Dear friends,
A couple of months ago, I wrote about a talk given by Laurie Adamshick on planning for that time in our life where we frankly will need more help to do all kinds of things. That newsletter elicited many responses, including the one below from my friend Dr. Steve Miller. I’ve known Steve for years and as always, his remarks are straightforward and insightful. My thanks to Steve!
TRANSITIONS AS WE AGE
Introduction
As we all age, we will go through declines in our senses and abilities. The following list of aging symptoms may help you and your family and caregivers to anticipate these changes by planning early to anticipate and prepare. Consider long term care insurance. The younger you sign up, the cheaper it is. Planning early will help you be as safe, comfortable, and worry-free as possible.
5 Essential senior documents:
- Healthcare directive
- Power of attorney for healthcare
- Power of attorney for finances
- Revocable trust
- Will
See: https://elderprotectioncenter.com/legal-documents-everyone-should-have/
Physical aids:
Mobility:
Tripping or falls — needs: survey home for hazards (clutter, rugs, wires, low contrast background)
Unsteady — needs: cane, walker, walker with seat, night lights for bathroom trips, traction slippers with heel support See: https://mydoctor.kaiserpermanente.org/ncal/Images/010526-037CL_tcm75-574622.pdf
Vision:
Unsure of street signs or where to step or seeing in low light.
See: ophthalmology exam for glaucoma or stroke or better glasses.
Low Vision Aids
See: https://www.macularsociety.org/support/daily-life/low-vision-aids/
Hearing:
Missing birds chirping, high-pitched voices?, saying huh? or what? too often, and change to silent or grumpy behavior — needs an ENT check of ears for wax, audiogram, and hearing aids.
- Hazardous driving
- Poor vision or squinting, especially at night
- Pedestrians or cars “appearing from nowhere”—needs check of side vision and driver training to recognize and spot hazards.
- Driving too slowly is a sign of lack of perception or confidence.
- More than 2 “fender-benders”, multiple “dings” on the car.
- Distracted by radio or conversations.
- Driver training for seniors is available as online courses on the internet, sometimes with an insurance discount. .
See: https://exchange.aaa.com/safety/senior-driver-safety-mobility/aaa-roadwise-driver/
When to stop driving:
- Getting lost, even when driving short, familiar routes
- Failing to obey traffic signs or signals
- Cutting off other drivers, straddling lanes, or making wide turns
- Reacting slowly to emergencies
- Falling asleep behind the wheel or appearing inattentive
- Becoming easily angered or agitated
- Using poor judgment, such as not yielding the right-of-way
- Forgetting to use mirrors or turn signals or check for blind spots
- Having trouble judging distances
See: https://www.healthinaging.org/tools-and-tips/tip-sheet-discussing-when-its-time-stop-driving
When to transition from independence to a caretaker or assisted living:
Before you start to lose abilities, plan far ahead for when you may need assisted living or nursing care. Visit various senior living arrangements and care homes. Check the length of waiting lists. You can look up their government ratings here: https://www.medicare.gov/care-compare/en/assets/resources/nursing-home/02174-nursing-home-other-long-term-services.pdf
Recognizing when it is time to transition to a different level of care involves several factors including each person’s unique situation and support system. These signs and struggles are usually precursors to person’s needing a higher level of care.
Physical signs:
- A decline in household mobility (difficulty with bathing, eating, walking, and transfers)
- Difficulty accomplishing daily activities (personal hygiene, medications, meal prep, light housekeeping)
- Increased difficulty walking to the mail, preparing meals, or relying on others for assistance
- Onset of medical conditions requiring specialized care
- Increased dependence on assistance with personal care
- Hygiene and living conditions deteriorate
Safety Concerns:
- Falls and fall-related injuries
- Cognitive decline
- Wandering
- Medical needs requiring specialized care
- Unable to safely manage and administer medications without assistance
Emotional or Psychological signs:
- Self-induced withdrawal or medical conditions causing social isolation
- Reduction or complete absence of participating in activities and events
- Symptoms of depression, anxiety, or confusion
- Difficulty adapting to change or managing stress
- You no longer enjoy activities you once used to
Practical signs:
- Challenges maintaining your household or financial obligations
- Struggling to manage your medications, medical appointments, and van reservations
- Becoming overwhelmed by your daily tasks and responsibilities
- Concerns about personal safety
- Caregiver becomes overwhelmed, stressed, experiencing burnout
End of Life Planning:
You should already have completed a healthcare directive or POLST (physician order for life saving treatment) specifying care which you do and do not want (breathing tube, feeding tube, pain relief). The POLST instructions, signed by your doctor, should be in a known place so that if there is an emergency the family, attendants, and physicians can see your wishes immediately.
You also should have powers of attorney for healthcare and for finances as well as a will and probably a revocable living trust stored where your caretaker and family can find them.
Even before a treatment course for a potentially fatal disease is finished, plan early for the end of life. Who will make arrangements for you if you cannot? What level and locations for 24 hour care do you want? Where is it best given? Who should give it? Do you want hospice services? What insurance will pay for it? What requirements must you meet?
Once death is inevitable or when in hospice care, narcotics and/or sedation may cause you to sleep most of the time. You may be reusable for a short talk. Families often feel that they should encourage eating and drinking to the point of tube feedings or IV hydration. But as the body shuts down we should take our cues from the patient’s preferences for their maximum comfort. In controlled studies, feeding tubes and IVs in patients dying from causes like cancer do not prolong life. They only cause disturbance. Offer, but do not force food and drink.
See: https://www.cancer.org/cancer/end-of-life-care/nearing-the-end-of-life/planning.html
