loved one’s doctor and/or consulting with a pharmacist can help prevent avoidable errors.

5. Wrong-Route Errors

In many cases, how a medication is taken is just as important as the dosing or possible interactions. Unfortunately, the administration of medications via a different route than prescribed can lead to adverse patient outcomes, including death. This can include everything from swallowing a pill meant to be absorbed under the tongue or injecting a liquid intended for use as a nasal spray.

Five More Common Medication Errors

The following bit of information could be summed up by reiterating the importance of reading a medication’s label, especially as it relates to “wrong-route errors,” but in the interest of your loved one’s safety, it’s worth repeating in greater detail.

1. Failure to follow instructions regarding food, fluids, antacids and ENFs

Many prescription medications require that patients take medication with a certain amount of liquid, with or without food, or after taking an antacid. The medication may not work or may cause harm to the patient if the instructions aren't followed. Additionally, some medications are prescribed to be taken with enteral nutritional formulas (ENFs). Failure to follow standard protocols for administering medications with ENFs can also lead to injury.

2. Failure to follow "do not crush" instructions

While it may be easier in the moment to administer medication capsules, tablets and pills by crushing or slicing them, this can impact their effectiveness. Resist splitting medication with "do not crush" on the label.

3. Failure to properly mix medication

Some medications require shaking, "rolling," or mixing prior to being administered. This is an important part of ensuring that patients receive the proper amount of medication. For example, air bubbles in insulin suspensions can displace the medicine and interfere with the patient receiving the correct dosage. Caregivers can avoid this situation by following instructions for proper preparation of medication prior to administration.

4. Inadequate administration of eye drops and metered dose inhalers (MDIs)

Eye drops must remain in contact with the patient's eye for a certain amount of time in order to ensure adequate absorption prior to subsequent eye drops. The same applies to MDIs, which require proper shaking, positioning and waiting times between puffs. Again, reading the instructions and precisely following them can prevent medication errors.

5. Failure to enforce sublingual drug delivery

Swallowing a pill can have a very different result than sublingual delivery (a type of lozenge that is dissolved underneath the tongue). If a patient is repeatedly swallowing sublingual tablets, talk to his/her physician about prescribing a different type of medication.

Depression

You may have heard warnings that suicides among seniors rise during the holiday season. However, this is a widely perpetuated myth, according to the Centers for Disease Control, based on data from the Annenberg Public Policy Center. In fact, suicide rates are actually at their lowest in December, but they do peak afterward – a phenomenon that some experts attribute to a letdown from the holidays.

The Takeaway for Caregivers

The post-holiday months are the perfect time to check in on the mental health of aging loved ones. Here's a closer look at the issue of senior depression, along with caregiver tips for safeguarding the emotional wellness of older adults.

About Seniors and Depression

According to data shared by Mental Health America, more than two million American seniors suffer from some form of depression. Not only can symptoms of depression be triggered by the onset of late-in-life chronic illnesses, they can be exacerbated by the death of a loved one. For example, a full third of seniors meet the criteria for depression a month after a spouse's death, with half remaining clinically depressed a full year later.

Depression is a major predictor of suicide in older adults, who make up 20 percent of the country's total suicide deaths. White males over the age of 85 are particularly vulnerable – with suicide rates nearly six times higher than the general suicide rate.

How Caregivers Can Help

Unfortunately, senior mental health often falls through the cracks when it comes to clinical care. This problem has several causes, including the fact that seniors are more likely than any other demographic to believe they can "handle it themselves." As a result, not only are older adults less likely than younger people to mention their symptoms, but they're also more likely to view depression as a "normal" part of the aging process.

Given the previously cited statistics, it is alarming that fewer than three percent of seniors are treated by mental health professionals. Perhaps more alarming: Primary care doctors accurately recognize less than 50 percent of depression in patients.

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Because of this, caregivers can play a vital role in identifying mental health issues in seniors, as well as in helping them get the help they need. According to the National Institutes of Health (NIH), sadness is not always the primary symptom of depression in older adults. Others signs of depression may include:

  • Anxiety or feelings of emptiness
  • Loss of interest in activities and hobbies
  • Feelings of pessimism, hopelessness, helplessness, worthlessness and guilt
  • Increased fatigue and decreased energy
  • Trouble concentrating and making decisions
  • Sleep changes, including difficulty sleeping and oversleeping
  • Appetite and weight changes
  • Irritability and restlessness
  • Thoughts of death and suicide
  • Aches, pains, and digestion issues with no clear cause and that don't respond to treatment

Symptoms persisting for more than two weeks should be addressed with your loved one’s healthcare provider.

The good news is clinical depression is very treatable. More than 80 percent of people are receptive to medication, psychotherapy, or a combination of the two, according to the NIH. Caregivers can help ensure that seniors get the mental health care they need by keeping watch for symptoms -- not just during the holidays but throughout the year.

Scams

This threat is difficult to address because scams are constantly changing, with newer, more complex and increasingly effective scams popping up every day. Seniors aren’t the only ones prone to fall for scams, but they are specifically targeted. The loss of retirement savings can be devastating for the entire family. Having a conversation about the following scams, even in passing, can be incredibly helpful in preventing your loved ones from being affected.

Below is a list and basic explanation of the five most common scams that affect seniors. Please bear in mind that this is by no means a complete list. As always, if something sounds too good to be true, it probably is.

1. Tax Phone Scam

Let it be said that the IRS will never call to inform a taxpayer that they owe money or back taxes. Threats of arrest and warrants for arrest commonly accompany this scam to inflict maximum fear and compliance with the scammer’s ultimate demand: Give me your money.

2. You’ve Won!

Amazingly, your loved one receives a call to let them know that their name has been selected to receive a wonderfully outlandish prize. Money, trips, cars are theirs if they call the provided number to claim the prize. Sadly, there’s no prize waiting to be claimed, just a scammer attempting to steal personal information, bank account numbers, social security numbers and whatever else they can get a victim to divulge.

3. Tech Support Scam

Typically this happens as a pop-up when going to a website that has been hacked by would-be scammers. The pop-up usually claims the computer has been infected with a virus or is in need of a specific service. As luck would have it, there’s also a handy “fix my problem” now button on this pop-up that will get all the needed help for a small fee. The much larger and more dubious fee comes in the potential stealing of passwords, logins, and any other personal information provided. There is alternatively a phone version of this scam, where the caller says that they’re with Microsoft tech support and that your loved one’s computer has been generating errors on the server for weeks. The goal is the same, and hanging up immediately is the best option.

4. Foreign Lottery Scam

One of the oldest standing scams, this one involves a phone call letting your loved one know that they’ve won a sizeable foreign lottery. The only thing needed to claim the prize is paying the taxes in advance – typically by wiring money through Western Union. This is a guaranteed scam. Save the headache, and have your loved one just hang up.

5. Medicare Calls

When receiving a call to confirm and update Medicare information, just know that this is a scam. What they’re after is the Medicare number. Or more specifically, they’re after your loved one’s social security number, which is the Medicare number with an additional letter and a number. This is not information you want in the wrong hands. Actual Medicare calls would never ask for this information because they already know it.

PART 4. Dealing with Dementia / Alzheimer’s

Tips, Behavioral Management & More

A diagnosis of dementia is never easy for families to accept – especially when it affects a beloved parent or grandparent. Adding behavioral issues to the mix and tense situations only add to the difficulty.

It’s almost incomprehensible to believe that someone you have known your entire life to be a kind, mild mannered, gentle person can suddenly become aggressive and combative toward their own family or others trying to help them. Behavioral disturbances in dementia can make it extremely difficult for the caregiver.

Some of the behavioral problems associated with dementia that are most disturbing to caregivers include:

  • Agitation
  • Aggression
  • Psychotic symptoms
  • Mood disturbance 

It is fairly common for families and staff caring for dementia patients to tolerate and support patients with significant impairment, including incontinence, disorientation, loss of memory or loss of ambulation. However, hallucinations or physical aggression usually prompt families to transfer the patient to a nursing home, where there is often a subsequent request for immediate psychiatric help.

Having to place someone in a facility due to their behavioral disturbances can be heartbreaking and can cause many challenges for families and caregivers. Support for the entire family is crucial and the Family Caregiver Alliance – National Center on Caregiving – offers some excellent recommendations for families about caring for someone with dementia who is having behavioral issues. Some of the top tips for handling troubling behavior include some ground rules to keep in mind:

We Cannot Change the Person

The person you are caring for has a brain disorder that shapes who they have become. When you try to control or change the behavior, you’ll most likely be unsuccessful or be met with resistance.

Accommodate Over Control

Try to accommodate the behavior, not control the behavior.  For example, if the person insists on sleeping on the floor, place a mattress on the floor to make them more comfortable.

Two Changeable Variables

Remember that we can change our behavior or the physical environment. Changing our own behavior will often result in a change in our loved one’s behavior.

The Importance of Sleep

Scientists are increasingly advancing our knowledge of the link between Alzheimer's disease and sleep, including recent groundbreaking research from Washington University's Knight Alzheimer's Disease Research Center. The research indicates that there's a "bidirectional relationship" between the development of the disease and sleep and circadian problems. The takeaway? In addition to being a common symptom of Alzheimer's disease, sleep problems may also be an early indicator of the disease. The more caregivers understand about sleep and Alzheimer's, the more restful sleep all involved are likely to enjoy.

Understanding the Causes

Many factors impact the sleep patterns of people with dementia and Alzheimer's. These include obstructive sleep apnea, depression and restless legs syndrome. If you suspect that your aging loved one may have one of these or another underlying condition, check with their physician to determine whether there are any potential sleep interventions.

Tips for Promoting Better Sleep

It's also possible for caregivers to promote better sleep by promoting certain lifestyle changes, including the following:

  • Seek out opportunities for daytime exposure to light
    • Both in the form of natural light as well as through specialized light boxes
  • Limit products containing caffeine, which can lead to sleeplessness
  • Limit alcohol, which can trigger anxiety and confusion
  • Schedule medications that have a stimulating effect in the morning and those that cause drowsiness in the evenings
    • Most doctors do not recommend sleeping pills as they can increase the risk of trips and falls
  • Encourage walks and other forms of physical activity
  • Restrict daytime sleep by limiting naps and limiting them to earlier in the day
    • Additionally, avoid napping in bed
  • Establish a regular routine for sleeping and waking, including setting up a comfortable sleep "zone"

In addition to helping people with Alzheimer's sleep better at night, these techniques can also be useful in preventing sundowning symptoms experienced in the late afternoon and early evening.

More About Sundowning

As many as 66 percent of patients with Alzheimer’s disease may experience a phenomenon known as Sundowning, also known as “sundown syndrome” or “nocturnal delirium.”

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What is Sundowning?

According to the Mayo Clinic, “Sundowning isn't a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer's disease.”

Many caregivers notice the onset of challenging behaviors with the fading of the light in the afternoon and progressing into the evening. Others observe sleep changes and/or restlessness at night. Both of these are examples of sundowning. While scientists haven’t yet determined a single cause for these issues, they believe they’re related to changes in the brain caused by Alzheimer’s which impact the body’s internal clock.

In addition to physiologic risk factors, environmental risk factors also exist, including changes in the environment and the amount of daily light exposure, high noise levels, daytime activities, nighttime disruptions, medications, and/or the presence of other diseases. Interestingly, a walk in the sun during daylight hours can work wonders.

The Symptoms of Sundowning

  • Confusion
  • Anxiety
  • Agitation
  • Aggressiveness with increased motor activity such as:
    • Pacing
    • Wandering
  • Resistance to redirection
  • Mood Swings
  • Suspicion
  • Increased verbal activity like yelling
  • Worsening of symptoms in the late afternoon and evening

What Causes Sundowning?

Researchers theorize that sundowning occurs as a result of circadian dysregulation, which may be triggered by a number of factors, including inadequate exposure to daytime sunlight; low lighting and increased shadows exacerbating late-day confusion; end-of-day physical and mental exhaustion; reactions to nonverbal cues from exhausted and/or frustrated caregivers; disorientation caused by the inability to distinguish dreams from reality; and reduced need for sleep.

Potential Contributing Factors

  • Hunger or thirst
  • Depression
  • Pain
  • Boredom

Impact of Sundowning

Unfortunately, the effects aren’t just felt by the person experiencing it. Caring for someone with sundown syndrome can also interfere with caregiver’s sleep, health and overall quality of life.

10 Tips to Make Mealtimes Easier

Outside of the previously discussed sleeping issues, mealtimes can prove to be equally hard times of day for caregivers. Factor in Alzheimer’s disease-related issues like cognitive impairment, coordination problems, and declines in sensory perception which can lead to loss of appetite, and the challenges faced by caregivers only rise. While there’s no cure-all for these issues, caregivers can apply these 10 steps to improve mealtimes for people in their care:

1. Create a Conducive Setting

People with Alzheimer’s disease may have trouble focusing. Caregivers can help by creating a distraction-free zone. Turn off the television, radio and other distractions; set a simple table and avoid placing extraneous items, such as floral arrangements, on the table.

2. Help the Food Stand Out From the Plate

Because Alzheimer’s disease can affect a person’s vision and spatial abilities, individuals may struggle with differentiating items on the table. Using plates with solid, contrasting color linens makes it easier to identify the food from its background. Conversely, patterned materials can have the opposite impact.

Trying to boost an Alzheimer’s patient’s food intake? Use a red plate. According to researchers at Boston University, people with Alzheimer’s disease eat 25 percent more when served meals on red plates!

3. Always Test the Food Temperature

People with Alzheimer's may be unable to determine when foods and beverages are too hot. To avoid burns, check food and beverage temperatures before serving.

4. Keep the Number of Foods Served to a Minimum

While a smorgasbord of offerings may sound wonderful to you, it can be overwhelming for an Alzheimer’s patient. To avoid this, offer only one or two foods at a time.

5. Keep Taste In Mind

The best way to get someone with Alzheimer's to eat is to offer something appetizing. At the same time, it’s important to remember that people with Alzheimer’s may develop new food aversions or preferences.

6. Allow Plenty of Time for Meals

Aside from the fact that no one enjoys being rushed through a meal, people with Alzheimer's may simply need more time to eat — as much as an hour or more for a meal. Allow adequate time, and encourage your loved one to chew and swallow slowly.

7. Make Meals a Social Occasion

Mealtimes are inherently social. However, given the daily demands of caregivers, many use this time to attend to other duties. As much as possible, resist this temptation and use mealtimes as an opportunity to eat together and enjoy each other’s company. This will improve the experience for you both.

Additionally, staying with an Alzheimer's patient while they’re eating offers other benefits, including modeling behaviors, observing the process and providing assistance, if necessary.

8. Find Other Opportunities for Eating

Getting an Alzheimer’s patient to sit for a meal isn’t always possible. Offering nutrient-dense snack opportunities throughout the day can help ensure that nutritional needs are being met.

9. Instill Independence As Much As Possible

Whether trying to rush things along or “make things easier,” caregivers may end up attending to tasks that Alzheimer’s patients could otherwise do for themselves. By allowing aging loved ones to do for themselves as much as safely possible, Alzheimer’s caregivers can nurture a sense of control, independence and dignity. This applies to eating, as well as to preparation and cleanup.

10. Plan to Adapt

As an Alzheimer’s caregiver, you’re likely already aware that things rarely go as planned. This absolutely applies to mealtime. Factor in that Alzheimer's patients are constantly changing, and attempting to predict what to expect during mealtimes can be an impossible task. The solution? Flexibility. If the patient is struggling with silverware, go with finger foods. Is the patient requesting breakfast after already eating breakfast? Breakfast-for-lunch, it is!

Mealtimes won’t always go as planned, and even with these helpful tips, they may be the hardest parts of the day. However, your approach and attitude can make all the difference when it comes to facilitating the most positive and beneficial experience for someone with Alzheimer's. One rule of thumb worth keeping in mind: Patience is always the best practice.

10 Tips For Dealing with Alzheimer’s

The challenges of caring for someone with Alzheimer's are frequently discussed. But most people tasked with managing care for someone living with this disease are already well aware of these challenges and are looking for something more: practical tools and actionable insights for managing them. Interestingly, the following tips are very similar to what is often recommended for caring for autistic children.

1. Have a Schedule

Most caregivers feel like they simply don’t have enough hours in the day. Creating a schedule can help you determine how and when to get everything done. People with Alzheimer’s do well with routines. In devising a routine for yourself, you may also minimize agitation and confusion for your loved one.

When designing your schedule, consider the needs of both yourself and the other relevant parties. For example: When are you best up for helping your aging loved one bathe? When is he or she most agreeable to this activity? When are other family members available to offer backup? Even scheduling routine trips to the bathroom can be a proactive strategy against incontinence.

2. Build in Adequate Time

On a perfect day in a conducive environment, it may only take you 15 minutes to pay the bills or fold a basket of laundry. However, these tasks can take much longer for caregivers who are juggling other tasks and/or whose attention may be divided. Expect things to take longer, and build in extra time to accommodate this reality. Also, be sure to schedule in breaks for yourself and for your loved one.

3. Prepare to Be Flexible

We’ve all heard the expression, “The best laid plans...”. This applies no more appropriately than to caregivers. A schedule may be a vital time management tool, but it’s not a foolproof one. There are going to be days when your plans go awry. Expecting this and adjusting as necessary can help minimize resulting stress—both for you and for your loved one.

4. Work with Your Loved One, Not Against

When time is short and obligations are impossibly tall, it’s easy to feel alone and overwhelmed. However, caregivers aren’t alone. As much as possible, allowing and encouraging loved ones to participate in their own care—from helping with the schedule to getting themselves dressed—can take things off your plate while empowering them.

5. Commit to Communicating Better

Many caregivers experience frustration when trying to communicate with loved ones who have Alzheimer’s. But if you show frustration, your loved one will feel it too. Maintain a calm, gentle and positive manner throughout your interactions.

Additionally, keep in mind that very few people function well when they’re distracted, but this is amplified for people with Alzheimer’s. Eliminating background noise like the television and radio can help your loved one focus on the task at hand. Not only does this boost productivity, it also reduces your own frustration.

If you find yourself getting too frustrated while trying to communicate (or negotiate), take a step back or leave the room to collect yourself.

6. Use Your Support Network

Caregivers hear a lot about the importance of building a support network. But these resources are only worth as much as they are used. Your loved one’s healthcare team, Alzheimer’s support groups, and your friends and family are all available to help with everything from questions about alleviating symptoms to tips for addressing behavior problems. The more you call on these resources, the more you stand to gain from them. The opposite is also true: If you don't use the resources available to you, they can't help.

7. Turn Meals into Opportunities

Food issues can be a particular challenge for Alzheimer’s caregivers. However, meals can also be an opportunity for socialization. Focus on the emotional aspects of eating as well as the logistical ones. Create a calm environment conducive to eating to make the process more pleasant.

This is another example of a time where engaging the person—for example, in preparing the food or setting the table—is beneficial. Not only can it lighten your workload once it becomes a habit, but it also promotes feelings of personal control while nurturing the functional skills in Alzheimer’s patients.

8. Find the Right Activities

Many caregivers struggle with keeping loved ones with Alzheimer’s engaged. Taking time to find the right activities can make all the difference. If your loved one already has a favorite hobby or activity, build on that. Make sure activities are aligned with his or her current abilities, and be patient throughout the process. Simple is always best. More complicated activities are more manageable if broken down into smaller steps. If you notice that your loved one is getting agitated or upset during any activity, offer help or move on to something else.

9. Embrace What You Enjoy

Being a caregiver doesn’t mean you can’t find joy in life. Neither does living with Alzheimer's disease. Finding activities you both enjoy and can do together can offer you both a sense of fulfillment while strengthening your bond. This can be as simple as going for a walk.

10. Reflect on What’s Working… and What’s Not

Are there any particular aspects of your daily life that are going well? Or aspects that have become a daily stumbling point? Taking time out to review your day can help you assess what’s working and what isn’t so you can make positive changes. This is also a great opportunity to acknowledge your own accomplishments — something many caregivers fail to do.

One last tip all caregivers need to hear: While some of these tips will hopefully lighten your load, difficult days can, and will, happen. Go easy on yourself and accept that you are doing the best that you can in a trying — yet worthwhile — situation.

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PART 5. Keeping Your Loved One with Dementia Active and Engaged

Coming up with age-appropriate activities that give dementia patients purpose and meaning is difficult. These purposeful, convenient activities offer enjoyment and recreation for someone with dementia and preserve their dignity and self-respect. You may not have all of these items, so some purchases may be required. Fortunately, they are inexpensive to bring home and the results can be more than worth it. As always with a person suffering from dementia, the success of each activity is highly dependent on the progression of the disease.

Activities for People with Dementia

1. "Playing" with Paint Swatches

Picture the paint swatch displays at your local hardware store. These free samples are available in an extensive range of colors, shapes, sizes, and textures – all of which can be engaging for people with dementia. Depending on the progression of your loved one's disease, they may engage with the paint swatches in a number of different ways, ranging from simply manipulating them with their hands, to matching similarities, to creating color palettes.

2. Exploring a Jewelry Box

Many people have fond memories of looking through an older relative's jewelry box as a child. In fact, jewelry boxes are literal treasure troves for people of all ages. Whether your aging loved one simply looks through the box or organizes it, they will enjoy participating in this age-appropriate activity.

Keep in mind that for some people with dementia, this task can be overwhelming or confusing, so be sure to factor in your aging loved one's individual capabilities when setting up this task.

3. Sorting Silverware

Researchers continue to discover the benefits of Montessori-based methods for dementia patients. Working with "practical life" material can help seniors maintain a connection with the world around them. Silverware-related activities can include everything from sorting and rearranging the silverware drawer to washing and polishing forks, spoons and knives. The complexity of the task relies on the progression of your loved one's disease.

4. Manipulating PVC Pipe Fittings

In another age-appropriate activity, PVC pipe fittings can be manipulated in a number of ways depending on your loved one's abilities. From taking them in and out of their bags to screwing pieces together, people with dementia often find this work fulfilling.

5. Cutting Coupons

Whether your aging loved one was previously an avid couponer or has never clipped a coupon in their life, there is still much fulfillment to be found in coupon clipping. Not only does this task keep dementia minds occupied, but it also involves a valuable element of socialization -- particularly if you work on coupon clipping together.

Remember, the final product doesn't matter. In the case of people with dementia, the true benefit lies in the act of doing something purposefully, not in the outcome.

6. Tupperware

While blocks may be suitable for children, Tupperware offers an ideal alternative for older hands. Not just a handy invention for food storage and organization, Tupperware is also a terrific way to engage people with dementia. Higher-functioning people may be able to take lids on and off as well as sort and stack Tupperware pieces, while others may simply hold and feel the containers.

If you don't already have a collection of Tupperware, sets can be purchased at a low cost at a dollar store or big box retailer. To add even more fun and flair to this activity, seek out brightly-colored pieces in different shapes.

As an alternative, try stackable measuring cups instead.

7. A Shoeshine Box

Shining shoes may seem like a lost art, but shoeshine boxes can be conveniently purchased for just a few dollars, or perhaps even found lurking in the back of your own bedroom closet. A person with dementia may well find significant fulfillment in polishing and buffing their own shoes. This task can also help people feel more independent and derive a greater feeling of meaning. In some cases, shining shoes and similar care-and-upkeep tasks can also bring back familiar memories and feelings.

A few warnings to keep in mind: Some shoe polishes contain toxic ingredients, while dark colors can be messy. Look for clear colors formulated with non-toxic ingredients to keep seniors safe while minimizing cleanup.

8. A Pocketbook

Pocketbooks can be literal treasure troves for people with dementia. From diverse textures to zippers, snaps and other forms of closure, they offer a time-consuming form of entertainment -- particularly when stocked with interesting items to explore, such as jewelry, keys (for non exit-seekers), books and photos. This activity can also be individualized by caregivers. Take time to consider what types of belongings your own aging loved one would enjoy discovering in a handbag.

Like shoeshine boxes, purses can elicit strong memories in users. However, it's also important to remember that handbags and pocketbooks can bring to mind thoughts of departures. Avoid putting the pocketbook over your shoulder to make sure you don't trigger thoughts of leaving.

9. A Toolbox

People will find plenty to examine in toolboxes, as well as comfortable familiarity. While handing over a toolbox containing hammers and other potentially dangerous tools is ill-advised, toolboxes also contain plenty of safe, intriguing items – from screws and paint swatch cards to paint brushes and tape measures – for seniors to hold, feel and manipulate.

If you think toolboxes are only for men, think again. Women also enjoy the experience of playing with the contents of a toolbox.

For detailed activities, download the ebook Activities for Dementia Patients.

Audiobooks

From visual impairment to arthritis, a number of different health conditions can impede the ease of just picking up a book, which most people take for granted. Unfortunately, this not only interferes with the continuation of a lifelong interest, but occurs at a vulnerable time in life when many seniors could use an escape.

For a former avid reader, audiobooks can improve the quality of life by putting reading back within reach. They can be an invaluable resource for older adults looking for comfort or a sense of connection with the world around them. Getting lost in a good book can be a distraction from pain, boredom, loneliness and many of the other issues faced by seniors today. Audiobooks also can offer a way to experience familiar stories that ignited passion and curiosity in their youth.

Reading, AKA bibliotherapy, has even been linked with alleviating depression! It can also be a form of cognitive stimulation and a delightful way to "see the world" when other options may no longer be possible. And it can be as simple as pressing a button.

Getting Started with Audiobooks

Audiobooks can be played on MP3 players or a number of other listening devices, such as a cell phone or tablet. Retired cell phones with built-in wi-fi connectivity can be used to download content over the internet connection – without the ability to make calls. This makes a wonderful new use for older phones that have been replaced with newer models.

Audible is a popular source of audiobooks, boasting more than 180,000 audio titles across a comprehensive range of genres, from classics and comedies to biographies and business. This is a great choice for avid readers willing and able to pay the monthly fee for unlimited access. Other subscription-based audiobook services include Downpour and Scribd.

Seniors on limited budgets can also get in on the audiobook action thanks to sites like OverDrive and Hoopla Digital, which partner with libraries to allow people to remotely check out audiobooks and ebooks. While selection is limited, depending on demand at your local supported library, the cost is free to people with library cards.

If your aging loved one is blind or physically impaired, the National Library Service for the Blind and Physically Handicapped (NLS) offers a free program consisting of braille and audio materials that are circulated to eligible borrowers by postage-free mail through a national network of cooperating libraries. Peruse the NLS database to find a participating library near you, then request an application to sign up for this service.

One thing to keep in mind: While seniors are indeed capable of adapting to modern technology, they can be easily overwhelmed or intimidated when first introduced. This is especially true for seniors suffering from dementia. Caregivers who are patient and offer support during this learning phase can facilitate the process.

Caregivers, too, can also benefit from taking a vacation via audiobook whether you set aside time every day to relax with a favorite novel or you listen while going about your daily caregiving responsibilities.

PART 6. Mobility Issues with Seniors

A How-To for Caregivers

Decreased mobility is one of the many challenges of progressing in age. Decreases in mobility can also create issues for the caregiver.

As previously discussed in depth, the desire to age in place is common among older adults today. Essential to helping them achieve this goal is the ability to attend to the “activities of daily living,” otherwise known as the “ADLs.”  Here’s a closer look at why the ADLs matter, along with the role that adaptive equipment can play in supporting mobility and independence in seniors.

About the ADLs and IADLs

ADLs are activities that are considered fundamental to self-care. Seniors who maintain their ADLs have a higher level of independence. Consequently, declines in these functions are predictive of poor outcomes in hospitalization, illness and higher mortality. The desired self-care functions are:

  • Dress
  • Feed
  • Ambulate
  • Toilet
  • Hygiene 

An older adult who only needs help with bathing may require assistance every few days, whereas someone who has difficulty transferring might require full-time help. The loss of independence in the performance of an ADL may be a sign of a chronic illness such as dementia, depression or heart failure. The loss of continence is a predictor for placement in long-term care facilities.

In addition to the basic ADLs covered above, there is also a secondary level comprising the Instrumental Activities of Daily Living (IADLs). These include more advanced functions that are still necessary for self-care, including:

  • Preparing Meals
  • Shopping
  • Housekeeping
  • Using the Telephone
  • Transporting Themselves
  • Medication Management
  • Managing Their Own Finances

As these are mostly essential survival functions, inability to perform IADLs only adds to the help a senior may require. In the event caregiver supports are not adequate and the patient becomes at risk, a change in living situation may ultimately be needed.

While these activities may seem simple to the young, strong and healthy, they can become increasingly difficult for older adults. In both cases, identifying changes in an individual’s ability to attend to the ADLs and IADLs can help determine areas for intervention.

Mobility Maintenance Tips

One of the best ways for seniors to maintain mobility in order to support their ADLs and IADLs is functional fitness training. This trains muscles to work together, preparing them for daily tasks by simulating common movements one might do at home, work or in sports. While using various muscles in the upper and lower body at the same time, functional fitness exercises also emphasize core stability.

Functional fitness training has benefits for people of all ages, but it may be especially beneficial for older adults as part of a comprehensive program to improve balance, agility and muscle strength, and reduce the risk of falls.

Adaptive Equipment

A number of tools exist aimed at helping older adults manage mobility challenges that might otherwise compromise their ability to continue to live independently. These include:

  • Dressing Sticks
  • Reachers/Grabbers
  • Long Handle Shoe Horns
  • Button Hooks
  • Sock Aids
  • Long Handle Sponges

While there is a learning curve involved with integrating adaptive equipment into daily life, the payoffs are profound in terms of boosting both independence and confidence in older adults.

Transferring a Person from a Wheelchair to a Car

Ever picked up someone from a hospital or a nursing facility only to have an aide easily glide the wheelchair over to the car door and effortlessly transfer the person into the car? It seems rather easy until you get to your destination and try to do the very same thing. Now how did they do it? Not knowing how to accomplish what appeared to be easily achieved moments earlier just adds to the stress and anxiety of a family caregiver.

Watch these step-by-step videos to learn the ins and outs of wheelchair transfers:

Changing Sheets of an Occupied Bed

While difficulties are often presented in terms of a caregiver’s emotional challenges, there are plenty of physical challenges too. One task many caregivers struggle with is changing the sheets on an occupied bed.

These are the nine steps involved in changing a bed while a patient is still in it:

1. Find a Partner, If Possible

While it's possible to change an occupied bed on your own, the task is significantly easier when done by two people.

2. Wash Your Hands and Wear Gloves

For your safety and the safety of the patient, thoroughly wash your hands before beginning the process of changing the bed linens. Gloves add a second level of protection.

3. Explain the Process

The act of changing an occupied bed can be awkward for both the caregiver and the bedridden individual. In order to mitigate discomfort, take time to explain your intentions.

4. Secure Your Loved One

Gently help your loved one roll onto his/her side in order to ensure that he/she doesn't roll off the bed. (If he/she can help in this process and/or hold onto the bed rail, the job will be both quicker and easier.)

5. Prepare the Sheets

Beginning at the opposite side of the bed, remove the tucked-in side of the sheet and roll it in the direction of the person lying down. Next, take a clean sheet and roll it toward them while he/she remains in the side-lying position. Then, help them roll onto his/her other side toward the clean sheet.

6. Swap Out the Soiled Sheet for the Clean Sheet

With the person remaining on his/her side, remove the old sheet while pulling in the new one. (Four hands make this task much more manageable than two.) Pull the sheet taut to ensure that it's free of wrinkles, then secure by tucking in the edges using hospital corners.

7. Change the Pillowcase

Gently slide the pillow from the bed using your hand to help lower the person's head to the mattress. Remove the cover and replace with a clean pillowcase. Taking the same care, return the pillow underneath the person’s head or back.

8. Check in

Confirm with your loved one that he/she is comfortable before covering him/her with a clean flat sheet and blanket.

9. Remove Gloves and Wash Your Hands

Remove and dispose of your gloves, then repeat the handwashing process.

This is not an easy job, but it's a necessary one – both in terms of promoting your loved one’s comfort as well as promoting infection control. Watch the process in the video below.

By following these steps every time you change the sheets, you're not only promoting good hygiene, you’re helping improve the quality of life of a bedridden person. Thankfully, the more you perform this task, the easier it becomes.

Senior Hygiene & Personal Care

Helping seniors with personal care can be an emotionally and physically challenging task for caregivers. However, there are some ways to lighten the load.

Here are five invaluable tips designed to help caregivers manage personal care and hygiene tasks while best supporting the dignity, independence and overall quality of life of aging loved ones:

1. Create a Comfortable Environment

While the task of helping a loved one bathe, dress or use the bathroom can be heartbreaking for caregivers, it can be equally stressful for those receiving the care. Creating as peaceful an environment as possible can help alleviate embarrassment and promote feelings of calm and well-being. Gentle lighting and tranquil music can simultaneously soothe and distract.

2. Follow Their Lead and Needs

Many older adults become set in their ways. While you may have particular bathing habits and/or a preferred schedule, acknowledging the needs and preferences of your aging loved one can help make the task more agreeable. For example, seniors who are not physically active may require full bathing just a few times a week and sponge-bathing on other days. Or perhaps your aging loved one prefers to shower at night as opposed to in the morning. Agreeing upon a schedule in advance can help you best fulfill his/her individual needs while simultaneously supporting a feeling of control.

3. Support Their Independence

Helping older adults remain involved in self-care for as long as they are able is vital to facilitating ongoing independence. Various types of adaptive equipment can make bathing and grooming-related tasks easier for aging hands.

Additionally, safety equipment such as non-slip adhesives on the floor, grab bars in the tub and by the toilet can help seniors get in and out of the bathroom with minimal assistance and increase peace of mind for you both. If you're not sure about independence-supporting modifications in the home, a consultation with an occupational therapist (OT) can offer invaluable insights.

4. Minimize Discomfort

While some degree of anxiety is natural when helping others with personal care and hygiene tasks, it is possible to reduce awkwardness by planning ahead.

Something as simple as ensuring that the room and water are at the proper temperatures can reduce apprehension, while having a warm towel available and ready following a shower or bath goes a long way toward honoring modesty.

Casual conversation about unrelated topics, meanwhile, is another way to defuse tension. Remember: Your aging loved one is attuned to your body language and emotions. The more comfortable you appear to be throughout these tasks, the more comfortable they will be, as well.

5. Use Your Resources

While caregiving can sometimes feel extremely isolating, the truth is that you're far from alone. In fact, millions of caregivers all over the country are experiencing the same challenges that you are. Joining a support group or online forum not only offers invaluable fellowship, but can also yield helpful suggestions from others facing the same struggles.

If these tasks do become insurmountable, consider hiring a private-duty caregiver for assistance.

One last thing to keep in mind: The more you learn about best practices and coping techniques for hygiene, personal care and other caregiving tasks, including everything from how to transfer someone from a wheelchair to a toilet seat to perineal care tips, the more prepared you'll be to face these tasks with knowledge, confidence and strength.

Assisting with Perineal Care

While peri-care can initially be intimidating, it is a very important part of the private caregiver/patient relationship. Here’s a closer look at the importance of perineal care, as well as how to perform this critical duty to ensure the ongoing health of your loved one.

Why Peri-Care Is Important

Peri-care – also known as perineal care – involves cleaning the private areas of a patient. Because this area is prone to infection, it must be cleaned at least daily, and more if your loved one suffers from incontinence. Typical times to perform peri-care include as part of daily bathing, after the use of the bedpan, and following episodes of incontinence.

Regular peri-care can not only minimize odors, it can also help prevent urinary tract, bladder and kidney infections.

Thoroughly wash your hands and don gloves before beginning any peri-care regimen.

When your hands are clean and you're ready to start, ask your patient to separate his/her legs. If patients are unable, caregivers will need to offer gentle help. Keep your loved one's body covered to prevent unnecessary exposure and help promote a sense of dignity.

One of the most important aspects of peri-care is checking for signs of infection. These include swelling, lesions, rashes, sores and boils. These symptoms can lead to serious conditions if not recognized and treated. If you do notice these warning signs, contact your loved one's health care provider.

Moving from front to back, use warm water and a clean washcloth (or disposable wipes) to clean the perineal area. For females, this involves cleaning the inner legs, labia and groin area, while for men it requires cleaning the tip and shaft of the penis, along with the scrotum. Both men and women require cleaning of the anal area, which will involve turning the patient on his/her side.

If possible, use a fresh wipe for each "swipe." If using a washcloth, use a clean area of the cloth for each motion, and never move from back to front as this can spread germs and cause urinary tract infection. Have several washcloths handy just in case you need more than one.

If your loved one has a foley catheter, wipe around and down the tubing, but avoid tugging on the foley as this can be painful and harmful.

When you are finished and the entire perineal area is clean, make sure to thoroughly dry each area as excess moisture can lead to chapping and bed sores. Moisturizers and creams can help protect this delicate area. Always be gentle, as this area of the body is sensitive.

Occasionally bed linens will become soiled during perineal care. If so, remove them and launder them along with the washcloth. A waterproof pad placed under the buttocks, meanwhile, can be a moisture barrier between your loved one and the bed linens.

Remember: the more comfortable you feel with this task, the more comfortable your loved one will feel. Conversely, if you treat peri-care awkwardly or with disdain, your loved one's discomfort will be amplified. Maintain a pleasant demeanor, and be sure to explain what you're doing every step of the way.

More Resources To Help You

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