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Caregiving: Keeping Parents Healthy – Water, Walking, Watch out for Delirium

Just call me lunchmeat. Not that I’m complaining, but that’s sometimes how I feel after several years of the pressure and crunch of over-stuffed Sandwich Generation duties. Now my parents are settled into their new home,and the kids are alright. Although I’ve continued to practice geriatric psychiatry part-time, I feel like I can pry open those crusts of whole wheat and move some of those back-burner projects, like writing and sharing health care advice, to the front.

My mother and father share a room in a nursing home, labeled the “Health Center,” in the continuing care community where they moved four years ago—I had to check my resume for the date—as it was when I last held a full-time job. Both have dementia. My father carries a diagnosis of Alzheimer’s disease. My mother has vascular dementia; her atrial fibrillation caused her heart to throw tiny blood clots to her brain, which led to “mini-strokes.”

My parents have stayed out of the hospital for almost a year. This is a triumph for my sisters and me, and for the nurses, aides, therapists, and doctors involved in their care. I’ve come up with three basics (for starters here) that have contributed to keeping my parents healthy–water, walking and watching out for delirium. These were important when they were still in their apartment as well. They’re important for everyone.

Water – Everyone’s heard this before but sometime’s it’s so incredibly hard to get older people (especially your mother!) to drink enough. As we age, we don’t get the ‘thirsty’ signal transmitted as strongly to our brains as when we were younger; it’s easier to become dehydrated. Lack of water can lead to low blood pressure and falls, to electrolyte imbalances and heart problems, to bladder and kidney infections, just to name a few.

Women of my mother’s generation didn’t walk around with water bottles or some other container of liquid constantly in their hand like many of us do. In addition, as older bladders start to leak, and going to the bathroom requires help, they may hold back on fluids on purpose.

It’s wise to ask the person you’re caring for what he or she likes to drink. As long as weight or diabetes or some other health issue isn’t a problem, give the person what she or he wants. Juices, tea, coffee, even soda, given that it’s not likely to be very much.

A plastic cup like they have in hospitals has helped. The handle on the side makes it easy to grasp, and the top and the straw easy to sip from. Putting the person’s name on the cup and maybe a picture he or she likes can help get their attention. How about “Drink to Your Heart’s Content!” I like Alice in Wonderland; I’ll want Alice and a “Drink Me” tag on mine.

Try to remember to offer (not just suggest) your mom (or dad) the cup as many times as is reasonable whenever you are visiting. Walk in with your own bottle (of water, juice, soda) and say, “I hate to drink alone”, or just “Cheers.”

Walking – The maintenance of strength, balance, and flexibility as well as getting one’s heart pumping continue to be important whatever your stage of life. Exercise is at or near the top of the list for keeping your brain healthy too. An increasing number of studies show that exercise appears to slow the decline in memory and other brain functions in people who have dementia.

My father continues to visit the same gym he frequented before joining my mother to live in the nursing home. He pedals the stationary bike and lifts light weights twice weekly with the encouragement and under the supervision of the physical training staff. He looks forward to going to see “the girls,” though he no longer remembers their names. One of my sisters or I must accompany him to the gym (and back), as the building is a couple of blocks from where he lives, and he can no longer navigate there himself.

My mother goes to physical therapy twice weekly. The therapy room is in the same building as where she lives, so it’s easy for staff to come for her. It’s also another social outlet, with the therapists and other residents. The cost is out-of-pocket and about $60 an hour (per session), comparable to personal-training sessions. (But, Medicare should cover some physical therapy costs if your doctor prescribes it to maintain or restore function and it is provided by a Medicare-certified therapist.) My sisters and I also get both parents walking whenever we can—outside when it’s not too hot (in south Florida).

Watching for delirium – When my mother told me, “They took me in the middle of the night to a shack in the boonies, a place in the swamp with nothing around except grass that swished all night with the rain . . . ,” I called her doctor to tell her my mother very most likely had another bladder infection and needed to be treated ASAP.

Although she was speaking perfectly coherently on the phone, my mother had been delirious the night before. She could acknowledge the improbability of the swamp scenario, although she kept referring to it. Her nurse said she had no fever, hadn’t been needing the bathroom more than usual, nor did she feel any burning sensations. This lack of specific symptoms is common in people her age.

It’s also common for family members to be the ones to notice that mom is expressing strange ideas, or is looking more sleepy or acting more irritably than her usual self. In nursing homes, bladder, or urinary tract infections, are the most common cause of sepsis, which is infection getting into the blood and possibly into other organs. These infections account for one-third of hospitalizations of patients in long-term care facilities, and studies show mortality rates ranging from 4 to 15.5%.

Dementia is the strongest risk factor for delirium. Even after recovering from an acute episode of an infection with delirium, brain function often worsens. Each time a person becomes delirious, it’s like the tide goes out a little further on his or her brain and never quite comes all the way back in. Besides infections, dehydration can lead to delirium, as can malnutrition, drug reactions, and lack of sensory stimulation, which can occur in an intensive care unit or with very impaired eyesight or hearing

More about risk factors for delirium and how to recognize it can be found here from the Hospital Elder Life Program for Prevention of Delirium.

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