Monday, 22 April 2013

Can I help you? – How to assist older people to do more, with less help

For many years I worked as a physiotherapist in nursing homes, mainly with patients in their 80s and 90s. Over time I became obsessed with making my patients move more and become more independent. For example, if the main difficulty of one of my patients was to stand up from a chair on his own, then the treatment was focused on strengthening the necessary muscles, learning the correct technique and practicing a lot until the person was capable of doing it with the least help possible.

Of course, many people asked me “ isn't it easier to help the older person get up from the chair?”, and I always answered: NO! I’m not saying this because I’m a bad person, but because, while it may look easier in the short term, this would only make things worse in the long term. Think about it: the more help I give, the less opportunity the person has to complete the activity on his/her own. The less the person practices, the quicker he/she loses the ability to complete that activity independently, requiring increasingly more help, and so on.

I believe that often we are the ones to blame for older people losing the ability to complete certain daily activities independently. I don’t think we do this because we are bad people, don’t get me wrong. I think we do this because since childhood we were taught it is polite to help older people. Of course there is no problem with being polite or helpful. The big problem here is that, in most cases, to help means to do something for the older person. Nobody taught us that when doing this we may be taking away their opportunity to do it themselves, what, over time, might mean them losing the ability to do that activity altogether.

So the question is: how can we help older people to complete their daily activities as independently as possible? My first tip is, before assuming that the person is incapable of doing something on their own, just OBSERVE. Pay attention to what aspects of the task are more difficult. Chances are that they are able to do a good part of it alone, needing help only in certain moments. Or maybe the person only needs clear verbal instructions. Many of my patients are capable of standing up on their own if I remind them step by step what to do. Also observe if it is possible to modify the task in any way to make it achievable. Often, simply changing the type of chair may enable an older person to get up independently or with minimal help.

My second tip is BE PATIENT. Older people may take longer than what you judge acceptable to complete a task, but that doesn't mean they can’t complete the task. Don’t let your impatience or anxiety dictate what the person can or can’t do. After all, your impatience is your problem, not theirs! Allow the older person to take their time, giving verbal instructions only when necessary and in a gentle manner. There is nothing more off-putting than someone constantly telling you what to do, especially if this is done with an impatient tone of voice.

My last tip is REPETITION. We all know that practice leads to perfection. This is no different with older people. Encourage the person to repeat the task daily. Praise them when they manage to complete it on their own. Recognize their effort and encourage them not to give up.

I’m not saying that following these tips is easy, but I can assure you that by doing this, in the long term, you are being truly helpful to the older person.

Brenda Reginatto

Friday, 5 April 2013

The next 21st C sequester: gentrified ghettos for geriatric newbies

I just came across this article tweeted by Aging 2.0 Katy Thomas Fike. Here's what I think.

I know there are a lot of CA retirees in their 80's living in these kind of places right now. For people with means, they are selling the family homes and snapping up progressive care villas. My now 87 year old neighbor moved into one when his wife died after 10 years of decline. Sold the family home and is now in a fully equipped apartment with total freedom, built in companionship, exercise facilities, fabulous dining etc. In fact it was so nice, that when I visited him recently, I told him I would have moved in, in a heartbeat.....except it is a silo for old people. A virtual ghetto. Yes, people come to visit and yes, as one partner fails, they get moved into the next level of care while the other partner continues to live fully functionally, for as long as possible. But the critical difference for the still functioning partner, from my observations, is something quite rare. They have total peace of mind and  have already made their decision. This is where they will finish their lives, in comfort, with medical care on tap and with dignity. So far so good.

My problem with these elite, fantasy islands is that it is an isolationist model. It's an extension of the out of sight, out of mind denial of ageing construct so popular with the still young. Let's put the old people somewhere we don't have to see them or interact with them! And look what we have to look forward to, here comes another totally detached generation, with  no experience of being with older people and no intergenerational connections being fostered.

I still saw its appeal and it is hard not to like this very pristine, while other worldly existence. Surreal in its perfection, particularly when the close to flawless California weather gets thrown into the mix. Part of the reason for that is that these retirees are empty nesters and their kids are gone. Some of those kids have had to move out because they can't afford to live in California anymore. Many others are working every hour God gives them in order to be able to afford to live there! They don't have time or interest in dealing with their parents in their gilded cages. They are quite obviously being very well taken care of and benign neglect is convenient and not guilt inducing.

I looked at the profile of the 81 year old retired head of Proctor and Gamble and his wife and wasn't sure how to feel. Both appear to still be quite hale and hearty, living in the lap of luxury along with other well heeled, like minded retirees. This is the model first established by these people's parents, when Florida was the preferred retirement destination for all the older residents of the northeast US, who could afford to be snow birds. Baby boomers appear to be replicating that model in Colorado at the moment.

As usual, it really does come down to money and whether you have saved enough. Not likely.  The predictions for most of the baby boomers is that they will not have and they won't be moving in to one of these swanky cocoons. Even if they do, they still could outlive their money. The model works currently because it is not yet at capacity and these are the people who downsized and managed to get out of the money markets, relatively sound. Regardless, advocating the ghettoizing of old people does seem the wrong way to go. Particularly as their numbers grow and we benignly agree to full participation in the new sequester, squandering the sum total of such accumulated talents, experiences and wisdom.

Deborah Gale