Experts on the AARP Caregiving Advisory Panel answer reader questions and offer helpful advice. Andrea Brassard, RN and senior strategic policy adviser for the Center to Champion Nursing in America, answers queries about caring for a loved one below.
Q. I am the long-distance caregiver for my parents, who both have chronic pain. I don't think their complaints are being taken seriously because of their age. What can I do to make sure my parents get the care they need, even though I'm not nearby?
A. Being a long-distance caregiver is difficult at best. The National Institute on Aging has a helpful handbook, "So Far Away: Twenty Questions and Answers About Long-Distance Caregiving," which you can download from its website. (To request a free print copy, you can also call 800-222-2225.)
It's best if you can accompany your parents on a visit to a new doctor or specialist. If this is not possible, one strategy that I used when caring for my father long distance was to fax a letter with my concerns to the health care provider before their scheduled visit. Be sure to use the phrase "I'm concerned" and be specific in your description. Tell the provider that you are available by cellphone during your parents' visit. Follow up with a phone call to the office to make sure your letter was received. And if the office has email, even better!
You also mentioned your parents need treatment for chronic pain. For musculoskeletal conditions, additional sources of care such as physical therapy or pain management clinics may be helpful.
Q. Should I control the amount of sleep my mom gets by waking her up (i.e., put her on a schedule) or allow her to determine the sleep pattern herself?
A. Sleep pattern changes are common in older adults, especially those persons with memory changes. It is important that both the older adult and the caregiver get enough rest. Establishing a schedule that includes morning sunlight, daytime exercise and a comfortable sleep environment is helpful. And know that many medications may cause drowsiness. Talk with your pharmacist or health care provider on the best times to take certain medications.
Q. I am my husband's caregiver 24/7. I have been searching for a caregiver who could relieve me a few days a month. I need a nurse who can administer eye care and oral pills. Can you help?
A. As a nurse myself, I know all about eye drops and medications. But I also know that care provided by an RN or LPN is very expensive. In many states, nurses can delegate medication administration to unlicensed assistive personnel. This is the case in most assisted living facilities.
Now is the time for you to develop a respite plan. Check out AARP's tip sheet on how to develop one.
If you need help for just a few hours, set up a pillbox so that the person you hire can easily give your husband the medications he needs at the correct times. If you are privately hiring a helper, you can teach her/him how to give eye care. Or check with your husband's eye doctor to see whether you can safely postpone eye care while you are out of the home.
Q. My mom keeps repeating questions and gets very anxious if I'm gone too long. Is she really afraid to be alone or she simply being controlling?
A. It sounds like your mom is anxious and afraid. Please share your concerns with your mother's physician. Be sure that your mother is safe when she is left alone. I'm sure you tell your mother where you are going and when you will be back, but it sounds like she is not retaining this information. In addition to telling your mom when you will be back, write a note in large letters telling her where you are and when you will be back. Put the note next to a big clock that is within her field of vision. You could also try to engage her in an activity such as folding laundry when you leave the house.
Q. My husband suffers from dementia. He has been living in a home with 24/7 supervision yet he fell and broke his hip last week. What can be done? Is it appropriate or legal to restrain or sedate him?
A. One out of every three persons over age 65 falls each year even though research tells us that most falls are preventable. Your husband has injured himself by falling and is at very high risk to fall again. You can advocate for him by telling the staff at every health care facility he stays in about his history and fall risk. Most health care facilities will implement fall prevention measures such as special wristbands or slippers to let everyone know he is a fall risk. Sedatives and restraints were used in the past but have been found to be ineffective and unsafe.
Q. My father-in-law refuses to take my mother-in-law to a doctor because he's afraid she has Alzheimer's. As a result, she just gets worse and we feel helpless. Do you have any suggestions?
A. Rapid onset memory loss can indicate several medical conditions in addition to Alzheimer's disease. These medical conditions may be treatable or even reversible. Delaying care is denying needed treatment. Your father-in-law is frightened and overwhelmed. Offer to make the doctor's appointment and accompany them. It may be more effective if your husband talked man-to-man to his father. He might say, "I'm concerned about my mother and worried that by delaying care she will get worse. What can we do to help?"
Q. We have noticed that my mother-in-law has been drinking on a regular basis and it's starting to affect her memory and personality. I suggested that her daughter might want to call her primary doctor to get some feedback. How can we address this issue?
A. Conversations are difficult to get started but you may find that your mother-in-law will appreciate your concern and help. Alcohol interacts with many medications so it is important to tell the doctor about her intake. If your husband and his sister can accompany their mother to the doctor, they can best express their concerns about her drinking and get her the help she needs. Older adults may increase their alcohol intake because of loneliness or depression, both of which can be helped.
Andrea Brassard, RN, DNSc, MPH, FNP, is past president of the Nurse Practitioner Association of the District of Columbia and the Washington, D.C., representative to the American Academy of Nurse Practitioners.
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