Dealing with Confusion

One of the biggest concerns of older people and their family members is that of losing memory and other mental capacities. Confusion and memory loss are not normal in aging. They usually have specific causes which can be identified. Confusion can take two major forms: delirium and dementia.

Delirium is a form of mental confusion that comes on suddenly and can go away just as suddenly. People with delirium may be disoriented about time and place, have disorganized thinking, and see or hear things that aren’t there. Causes of delirium include: changes in medication, infections, heart disease, sudden and unexpected changes in the person’s environment such as going into the hospital and poor nutrition. Usually, delirium will go away after the conditions that cause it are removed. So, if confusion comes on suddenly, look for some of these causes, then see a doctor to help remedy the problem.

While delirium starts quickly and can end as quickly, dementia comes on slowly and just gets worse with time. Dementia means: loss of intellectual abilities so that it interferes with social or work life, and memory loss possibly combined with poor judgment and changes in personality.

Dementia can be caused by small strokes, Alzheimer’s disease, or other disorders that affect the brain. If your family member exhibits slow changes in intellectual abilities or memory loss, perhaps combined with lapses in judgment or personality changes, you might check with their physician to see if the cause can be identified, and if anything can be done to slow or stop the process. Regardless of the cause, confusion is difficult to deal with. So what can be done?

First, recognize that the family member cannot control this behavior and has the right to be treated as an adult despite the confusion. The confusion may come and go, making it appear that the person has control, even when they may not. This can be extremely irritating to you, so try to remember that the person cannot control this behavior.

It helps to keep the person in touch with what is going on around the home and remain part of a daily routine. You can arrange the home to be safe: Take locks off inside doors so you can have quick access if a fall occurs; put safety latches on cabinets that contain potentially hazardous cleaning agents; remove knobs from the kitchen stove if the stove presents a danger; use child proof door knob covers where appropriate; and have identification on the person at all times a bracelet and names on clothing in case of wandering.

You can provide memory aids, such as large faced clocks and big calendars for easier reading; use a bulletin board to display a daily schedule, reminders of things to do, personal greetings; use the person’s name and your name frequently, such as “Good morning Stan, it’s Kate. It’s time to have breakfast in the kitchen.”; speak slowly and calmly, giving directions one step at a time.

It also helps to have a daily routine. You can involve the person in simple routine tasks like setting the table; have a list of daily activities available on a bulletin board; remind the person what’s going to happen next; and repeat basic information throughout the day. Introduce changes in routine very slowly to allow for adjustment.

All these strategies taken together can be helpful in reducing stress or tension in the home as you go about helping the confused person.

Are you in a caregiving situation?

The Caregiver’s Resource Audio E-book allows you to quickly and easily assess your needs as a caregiver for an aging family member or an elderly loved one. You’ll be able to process information and take steps to develop your plan of action. Some of us learn better by simply listening to information and others like to read for reinforcement. The Caregiver’s Resource Audio E-book combines these elements enabling you to do both!

Click here for a FREE PREVIEW!

Includes:

• Interactive content
• Over 2 hours of professionally recorded information
• Comprehensive answers to the most common concerns caring for an aging family member or loved one
• Self-help strategies to manage stress and burnout
• 160 pages of the Caregiver’s Resource Companion Guide including narration scripts, worksheets, assessments etc.
• Printable worksheets and assessments
• Internet links to targeted products, services
• Online resource directory to over 100 professional organizations
• Distributed instantly, allowing you to begin reading at once, without the need to visit a bookstore or await postal delivery

Safety in the Home

If an older person is living independently or has moved into your home, there are things that you can do to make the home safer and reduce the chance of accidents.

First, take a tour of your home and take notes for each room. Four major concerns you should attend to are lighting, floor covering, furniture and furnishings, and temperature.

Lighting

Good lighting can prevent accidents from occurring. Good lighting would include: lights at the front and back doors and all other house entrances. Light switches should be easily reached and easy to operate. (You may need to use extension devices or have an electrician lower the switch, if necessary). There should be light switches at the entrance to each room to prevent walking in the dark. You might consider motion activated lights instead of switches for hands-free operation. Install three way switches to provide better access and control of lighting especially in stairwells and corridors. Use automatic night lights in halls or bathrooms to keep these areas from being completely dark. For reading, be sure the bulbs are bright enough, and there are enough lamps for adequate lighting. And for emergencies, flashlights with fresh batteries should be kept in easily reachable spots around the house.

Floor Covering

The type of floor covering can contribute to falls a big problem for some older people. If your family member has a problem with walking, consider using low pile carpet and reducing padding to provide a more solid footing … and nail down the carpet if necessary. Get rid of scatter rugs which can slide under foot, and place non-slip treads on stairs both in and outdoors. Remove doorsills between rooms if they create an obstacle to wheelchairs or walkers or increase the possibility of tripping. Avoid highly waxed wood floors which are slippery. And, keep floors free of extension and electrical cords and other clutter that may be tripping hazards – especially in corridors and foyers.

Furniture and Furnishings

The right type of furniture in the right place can be a big help in providing for the safety and comfort of the older family member. You should make sure the furniture is arranged to allow room for walking, especially if a walking aid is used. And use furniture that won’t tip over in case the person needs to hold on to it. Eliminate chairs with wheels or remove them. Use chairs and beds that are high enough to get in and out of easily and that have arms and cushioned seats.

Temperature Control

Maintaining a comfortable temperature can help a person feel better and stay healthier. Ask the person what is comfortable for them. Don’t judge by your own feelings because older people have different tolerances for heat and cold than you do and may feel uncomfortable at temperatures that are comfortable to you. Provide air conditioning which can be vital to people with breathing problems. Avoid extreme heat which causes drowsiness and dryness of mouth and nose, and if necessary, use portable humidifiers to eliminate dryness in the air. Label the thermostat with larger lettering and numbers and use tape to show which direction the control needs to go to increase and decrease the temperature. You may need to put a light near the thermostat to make it easier to read.

There are two rooms that need special attention: the Bathroom and the Kitchen. Bathrooms can be very hazardous, but there are a number of things that can be done to make the bathroom safer. Use wall-to-wall low pile, rubber backed carpets that don’t interfere with walking aids such as walkers and canes. Use strong towel racks and shower curtain rods that won’t break down if used for support. Put in grab bars along the tub wall, on the side of tub and near the toilet. Use a rubber mat or other non-slip surfaces in the tub, and if needed, install a permanent seat. Install a hand-held showerhead to help the person control and direct water when bathing. Change the faucet on the sink to one that has separate hot and cold-water handles that are easy to turn. Lower the hot water temperature to avoid scalding 110 to 120 degrees is plenty hot. Elevate the toilet seat to make getting up easier and make sure the toilet paper is in easy reach.

The Kitchen also has many hazards and care should be taken to make it as safe as possible. You might want to keep the stove light on all day if the kitchen tends to be dark. The most often used supplies and equipment should be stored in easy to get to places. Keep this room brightly lighted but non-glaring. Use “D” shaped pull handles for drawers instead of hard-to-grasp knobs, and make sure cabinet doors and drawers open easily. Have microwave and toaster ovens available for convenience and give instructions about how to use them. You may need to post instructions nearby for quick reference. If practical, use wall racks to hang things in easy to use locations. Place rubber mats or racks in sinks to prevent breakage when less-steady hands drop things. Replace heavy pots and pans with lighter ones. And if you have smoke detectors which you should be sure they are not too near the cooking area where they might be set off by normal cooking activity. If they are triggered too often with normal activity, you may be tempted to disconnect them and defeat their purpose.

When you don’t have the time to go online.

Today, one (1) out of four (4) adults are coping with responsibilities of caring for an aging parent, disabled spouse or elderly loved one. Unprepared, their biggest challenge is finding local resources, support and services. Caregivers need solutions to meet immediate concerns or crisis involving their family member.

Even if one had the time to go online to search for local resources, you’ll experience information overload as you try to sort through pages listing names of eldercare providers who pay to advertise. How useful is this information when you have to make a critical and timely decision? Just like the Yellow Pages, one is likely to gravitate to the largest display advertiser without any credible knowledge about the quality of the service.

Like Angie’s List and JD Powers, the trend is for more customers to rely on these service organizations to screen for quality and customer satisfaction when making a buying decision. Similarly, the Caregiver’s Resource Helpline™ of Houston (866-608-6131) meets the demands of the consumer by providing user-friendly telephone access to elder care businesses and providers that have been screened for the highest level of customer satisfaction.

Taking the Car Keys Away

One of the most difficult things to do is to take the car keys away from an elderly family member. To facilitate this traumatic loss of independence, experience has offered the following tips:

1. If the person has been diagnosed with an illness or diagnosis that makes it unsafe to be driving, have the diagnosing doctor write an order on a prescription pad to the attention of the state’s department of public safety. The order should read, “It is unsafe for the patient to be driving because he or she is harmful to his or her self or can cause unintentional, but serious and sudden harm and injury to the public at large.” This accomplishes several things. The physician is a credible person who the majority of elderly people trust and depend on, and who comply with. Most elderly drivers will tell you that they are always able to focus and thus maintain control of their car. They may never have caused an accident before, so they say, so why would they have one now, just because of an illness! Why does the doctor use the word, “unintentional” in the order, and with a special emphasis on the phrase, “serious and sudden harm and injury to the public…”. Because, the patient doesn’t have control of the car regardless of any previous driving record or how good of a driver the patient has been in the past. The illness can have a sudden, unexpected affect on the patient’s ability to drive the car safely.

2. It is against the law and it is a violation of the law for a physician or any other professional, who knows that a patient may be unsafe to drive because of a known illness or diagnoses, yet does nothing to warn the public, family members, the patient, and the regulatory government agency of this possibility. The fact that the physician knew of the dangers of a patient driving, but withheld reporting the consequences to the family and the proper authorities is a violation of the law and the code of professional conduct.

3. Other possible and credible explanations could be offered along the same lines that can be used with or without a physician writing an order:

a. The elderly person or patient may also be subject to the auto insurance carrier who insures the patient to raise the premiums or no longer even insure the driver/patient due to the increased liability risk from the patient, especially if driving against doctor’s orders.
b. Liability issues from potential litigation arising out of an injury sustained by another party caused by the patient’s reckless endangerment while driving, regardless of insurance coverage. No one wants to open their check book and write a blank check, especially the WWII generation.
c. No one wants to drive in major metropolitan areas with continual traffic congestion and construction. It’s frustrating and not good for anyone’s health.

4. Tips: The patient’s family member should be present at a physician’s office visit to discuss the consequences of driving. The patient’s family member should call the physician before an office visit and ask that the physician bring this up with the elderly patient while the family member is present, and that the physician be doing much of the talking. The family member would then contact the local office of the state department of public safety to receive instructions on how to submit the physician’s order to permanently suspend or revoke the patient’s driver’s license. Most physicians won’t obligate themselves to take any further steps for fear of liability from their patient.

5. Some physicians while writing the order, won’t discuss the dangers of driving and will leave that up to the family member for fear of losing their patient, some of whom who’d consider receiving the physician’s order not to drive worse news than a diagnosis of 3 months to live. If this is the case, the family member can also solicit the participation of another of the patient’s trusted friend, professional adviser or clergy to help in explaining the dangers and the reason for the order. Again the family members can remove themselves from the emotional trauma of being the ones to pronounce a sentence of loss of independence that no elderly parent or spouse wants to hear!

6. Another common method of dealing with this dilemma is to physically remove the car from the garage. Removing just the keys doesn’t sit well with an elderly parent or spouse who sees the car in the garage, but can’t drive the car because of not having the keys. It becomes a tease for an elderly person who can see their independence sitting in the garage, but can’t use it. It’s like being a prisoner. The best thing to do is to remove both the keys and the car. If the elderly person is demented, removing the car and keys is not as challenging. Once the keys and car are removed from the house, simply explain to the elderly parent or spouse that the car is at the mechanics for a major overhaul, but that it may not be drivable any longer because of the poor condition of the car.

Caregiver’s Resource Helpline™ for Physicians

If your elderly patient depends on a caregiver, we can help you provide them support,  save time and help to grow your practice!

The Caregiver’s Resource Helpline™ improves practice efficiency, patient satisfaction and communication with your elderly patient and their family caregiver.  Positive outcomes include:

• More efficient use of your time to focus on medical issues
• Track source of new patients generated by promoting service in the community
• 24 hour user friendly telephone access for your patients and their caregivers to call for comprehensive caregiver education, eldercare and community resources
• Eldercare expertise to complement your medical practice resulting in better care for the patient and family caregiver

Majority of caregivers turn to a doctor or nurse for information about some aspect of helping an aging family member or elderly loved one. Caregiving in the US 2009 National Alliance for Caregiving

We’ve got the prescription to help!

With the Caregiver’s Resource Helpline™, our goal is helping you to easily provide solutions to their eldercare issue.  Anticipating your need to respond to their concerns during an office visit, we’ll provide you with a “prescription” referral pad for you to give to your patients to call the service.  It includes a check off for the areas of concerns you think are most important for each patient and family caregiver.  We’ll also provide brochures to place in your waiting room explaining how patients and family caregivers can easily access the service.

How does it work for you?

Operating 24 hours a day, patients and family caregivers simply dial the Caregiver’s Resource Helpline™.  This is a proven way of building your practice by branding your message and offering answers to the most common concerns of your patients and their caregivers.   They first hear your personalized message welcoming them as a sponsor and supporter of the service.

Conservatively, we estimate you can appreciate a time savings equivalent to seeing at least one (1) additional patient per day by referring the Caregiver’s Resource Helpline™.  The annual subscription cost is more than offset by the additional revenue you could generate over a year.

• Your staff is freed up to attend to billable services and activities when callers are referred to the service
• Personalize 30 second “Welcome Message” with your practice information
• 5 customized pre-recorded messages (up to 3 minutes) to deliver practice related  information to promote practice news, patient education and preventive services
• Improve doctor/patient relationship for elderly patients and their caregivers
• Click-to-Call banner to promote awareness from your website

Subscription Service

Subscribing to the Caregiver’s Resource Helpline™ enables you to partner with your patients and their family members and empower them to better manage their caregiving roles and responsibilities.  Building on the trusted doctor/patient relationship this program helps educate your patient and family caregiver, increases patient satisfaction and ultimately improves patient retention.  Satisfied patients are more likely to recommend your practice to family and friends. We provide:

• Unlimited supply of customized Referral Prescription Pads
• Unlimited supply of waiting room brochures
• 32 Topics of Interest covering most common concerns of caring for aging family member
• Direct-Connect to eldercare businesses, service providers and local resources
• Customization of your recorded medical practice messages using professional voice talent

90 Day Guarantee – Upon implementing the service to include distribution of prescription pads and waiting room brochures to your patients and their caregivers, if the results are not satisfactory, we will refund the remaining 9 months of the subscription.

Call 813-421-2741 for rates and information.