The eldercare thread

[Laura Ingalls]

I stated in my journal that my mom is having cognitive decline and the topic could use its own thread. I know that I am not the only person on this board in the elder care phase.

I just got done with trying to help my mom order some flowers for a friend’s funeral. She attempted online then asked for my help. I thought we got it and she had more troubles. She called the florist directly and still struggled. I helped again, she called back and finally succeeded.

[The Old Man]

My mother is also experiencing cognitive decline. Until recently I was helping her. She cannot live alone. My sister has now taken over.

What specifically are you trying to address?

[Laura Ingalls]

Mostly how to balance the elder’s need for support with the need for self-determination.

Also a safe place to vent.

[jacob]

She attempted online then asked for my help.

Mostly how to balance the elder’s need for support with the need for self-determination.

Also a safe place to vent.

Okay, I'll vent.

I'm wondering whether we, the non-old, too often let the elderly get away with age-based excuses that really has more to do with their lack of effort or interest. For example, if I had a dollar for every time I've heard a given senior talk about "how that computer stuff just come naturally to young people", it could have paid for at least one IT-course at the senior center. Ditto "not being able to do this or that activity because they're old" and not because they haven't picked up a dumbbell for the past 30 years. Some old people learn just fine---but some simply don't care to learn and at some point they realize they can just ask others to pick up after them.

Maybe I should flip it around and ask an elder person if they could come over because I got 5 pounds of potatoes to peel and "potato peelers just come naturally to older generations".

People have a right to self-determination, but insofar they self-determine to avoid taking responsibility for keeping up with the times, they don't have a right to have others to pick up the slack just because they're a certain age.

[J_]

I, ll vent too. @ Jacob speaks about using or losing one‘s strength, I have, by lots of study time and practicing gained knowledge about growing healthy old.
I do really think that each of us can avoid most sicknesses and illnesses by eating and drinking only healthy food and beverages.

So how difficult and “not done” as it is nowadays we can still say to our elderly: learn and change accordingly to become or stay not an ailing person.

[Laura Ingalls]

@Jacob it see the excuse part of it too. In her case this would have been very manageable six months ago. She was frustrated and trying.

OTOH my IL’s run a business (farm). My MIL does the books without any computer. It’s obnoxious how she calls places like the grain elevator asking for paper copies of things. Usually stuff she is required to submit to the USDA for crop insurance.

The rest of the world uses a fillable online form and dumps the information from spreadsheets that they use to figure out yield and input costs from. I would be embarrassed to look that ignorant. She seems too ignorantly to know that she looks so tech un-savvy and basically unprofessional as a result.

[zbigi]

I do really think that each of us can avoid most sicknesses and illnesses by eating and drinking only healthy food and beverages.

Do you perhaps know any studies which confirm that?

[Henry]

People need to realize that elderly people are dangerous. They should come with warning labels. They can't think, they can't drive, they can't be trusted yet they trust each other, they can't see beyond the next five minutes, they believe the last thing they heard which they forget the moment they hear the last thing they heard, they are selfish beyond belief and most significantly, they use toaster ovens. I have observed that very few excercise and very few continue to learn. If you are foolish enough to enter their world, you will both lose yourself and never be seen again.

[The Old Man]

I'm wondering whether we, the non-old, too often let the elderly get away with age-based excuses that really has more to do with their lack of effort or interest.

Remember, this thread is not about the generic old, but those experiencing cognitive decline.

My mother cannot operate the phone. Too many buttons and not like the rotary phones of old where you just pick it up to answer. Sure, you could explain and show her, but she won't remember.

For finances we asked for an intervention from her financial advisor. He personally came over to the house and strongly suggested she hand over power of attorney to her daughter. I am no fan of financial advisors, but there are times where they are worth their weight in gold. Financial management is one of the first skills lost when a person is experiencing cognitive decline.

[jacob]

Remember, this thread is not about the generic old, but those experiencing cognitive decline.

How do you tell the difference between "can't" and "won't"? It's my understanding that cognitive decline can be postponed for a long time by learning and maintaining systems and habits. It is harder to tell whether a professor is getting demented than a bricklayer because the professor is developing workarounds, like always putting the keys in the same place instead of relying on remembering where they put the keys down last.

For example, learning how a cell phone works and using it regularly so that when cognitive decline sets in, one is already familiar with how it works. Whereas, there is a strong tendency for many to build up "infrastructure debt" and then expect that various helpful family members will keep maintaining or cleaning things up. In other words, I think a competent computer user will suffer less from cognitive decline than someone who never really bothered to sit down in front of a computer.

What I see in many old people is simply an indirect refusal to keep up (and using their age as an excuse... senior privilege?). Instead, they find workarounds to maintain "how they did it in the old days", like @LI's example with calling for a paper printout. These workarounds tend to get more and more bizarre, the more outdated the solutions the person insists on. Someone who insisted on handwritten snail mail will some day find their ability to communicate taken away (as the local post office closes down since nobody else uses it) if they never bothered to learn how email works.

My takeaway (personal planning) is basically to keep evolving my "ingrained habits" (not getting stuck with habits from 50 years ago that nobody else uses) so I can fall back on those when/if my active processing capacity begins to fade away.

[Laura Ingalls]

Yesterday my mom reconciled her checkbook. She had eight checks and no ATM withdrawals and spent like $2k. It took her awhile but I have confidence that she is still up to this task.

She is definitely in the go slow phase of retirement. My father died of cancer. He was inactive some of the days he felt crappy from treatments but never was this inactive until his final few weeks.

[J_]

Do you perhaps know any studies which confirm that?

See: forkoverknives.com
Read: “How not to die”, or “How not to Age”, by dr M Greger, “China study” by T.C. Campbell, “Eat to live” by J Fuhrman and “Your body in balance” by N.D. Barnard.
And google for “The intensity and effects of strength training in the eldery”
Last broad study mentioned a comparison about training by women of 29 and over 60. Same results in muscle development for both.

[IlliniDave]

Anyone who peeks into my journal knows much of the last three years of my life has been intertwined with my dad's situation. He'll turn 85 in 9 days and has been having memory issues for quite some time.

The balance between stepping in and being our parent's parent and letting them have an amount of dignity as adults has been one of the tougher rows I've had to hoe. Sort of the mirror image of the last few years of a teenager moving towards independence. You want them to thrive and live a good life of their choosing, but they can still be a danger to themselves and sometimes others. Something I've recently struggled with is nutrition. I've invested a lot of thought and research into my own nutrition, but for a while when the elder of my younger sister's had her own health concerns I was in charge of all the grocery shopping (he basically can't shop for himself). Most of what he enjoys eating on a daily basis are things that a) I wouldn't eat myself and b) as a general class they are actually linked to Alzheimer's, Parkinson's, etc., so likely contributing to an acceleration of his decline. There are a lot of no-win situations a caregiver has to negotiate.

One thing that we've done that's been immensely helpful is to hire a part-time in-home healthcare person. Luckily, in our case Dad can afford it. Aside from relieving some of the day-to-day workload from my sister and myself, it removes some of the preexisting parent-child dymanics when trying to convince him to do things he doesn't want to do (like medical/dental appointments, small chores around the house he can still do for himself). If that's an option I'd recommend looking into it. Otherwise, aside from having great sympathy and empathy, I can't offer much. It's hard. Do remember the oxygen mask principle--you won't be able to help as well if you let yourself get run down trying to be everything for everyone.

There is something to what jacob said above. My dad will occasionally sandbag a little hoping to get someone to do something he should be doing (part of our strategy is to keep him doing as much for himself as he can for as long as he can). I don't think he means to be exploitative, he just reverts back to habits while my mom was still alive and they had a five-decade division of chores they'd settled on, and hoping that if he played dumb someone would step in and play Mom.

That said, he's not just pretending to have cognitive decline. It's real, unless he's playing some form of 5-D chess and is excessively more strategic and intelligent than I ever gave him credit for. To his credit, he's 85, lives on his own in the same house, and he (and we) employ many workarounds (always putting his keys and wallet in the same place is one of them). But when you watch him try to change channels on the TV with the cordless phone, multiple times the same morning, you know something is up. He hasn't tried dialing the TV remote yet, though.

[IlliniDave]

Do you perhaps know any studies which confirm that?

There are numerous epidemiological studies that link lifestyle and nutrition to the "metabolic cluster" (aka the diseases of aging) of type II diabetes, arterial disease, coronary disease, liver disease, stroke, hypertension, and cancer. Just get on Youtube and search something like "nutrition for healthy aging". Also look into longevity (the key to longevity is holding off the diseases of aging).

One name that comes to mind is Mark Hyman, and also a father-son pair of doctors named Perlmutter (sp?) who are more focused on neurology and cognition. There are probably many other names I should be remembering as well. They've all written books that probably have many references if you're more interested in reading research papers.

I'll link a podcast I'm partway through featuring Dr Casey Means (one of those names I couldn't recall a moment ago). She recently had a book published that I have in my cue. I'm not familiar with her entire body of work, but the book was inspired by her mother's story who had the best of Medicine 2.0 care, yet the forest may have been missed for the trees.

https://www.youtube.com/watch?v=t2OeZcxVVI4&t=1s

[Hristo Botev]

Okay, I'll vent.

I'm wondering whether we, the non-old, too often let the elderly get away with age-based excuses that really has more to do with their lack of effort or interest.

Dang; hot take, @Jacob.

Circle of life, I guess, exacerbated perhaps by the rapid rate of technology change--not necessarily rapid technology improvements, more so just the way we interact with the world as mediated by technology changing so rapidly now as compared to say the late 20th century. I'm in my 40s and I sometimes struggle to keep up (probably not helped by the fact that I'm a technology-hating Luddite at heart). The tools seem to own us these days.

Anyone that has kept up with my journal knows we've been dealing with the cognitive decline issues with my stepmom, who is now (finally) in an assisted living facility, which was needed because (a) she was WAY too much for my dad (81 yo) to manage, even with my limited assistance with things like picking her up off the ground when she fell off the toilet, etc.; and (b) her son is a barely functioning adult himself. I always got the sense that she was kind of just giving up, and was using self-diagnosed dementia as an excuse to not have to do anything for herself or interact with anyone other than my dad. But, if she were my mom as opposed to my stepmom, I'd probably feel differently about the situation. As it is I just had some animosities towards her because she was preventing my father from forming stronger bonds with me and my kids in his old age.

That said, I definitely feel the squeeze I'd kept hearing about when middle age functioning members of society have both kids in the house to take care of and aging parents down the street who also need help. Most of my hobbies are gone, as are my career ambitions; my life at this point is as breadwinner and caretaker, and that's fine--there's a lot of happiness and joy in that; it's nice to have a purpose and to have people who rely on you. And not just because of some universal reciprocal tradeoff where I know I will need to rely on someone else at some point.

[The Old Man]

It's my understanding that cognitive decline can be postponed for a long time by learning and maintaining systems and habits.

This is a coping mechanism, not a means to delay cognitive decline.

There is some evidence to suggest that keeping your brain active delays the onset and progression of dementia. It seems the nervous system can be likened to a muscle. Exercise it and it will repair at least some of the damage. Don't exercise it and the body won't miss it and thus will not repair the damage.

[Laura Ingalls]

@IDave
I have wondered if a home health aide is an option for my mom?
She has a weekly schedule of yoga (2x), quilting group (2x), Bible study, and grocery store.

Honestly, if someone could drive her to these things, help her get the groceries in and out of the car, organize her medications, and either make lunch for/with her or go out for lunch with her it would go a long way. 20 hours per week all weekdays.

Right now our youngest son lives with her and my brother that lives nearby is laid off. DS traveling with his brother and two cousins next week. My brother starts a new job on Monday.

[IlliniDave]

@IDave
I have wondered if a home health aide is an option for my mom?

The devil is in the details but I would think in theory an IHHC service would potentially be a very good option--at least worth investigating.

I think in general the types of services available from an IHHC provider for an elderly person would depend on the specific provider, but nothing you mentioned seems like it would be outside reasonable expectations.

In our case, my dad still has a driver's license (passed the test last summer), but generally does not drive himself places.For most errands like running to the pharmacy or appointments or occasional shopping she'll have him drive and accompany him. If it's a slow week she'll make up a reason or two to go out for some reason. The reason is mostly get him out of the house and interacting with the world, but also to keep an eye on his driving. The woman we have has specialized in eldercare and has had many "memory" patients, so we're counting on her expertise to help us decide when to take the keys away from him. Prior to that it got to the point I was driving him anywhere he needed to go, or occasionally my sister would. It sounds awful to say but for both of us it was just much easier to just go ahead and drive him rather than try to guide him from the passenger seat and tweak the now reversing parent child dynamic. For most of his regular day-to-day shopping like groceries my sister just orders stuff online and has it delivered. She does it while doing her own orders (she is quite frail due to rollercoaster health issues). But for small things that come up she'll accompany him to/into the store.

Other things she does are laundry (Dad has to, or is at least more comfortable, descending stairs backward so none of us think it's a good idea for him to be carrying things up and down stairs and the laundry is in the basement), housekeeping, keeps his pill caddie filled and honchos prescription refills and the like. She also does some amount of cooking and prepares/plates suppers for him (that's really not necessary, Dad can still cook his meals, long story behind it). She also is trying to keep him interested in gardening. From talking to her, and discussing the future trajectory with my dad, she's had clients she assisted with bathing, administering intravenous meds, and end of life care.

She's an independent provider (we found her through family connections) and a CNA, which is good. Now that she and Dad have bonded we anticipate being able to keep her for as long as IHHC is a viable option for him. Right now she comes for 10 hrs/week, which is basically all the open time she has, but we have plans to increase it. Inherent to eldercare is a relatively high turnover of clients, and we had to make things work with her schedule. A provider that's more a business might be better positioned to cover fixed schedule needs on her part, with the regret possibly being that it could be different people on different days.

There may be ride/transportation services in the area that specialize in providing rides to people who can't drive due to medical conditions or age. That might be an option with her activity schedule if an IHHC provider can't accommodate her schedule completely. My understanding is that with the right diagnosis Medicare+supplements will cover some of the cost of IHHC. Initially we didn't have such a diagnosis so we didn't pursue that.

Every little bit of help helps since it's grind that plays out over years instead of days or weeks. Even if you can't find a single solution to cover everything, if you can reduce the load on family members by 50%, or some decent fraction, it could make a large difference.

[J_]

On 13 June 2024 wrote @Jacob in this thread

„I'm wondering whether we, the non-old, too often let the elderly get away with age-based excuses that really has more to do with their lack of effort or interest”.

Let’s say, as a long participant in this forum, I belong too to the „non-old”.

Age-based excuses are so often wrong.

We, the non-old, have to take care about ourselves to not fall in the same trap as many elderly do. It does not take a long time before you are an „elderly” yourself.

Older people believe these traps are unavoidable: As you become an older person you get sick, your movements go with pain, your mental capacities dwindle, your body shrinks in length, your becomes heavier, you will get one of those many cancers nowadays, you have to replace a knee, a hip. You get skin problems etc , etc. You believe in medical treatments. Treatments which in most cases does not heal the underlying causes.. Causes which are fueled by wrong eating and lifestyle habits which are not altered after the „treatment”…

The knowledge about nutrition and good health is now available for those who are really interested in growing old with a healthy body and mind. But it needs effort, it needs study and filtering through the vast amount of biased texts and vast amounts of misleading (even government) media-outings. It needs trial and effort by changing wrong patterns in your life. It needs time to get used to new tastes, new textures, new cooking habits, new shopping manners.

Really just like stopping being a wage-slave and internalizes how to become a more „free-to” renaissance person.

[Laura Ingalls]

@IDave
Thanks for the detailed response.

She live is a transport desert. Functionally no ride share or bus service. Technically dial a ride but they only pick up. She has been dizzy and advised not to drive. She does drive but no one really wants that.