Saturday, January 29, 2011

Aging Parents: To Drive or Not to Drive--That is the Question

This e-mail photo was forwarded to me by a casual acquaintance who doesn't know I write a blog.  I could see the humor, yet my reaction was not to laugh.  It perpetuates the idea that older people are scary drivers. When we think "seniors' driving," do we think "responsible older people trying hard to stay independent, alert and safe?" Hummm.....
Next Tuesday's post will impart specific information and help for the senior driving dilemma. Today I let you into the heads of older women participating in a driving discussion at a Woman’s Club in New York. Prevailing reluctance to give up driving coexists with an acute awareness of responsible driving.
“I think one of the worst things is, when you can’t drive.  I can’t—I can’t envision my life—can you?  It really means a terrible change—It’s very limiting— especially in a suburban community,” says the Club President, who’s in her late seventies.
Ninety-two-year-old, still-driving E adds: “It’s the worst thing about getting older…you don’t want to lose your independence…but there comes a time…”
Eighty-five-year-old L chimes in, “But you can’t put someone else’s life in danger…”
E continues, “If I have a day when I don’t feel right, I don’t drive; if I feel tired, I don’t drive, and I’ve gotten so I don’t drive except when I’m absolutely sure where I’m going.”
J, whose age we don’t know because she won’t tell us until she’s 100, sums it up: “A lot of people can’t be honest with themselves and try to be something they can’t be.  It’s accepting of a lessening of yourself and it’s not pleasant.  But you have to settle for some of this.”
Honesty.  Acceptance.  Why, when it comes to driving, do these traits seem to be lacking in otherwise rational, older adults?  One answer lies in a powerful psychological defense mechanism: denial.  It's the opposite of acceptance. Mental health professionals tell us that denial protects us from having to face a reality we are not yet ready to cope with.
J, is a no-nonsense woman, who graduated from law school in the 1920s. It explains perhaps why she instinctively evaluates, is honest with herself, and has recently confined herself to local driving.  Of the “old school,”she gave up her profession, raised a family and joined a garden club.  While she had been driving major highways for decades to judge garden club events and flower shows, she says one day she began feeling less comfortable.  “I kept thinking about the possibility of an accident--someone else’s--on the highway and I asked myself, ‘Do I want to risk getting stuck in a traffic jam and having to wait for an hour or more on a major highway?'

Then I realized highway driving wasn’t enjoyable anymore… It’s something--limiting my driving--I do for myself.  No one wants to be of a certain age and be treated like an infant.  I want to make these decisions for myself.”
How long should the elderly drive? This question haunts almost every family with aging parents.  As we try to help parents age well, getting as much information as possible for mentally alert parents, before a problem arises, makes sense and can prevent older parents from feeling diminished, from being treated like an infant. Stay tuned for this Tuesday's post.

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Tuesday, January 25, 2011

Elderly Broken Hip, Full Recovery, Going Home: Summary--Part 4

R. is going home.  She's using a cane (for short distances); a walker for longer distances. Her recovery is due to a variety of factors including the fact that her doctor deemed her health very good for a person her age.

Summary of R's broken hip and recovery:
1.  Her broken hip (from a fall) involved a broken femur.
2.  Her doctor insisted on a highly experienced orthopedic surgeon who had "good hands" and thus could "get in and out quickly" when putting in the pin. Surgery causes trauma to the body at any age, but more for old people. Less time in the operating room, less blood loss, less anesthesia, less trauma.
3.  R came out of the anesthesia quickly.  The hospital stay went as planned.
4.  First priority when selecting the rehab center: physical therapy team's reputation. Narrowed to two candidates, the one closest to R's home was chosen...easier for us to get her daily mail etc.  Maintaining her interest in the world outside herself was important.
5.  Initially she was helpless, confined to lying on her back, needing to adjust to new routines, people, food, problems (eg. everyone was given Tums to boost calcium. Tums never agreed with her.  Her calcium pills+D needed approval by the rehab center's doctor which took time.  No big deal, but for someone lying in bed it can become a major deal.  Frayed nerves, stressed emotions from pain and the surgery.
6.  R quit prescriptions pain killers once she thought she could handle the pain with an over-the-counter drug.  Didn't want side effects of prescription pain killers if unnecessary.
7.  Surgeon's orders: no weight-bearing on the side with the broken hip for 90 days.
8.  Physical therapy began immediately with the above restriction.
9.  Being the oldest "rehaber" R learned to inform the young therapists when she knew she'd done enough.  When she didn't, she would be too sore to have therapy for a day or more, and she didn't want to lose ground by foregoing a day of therapy. She knew herself--knew when enough was enough for her at 97.
10.  R chose not to eat in the dining room. Older people with bibs or napkins clothes-pinned around their necks to ward off spills was depressing.
11.  Once she could sit in a chair--rather than lying in bed--she alternated with sitting, conscious of moving as much as she could each day.
12.  90 days later, new x-rays showed hip healed.
13. Her therapy changed. Able to bear weight on both legs, she had to learn to walk again.  Things we do--and she'd done--automatically for decades, she had to relearn.
14.  Relearning how to walk, took longer than she anticipated. Some days were discouraging. Then suddenly it all began to come together. She was mobile.
15. She'll stay in her home--no caregiver through choice--with an alert-pendant-bracelet.
16.  Scheduled out-patient physical therapy at the rehab center: twice a week. One of us will drive her.
17.  We try to help parents age well. We've offered our help and will help when asked; but R will "call the shots."
Note and disclaimer:  This should not be construed as medical advice. I am a counselor (not a medical person) wanting to share R's experience so people realize under the best circumstances an elderly person's broken hip can heal and one canwalk again. While this worked for R., it may not work for everyone.
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Saturday, January 22, 2011

Aging Parents: Elderly Broken Hip--Full Recovery Part 3

Attitude+Rehab=97-year-old's Broken Hip Recovery
Excellent physical therapists play a major part in aging parents' broken hip recovery success following surgery. But there is considerable initial adjustment.
An aging parent's broken hip means a lot of down time and takes a lot of patience--especially at first. Little strength is limiting; lying flat on one's back produces boredom. Pain and the insecurity of what lies ahead can easily lead to grouchiness and depression in the nicest people--until they see progress. Because we're a culture of instant gratification and short attention spans--or so they say, older parents may have more patience than we, which clearly benefits elderly broken hip recovery.
97-year-old, Senior Advisor R. reports that upon admission to a rehab facility one must make a complete adjustment. One must accept the way things are. "It's not like a hospital--not like having someone at your beck and call when you ring the call-button, says R," adding "It's not real nursing (except for those who must have it).  Asking the hardworking staff for more than one's entitled to only incurs frustration for both patients and attendants. Realizing this early, helps. Indeed some people make themselves miserable wanting more than the staff can provide."
R. says she continually reminded herself that she was only there for one reason: the therapy---not full attention from an aid whenever she wanted it. They made it known: "We're not here to help you, we're here to help you go home."
R. laughs when she recalls the first day of therapy: a circle of wheelchairs inhabited by "a bunch stroke victims, fall victims, Parkinson sufferers, mentally disabled--all in physical trouble."
It helps aging parents to move forward when they understand that some can't do the exercises at first, but shouldn't get discouraged. "Our strength is in short supply when we begin," R observes.  "While a lot of pain at first is discouraging....there are good days and not so good days. But you've got to get through it."
"The Parkinson woman, for example, had no expression, her head would go down on her chest, she couldn't follow through, but bit by bit they keep working with her and finally make progress. There's pain, some exercises are easier, some so hard, some people are doing well, some not so good. When there's wonderful therapy, bit by bit people get stronger."
One grown daughter comes for her mother's sessions.  For some mothers (and fathers) their adult children's support is encouraging and it doesn't disrupt the group's work.
So we help aging parents' broken hip recovery by finding excellent rehab for them...And then by our presence, our encouragement, our empowering, our running errands as needed...and perhaps by a few prayers.
Please go to my new site: for more "bells and whistles."

Tuesday, January 18, 2011

Broken Hip: 97-year-old's Fall, Surgery, Rehab, Amazing Recovery Chronicled--Part 2

Rehab--Attitude and Reality
A broken hip makes one helpless.  Can't move, can't get up and do what you and I take for granted daily.  Excellent doctor, successful surgery, excellent rehab facility. Yet as R lay flat on her back in a hospital bed after admission to the rehab center, we realized there would be "down days" and physically-challenging work ahead.
The importance of attitude loomed front and center.  First concern--whether a proud, successfully independent 97-year-old woman would have the will to endure, and recover from, almost complete dependency accompanied by the pain remaining after surgery and accompanying the physical therapy.
Control and Empowering: We couldn't control much, but wanted R to feel empowered, not like a helpless little old lady.  She'd never considered herself that way, that would be so undermining. To this end, we immediately requested that the staff call her by her first name, never "honey" or "sweety" (or any other too familiar or what she might consider a diminishing pet name so commonly used in care facilities).
Next, we asked R to give us orders--where to put things, what things she wanted us to bring her from home, what we could do to make the room more user friendly for her etc. etc. That gave her a smidge of control. Within a week, she also tried to control what little she could.  "Pick the dead leaves off that plant, she would instruct.  "I don't want to look at dead leaves," she'd emphasize." "I don't want clutter in this room," she'd say. We complied with any "orders".  Her mind worked well, we wouldn't interfere unless asked.
Adjustment: The first week in an institutional setting is similar to a child's going to school for the first time: unfamiliar routines, new people, different food, expectations, surprising disappointments. When we don't feel good, we're weak, we lack energy and we're not mobile. We may not feel much like adjusting.  We may be cranky or worse.  Understandable, isn't it?  Here's where focusing on the big picture helps.
What's the goal? keeping the goal always in mind, helps dilute the disappointments, insults, temporary setbacks--equally applicable to help aging parents and their children.  The goal in R's case was to be able to walk again, have independence and not be confined to a wheelchair. But R had an intermediate goal because of her surgeon's instructions to the rehab center: "no weight on the left leg for 90 days," then an X'ray to be certain the hip was healed, before regular walking could be added to her physical therapy routine.
Patience: Unbeknownst to us, until she told us she had passed the half-way mark of 45 days, R was mentally crossing off the days until her return to the surgeon and X'ray--90 days. be continued

Saturday, January 15, 2011

Broken Hip: 97-year-old's Fall, Surgery, Rehab, Amazing Recovery--Part 1 (of 4)

97-year-old Recovers and Regains Independence After Fall and Broken Hip--Part 1
Finally, I'm back. Getting wireless internet connection while out here with R, as she prepares to leave rehab, took longer than expected.  That said, a recap of R's experience will, I hope, provide a frame of reference for those going through this not-for-sissies/prima-donnas experience.
For everyone fearful of...caring for...or recovering from...a broken hip,  Help! Aging Parents will chronicle Senior Advisor R's fall, her "rescuers," surgical consideration, rehab highlights and insights, and lastly her preparation for returning home.  Ultimately she will be aided by an alarm wrist bracelet, a cane, and a walker with a basket for carrying things (the rehab therapist says she only needs additional support when things must be carried from place to place). No caregivers.
Part 1: The Fall, the Rescuers (911 and doctors)
What follows may repeat snip-its from earlier posts.  But the chronology and additional information make it hang together better.  R. didn't have an alert pendant.  In late September she was walking from her bedroom to the kitchen when she noticed her twice-a-month cleaning help had moved something on the desk she was passing.  She reached over to reposition it, realized she was losing balance, grabbed the nearest chair, but it wasn't heavy enough to support her weight, and they both fell on the carpet.
R. remembers she grabbed at a table leg thinking she'd pull herself up; she couldn't. One side of her body would not move. She knew immediately she couldn't get up. That ad, "Help, I've fallen and I can't get up," for the first time--resonated, R said.
The next 3 hours were spent inching her way back towards the bedroom, to a telephone.  She rolled over on her stomach and with her arms in front "kinda pulled her knees and body along." Her knees sustained carpet burns, one of which is still not completely healed.
The phone, on a table, was too far to reach from the floor, but there was a waste basket nearby.  R grabbed it, was able to reach up and, after repeated attempts, knocked the phone out of the cradle.  "Very hard work," she says.  She phoned a nephew, who drove to her home, called the doctor, got the answering service, who told him to call 911.
The paramedics came immediately. First 2, then more to make certain her condition was stable then to place her on the gurney and transport her to the hospital designated by her primary care doctor (who by this time had been contacted).
Now in the "right" hospital, the next step was the "right" surgeon, for this 97-year-old, with a broken femur. R's primary care doctor was insistent on one particular orthopedic surgeon who had "technical excellence" and "good hands."  Why?  "Surgery is a trauma to the body. It is not tolerated as well in the elderly as in the young," according to R's highly regarded doctor.  "It's important to get in, get out, do a quick job with less anesthesia, less blood loss, less time in the operating room.  That means less trauma."
Clearly these early steps cleared the way for R's ultimate excellent recovery and gave us far-away-living children (one of us was out here almost all the time) confidence that--in terms of helping parents age well--we were on the right track. To be continued...

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Saturday, January 8, 2011

Aging Parents: 97-year-old, Broken Hip, Rehab, Walking

Today's post is brief.  Certain details are needed to make it useful and I don't have them yet. Nevertheless as we try to help parents age well, knowing  that a 97-year-old broken hip can heal and that beginning to walk again with a walker signals regained independence ahead is heartening.
Knowing the value of more specifics, and since I've just returned (my husband, her son, has been here most of the time since the fall), I want to be certain I can accurately convey certain aspects of her fall, diagnosis, prognosis, and progress to date.
That said, Senior Advisor, R, is literally in the home stretch. Her home awaits her.  Having lived independently and successfully alone since her husband's death over 40 years ago, if anyone could have successful rehab for a broken hip, it would be R. She is our only living parent at this point. Of course, we know the delicate balance aging parents must deal with and probably won't completely relax until she is back home.
In the meantime, hoping to have useful details in this coming Tuesday's post....
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Monday, January 3, 2011

Creative Strategies for Overcoming Vision Loss

While vision loss is sobering and scary, Jane Brody's NY Personal Health column in the December 28th NY Times, Science Times Section, is an important read, offering strategies and information for people with vision issues.  Those with macular degeneration and Veterans with impaired vision will find this column especially compelling.
An 84-year-old man of intelligence and means, who wouldn't settle for a diminished life due to macular degeneration, finds ways to overcome low vision, enjoy independence and quality of life. His search and the information he uncovers is detailed in Jane Brody's column. it on.
It's hard to predict how people react, because we can't stand in their shoes. Yet I think anyone with serious vision problems would consider the information in this column a gift of hope.  Agreed?

Saturday, January 1, 2011

Aging Parents: Alert Pendants/Bracelets Reviewed and Researched-Part 2

Happy New Year!  It's happy for us.  My 97-year-old mother-in-law, R, is walking now, steadied/aided by a belt around her torso that the therapist controls to give her a feeling of security and stability. The hip has healed, her left leg can bear weight, and physical therapy is doing its job. R has walked for three days now; she says it's "hard work."  More progress updates in another post.
Soon R will be ordering an alert pendant. The information on these last 2 posts can help older alone-living parents, grandparents as well as R (before she goes home) make a selection. Since R thinks clearly, she wants to read the brochures before deciding (doesn't use a computer). So I've requested brochures. You, however, have these summaries and a head start, should your parent prefer a hard copy.
The list of companies continues...
  • Life Fone (888-678-0451) 30 years in business, it's the alert system of choice (after checking 3 companies) for a smart, older working wife who realized her husband couldn't physically help her if something happened.
    Range600 ft.
    Don't outsource, have own call center in New York, with trained people, quick response.
    TestingAsk older person to test 1-2x a month to stay familiar with system (yet they monitor also)  
    Battery life
    : 5 years (free replacement)
    Contacts5 people on list
    FinancialNo contract.  $24.95-$29.95 depending on number of prepaid months.
    Other stuffEasy to install; bracelet, pendant.
  • Medical Home Alert (800-800-1297) Good Housekeeping's "top pick" in 2005. CVS selected MHA as their exclusive provider of Medical Alert Systems in their 6000+ stores in 2007. A couple I've know many years, in their mid-80's, he still works, recently signed on for this system and is "completely satisfied."Rangeup to 600 feet from the base.Responsea "911-certified" person in their large state-of-the-art headquarters facility in New York answers within about 2-30 seconds. Remains on the line until help arrives.
    Testingthe self-testing mechanism automatically contacts the monitoring center every 28 days; but they recommend that once or twice a month the pendant-wearers also make contact so they feel connected.
    Battery lifeback-up battery continues to operate up to 36 hours if power outage; button lasts 5-7 years
    Contactsno limit to # of names on emergency list
    No contract. $29.95 a month; 1 month free if pay for a year in advance.
    Other stuffin business since 1977. Easy to assemble and disconnect system. Easily transportable. Pendant, wrist band, or belt clip. 2nd button may be free if requested.
Life Alert (800-360-0329), used and liked by several older people. One daughter says they are "very responsive, have wrist straps and pendants and my mother really likes them. She checks in every Monday to make sure everything is working. She prefers the wrist strap since the pendant goes off inadventently sometimes if you happen to press it (while sleeping, etc) ."
On the other hand, in October 2010 my octogenarian cousin phoned Life Alert. She wanted an alert system and her son's mother-in-law uses--and is satisfied with-- Life Alert.  My cousin reports the salesperson was aggressive: she said she couldn't order immediately--she wanted to speak with her children first; he responded something like "why do you need your children's permission?" and called her back at least three more times that day.  Life Alert also requires a 3-year contract. I add this link to regarding Life Alert provides another source of information.
We try our best to support our parents' independence; we do our best to help them age well. Yet with many competing medical alert companies and with such similar names, the decision becomes difficult.
The other night someone asked me if I get paid or take advertising for doing this blog.  The answer to both questions-NO.  Those of us who are counselors at heart, simply try to make things better for those we care about as well as for who are needy and come into our lives.  Aging parents and older people (add pets and animals) are in this category. May 2011 be a very good year for you and for those you care about.

Visit my other site: to see this laid out correctly.  Blogspot is not cooperating with a bulleted layout. Sorry.