Manual ElderCare Simplified: A Comprehensive Manual to Guide You Through the Stages of Aging

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Irritability that leads to moodiness and triggers negative responses and actions.

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Lack of concentration that makes it difficult to perform familiar tasks. Health problems that begin to take a mental and physical toll. Burnout reduces your productivity and saps your energy, leaving you feeling helpless, hopeless, angry, and resentful. Eventually, you may feel like you have nothing more to give.

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  • These tips can help:. Seek regular respite care. You cannot do it all alone. Ask other family members, friends, or members of your place of worship for help with respite care so you can get a much needed break. You can also seek help from volunteer organizations, support groups, day care programs, and residential respite care facilities. Schedule frequent breaks throughout the day, take time out to pursue hobbies and interests, and stay on top of your own health needs.

    Get moving. Regular exercise not only keeps you fit, it releases endorphins that can really boost your mood. Aim for at least 30 minutes of exercise on most days. Take a walk or jog outside, dance to your favorite music, work out to an exercise DVD, or cycle to the store. Taking a group exercise class or working out with friends can give you a valuable social outlet as well. Talk to someone. The simple act of talking face-to-face with someone who cares can be extremely cathartic. In fact, most friends will be flattered that you trust them enough to confide in them, and it will only strengthen your bond.

    Top Books on Caregiving

    Take time to play. Join an online scrabble tournament, practice your golf swing, or play with a pet. Try something new. With just a few minutes of practice each day, you can flex mental muscle and relieve harmful stress. See the funny side. Humor is a well-known antidote to stress, sadness, illness, and boredom. Give yourself permission to chuckle at the absurdities you and your loved one experience, and surround yourself with laughter.

    Instead of heavy dramas on TV or video, go for a hearty belly laugh by watching episodes of your favorite sitcom. Your infectious good mood can help replenish your inner resources and sooth your loved one. At each new stage of the disease, you have to alter your expectations about what your loved one is capable of. By accepting each new reality and taking time to reflect on these changes, you can better cope with the emotional loss, and deepen the feelings of satisfaction and love in your role as caretaker.

    Keep a daily journal to record and reflect on your experiences. By journaling your thoughts, you can mourn losses, celebrate successes, and look for those thought patterns that keep you from acting in the present. Count your blessings. A daily gratitude list can chase away the blues and let you focus on what your loved one is still capable of, rather than the abilities he or she has lost.

    Celebrate what is possible. Your loved one still has many abilities. Structure activities to invite participation on whatever level is possible, and you will both find real enjoyment. By valuing what your loved one is able to give, you can find satisfaction on even the toughest days. Practice relaxation techniques. Meditation, deep breathing, visualization, mindfulness, yoga, or rhythmic exercise can calm, restore, and promote happiness.

    Experiment with different techniques to find the ones that work best for you. Improve emotional awareness. Remaining engaged, focused, and calm in the midst of such tremendous responsibility can challenge even the most capable caregivers. By developing your emotional awareness skills , however, you can relieve stress, experience positive emotions, and bring new peace and clarity to your caretaking role.

    Avoid all distractions and focus fully on the person. And it can also have the same effect on your loved one. Many caregivers find it difficult to ask others for help, no matter how much they may need it, so make the offer. And when you do, be specific. Be a friend. Caregivers are prone to withdrawing from family and friends but they still need regular contact with the outside world. Be a good listener. Page 5. List of Needs, Types of help available, When community agency help is needed, Services available to impaired elderly.

    Chapter Types of Help Available. Page 7. Chapter Caring for the Caregiver. Page 9. Caregiver's self-rating scale, What can I do to help myself, Seek Information, Join a caregiver support group, Set realistic goals, Practice good communications skills,Communicate with your family and friends, Use community resources, Use respite care services, Maintain your health, Relaxation exercise, Laughter is the best medicine, Avoid destructive behaviors, Seek help, Build your self-defense, Caregiver's bill of rights.

    Chapter Personal Care. Page Bathing, shampooing and shaving, skin care, Toileting, constipation or irregularity, Assisting with eating, transferring, rest and sleep, Tips for encouraging self-care, Nutrition, Nutrients listed on food labels, Adapting meals for people with dietary restrictions, Four food groups, Common problems interfering with good nutrition, General tips for helping the older person to eat well. Chapter Nutrition. Chapter Medical Aspects of Caregiving.

    Encouraging routine physical examination, Keeping records and managing medications, Choosing a doctor, Emotional and intellectual well-being, Depression: signs and causes, Suicide prevention, Promoting emotional well-being, The importance of lifetime learning,Memory problems, Sensory problems, Confusion, Behavioral problems, Mental stimulation. Chapter Emotional and Intellectual Well-Being. Chapter Legal and Financial Affairs. Chapter Choosing a Residential Care Facility. The first step in organizing a rational care plan is making a list of needs.

    As family members or friends care for an impaired elderly person, several questions present themselves:. In answering these questions you are developing an important List of Needs of the impaired elderly person, and bringing into perspective the caregiver's needs as well. The questions do not have easy answers and the solution may vary in every situation.

    The care of an impaired older person can create stress that affects the ability of the caregiver to continue giving necessary levels of care. Providing physical care to an impaired older person can cause physical stress. General homemaking and housekeeping activities such as cleaning, laundry, shopping, and meal preparation require energy and can be tiring, particularly when added to existing responsibilities in one's own home. Personal care required for the supervision of medications and the maintenance of hygiene can also be stressful, particularly in situations of acting-out behaviors, incontinence loss of bladder or bowel control , colostomies, or assistance with bathing.

    Lifting and transferring individuals with limited mobility is not only tiring, but also can result in injury to the caregiver or the impaired person. In some instances there is the additional responsibility of maintenance of equipment such as wheelchairs or hospital beds.

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    The care of an impaired elderly person has many financial dimensions. For those services that cannot be provided by family members medical, pharmaceutical, therapeutic, etc. When money is limited, many families assist with the cost of care, causing financial burdens on all family members. The proper home setting has to be chosen. If the care-receiver is to remain in the home, some major adjustments in the living arrangements and patterns of daily living will be necessary.

    Providing personal care up to 24 hours a day can cause social stress by isolating oneself from friends, family and a social life. What can result is a build-up of anger and resentment toward the very person receiving the care, as the care-receiver is the cause of the lost socialization. All of these factors often result in tremendous emotional stress. Compounding these sources of stress are the difficulties in managing one's time, juggling multiple responsibilities, and feeling the pressure of the increased dependency. For family members providing care, the various forms of stress can result in different feelings.

    Anger, resentment and bitterness about the constant responsibilities, deprivation and isolation can result. This is also a time when many of the unresolved conflicts from parent-child relationships resurface and can intensify, causing anxiety and frustration. There might even be the unspoken desire, at times, to be relieved of the burden through institutionalization or even death of the care-receiver. This desire is frequently and swiftly followed by feelings of guilt. All of these can be felt, then denied because they seem unacceptable. The person giving care needs to be assured that, in fact, these feelings are common even though they may not be expressed.

    Top Books for Caregivers

    There are resources that can help caregivers. The remainder of this book will address those resources, such as joining a caregiver support group, using community resources and above all, caring for yourself the caregiver. First make a detailed inventory of any assets individual family members and friends can contribute, including the assets of the impaired elderly person needing the care. Assets include available time, skills, space, equipment, the strengths of the person in need care, and most important money. Sit down with all the family members or at least as many as are agreeable and work out a plan for giving help.

    This involves defining and agreeing upon what tasks will be performed, by whom, on which days, and so forth. Some situations may allow for exchanging support services such as the Caregiver Exchange through Area Agency on Aging. A friend who has similar caregiver responsibilities may care for both impaired individuals one day a week in exchange for your providing the care on another day. When family or other volunteer help is not available or cannot meet your needs, caregivers or care-receivers may wish to seek help from agencies. A wide range of help may be available. All of it can be purchased.

    Sometimes the service costs may be based on the income of the care-receiver. Each agency has its own fee structure; you may want to ask about their arrangements before ordering the service. It offers a range of therapeutic, rehabilitative, and support activities, including nursing, rehabilitation, assistance with life activities, social work services, meals, and possible transportation, provided in a protected setting for a portion of the day, one to five days a week, usually during weekdays.

    Companionship Services: Companions visit isolated and homebound individuals for conversation, reading, letter writing, and general light errands. Escort Services for the Elderly: These services provide personalized accompaniment to service providers as well as personal assistance. Geriatric Assessment Units and Special-Care Units : Specialized geriatric units, both inpatient and outpatient, exist in some hospitals and medical centers; e.

    Home Delivered Meals: Some nutritional programs as well as well as specialized meals-on-wheels programs offer home delivered meals to the frail, homebound aged. Subsidized programs ask for voluntary contributions, while others may require full payment cost for delivery of a hot, well balanced lunch, and sometimes cold evening meal. Home Health Aides: Provide personal care to individuals at home These services may be covered by health insurance if ordered by a physician.

    Aides assist with eating, dressing, oral hygiene, bathing, colostomies, administering medications, etc. Home Health Care: Organized programs of nursing, social work, occupational therapy, physical therapy, and other rehabilitation services to individuals in the home. Homemaker Services : Provided by non-medical personnel, services include shopping, laundry, light cleaning, dressing, preparation of meals, and escort services on medical visits. Homemakers can be of great help in supplementing help provided by family members, or providing relief when family caregivers need a break.

    Homemakers can be secured through in-home health care agencies, the Area Agency on Aging, the Department of Social Services, and religious groups and organizations. Some agencies provide bonding and training for their homemakers while others provide only a registry of homemakers' names and phone numbers, in which case you must thoroughly check references and draw up a contract for the required services. Hospital and Surgical Supply Services: Supply houses rent or sell medical supplies and equipment like hospital beds, canes, walkers, bath chairs, oxygen and other equipment.

    Consult your Yellow Pages. Housekeeping Services : These usually include cleaning, shopping, laundry, and meal preparation. Housing Assistance: Housing assistance programs exist to help in the search for senior housing, shared housing, and finding emergency shelters, such as Heartland Human Relations and Area Agency on Aging. Nutritional Programs: Congregate meal programs feed many older adults as a group in a senior center, community center, or school. A noonday meal is provided, containing one-third of the recommended USDA dietary allowance, usually for a voluntary contribution.

    Additionally, some centers provide recreational and educational activities. Occupational Therapy: Occupational therapy, or OT, is restorative, to enhance or restore skills necessary for daily living. It should be provide by a qualified occupational therapist who is referred by your doctor. Physical Therapy: Physical therapy, or PT, is rehabilitative therapy to maximize mobility. It should be provide by a qualified physical therapist, usually recommended by your doctor or hospital. Respite Care Services: Respite care programs provide temporary and in some instances up to twenty-four hour care to give relief to primary caregivers.

    The care may be provided in the person's home, at an adult day care center, or other facility. Skilled Nursing Services: These specialized services are provided for specific medical problems by trained professionals through local home care agencies. Your doctor must prescribe nursing services.

    Speech Therapy: Speech therapy is provided by a qualified speech therapist to overcome certain speech and communication problems. The doctor usually recommends this. Social Day Care: Provide supportive but not rehabilitative services in a protected setting for a portion of the day, one to five days a week. Services may include recreational activities, social work services, a hot meal, transportation, and occasionally, health services. Telephone Reassurance: Friendly telephone calls are provided by agencies or volunteers offering reassurance, contact and socialization.

    Telephone reassurance can be a lifeline for older people who must be left at home alone during the day. Transportation: Transportation services provide travel by automobile or specialized vans to and from medical care. Caregivers experience mixed emotions. Love for your family member and the satisfaction you derive from helping may coexist with feelings of resentment about the loss of your privacy and frustration at believing you have no control over what happens.

    You may find it hard to accept the decline of the special person for whom you are giving care. Such feelings will depend in part on your prior relationship with your care-receiver, the extent of your responsibilities as a helper, and daily activities in your life professional, social, and leisure pursuits. Your conflicting emotions may cause guilt and stress. To guard against becoming physically and emotionally drained, you must take care of yourself.

    You need to maintain your health and develop ways to cope with your situation. Below is a scale to evaluate your level of caregiving. It is an excellent effort to provide some guidelines for caregivers and to evaluate your level of care and value wich you give your care-receiver and yourself. Put a number from 1 to 10 to best describe your feelings. Number 1 is no feeling, numbers between express stronger feelings with 10 being strongest feeling.

    You can place yourself on the Scale of Caregiving to determine how you value your care-receiver as compared to yourself. The low numbers give little or no value honor to the needs of your care-receiver. The high numbers 8, 9, 10 give little or no value to your own needs as an individual and as a caregiver. The numbers in the middle are where you find a balance between undercare and overcare.

    Neither of the two extremes is healthy; they represent positions where you are not helping your care-receiver. Acknowledge your feelings: Your feelings have a lot to do with the way you view and cope with caregiving. All feeling are legitimate, even those that may sem disturbing to you including anger, frustration, and sadness.

    Recognizing and accepting your emotions are the first step toward resolving problems of guilt and stress. Learn to express your feelings to family members, friends, or professionals. Take the following caregiver Stress Test; determine how much stress you are under. The following test will help you become aware of your feelings, pressures and stress you currently feel.

    Which of the following are seldom true, sometimes true, often true, or usually true? I find I can't get enough rest. If the response to one or more of these areas is usually true or often true it may be time to begin looking for help with caring for the care-receiver and help in taking care of yourself. Check your public library for books, articles, brochures, videotapes, and films on caregiving.

    Help is available! In addition to offering useful information, such groups provide a unique forum for caregivers to come together and share their feelings in a supportive environment. Groups help caregivers feel less isolated and can create strong bonds of mutual help and friendship. Participating in a support group can help mange stress, exchange experiences, and improve skills as a caregiver. Sharing coping strategies in a group setting lets you help others while helping yourself.

    It may also help you to realize that some problems have no solutions and that accepting the situation is reality. Caregiving is probably one of the many conflicting demands on your time. It is important to set realistic goals. Recognize what you can and cannot do, define your priorities, and act accordingly. Turn to other people for help - your family, friends, and neighbors.

    Prepare a list of tasks for anyone who may offer assistance. The list may include:. Turning to family members or friends for emotional support and help can be a mixed blessing. Their visits may make you feel less alone and better able to deal with caregiving responsibilities. They can give you a break by spending time with your care-receiver. However, other relatives or friends can be critical of the way you provide care. They may feel the house is not kept clean enough; or they may not like the way your care-receiver is dressed. Recognize that they are responding to what they see at that time and are lacking the benefit of experiencing the whole picture and any gradual changes in your care-receiver's condition.

    Harsh criticism may be a response to their own guilt about not participating more in the care process. Try to listen politely to what is being said even though this might not be easy. However, if you and your care-receiver feel comfortable with the way you are managing the situation, continue to do what meets your needs. Schedule a family meeting from time to time to help other family members understand the situation and to involve them in sharing the responsibilities for caregiving.

    Investigate community resources that might be helpful. Consider using in-home services or adult day care. Employ a homemaker to cook and clean, or an aide to help your care-receiver bathe, eat, dress, use the bathroom or get around the house. When you need a break from providing care to your care-receiver, look at respite care. For example, a companion can stay with your care-receiver for a few hours at a time on a regular basis to give you time off.

    Or have your care-receiver participate in an adult day care program where he or she can socialize with peers in a supervised setting; this gives your care-receiver a necessary break from staying home all the time. Hospitals, nursing homes, and particularly residential care homes offer families the opportunity to place older relatives in their facilities for short stays.

    Your general well-being affects your outlook on life and your ability to cope. Taking care of yourself is important and involves:. Food is fuel for your body. Skipping meals, eating poorly, or drinking lots of caffeine is not good for you. Learn to prepare and eat simple, nutritious, well-balanced meals. Avoid alcohol above ounces daily. Being physically active can provide you with an outlet that is relaxing and makes you feel good. Stretching, walking, jogging, swimming, or bicycling are examples of invigorating exercises.

    Consult your doctor before starting an exercise routine. Your doctor can help design a program that fits your individual needs. Leisure time allows you to feel better and more able to cope with your situation. Having time to yourself to read a book, visit a friend, or watch TV can also bring enjoyment and relaxation, and break the constant pattern and pressure of caregiving. Sleep refreshes and enables you to function throughout the day. If your care-receiver is restless at night and disturbs your sleep, consult your doctor and fellow caregivers on possible ways to handle the situation. You may need to have outside help in the evenings to allow you time to sleep.

    If you are unable to sleep because of tension, practice relaxation exercises. Deep breathing or visualizing pleasant scenes can be helpful. Continued sleep disturbance may be a sign of major depression, which needs medical attention. This is an old expression popularized by Norman Cousin's book Anatomy of an Illness, in which he describes his battle with cancer and how he laughed his way to recovery. His hypothesis and the subject of many studies suggests that there are positive effects to be gained from laughter as a great tension-releaser, pain reducer, breathing improver, and general elevator of moods.

    It sounds miraculous, is not proven, but studies continue.

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    Groups such as the International Conference on Humor and many hospitals use positive emotion rooms and humor carts. In short, humor therapy is valuable and it helps us through difficult or stressful times. Sometimes people handle stressful situations in ways that are destructive. Instead of openly expressing feelings, they overeat, use alcohol, drugs, or cigarettes to mask their difficulties. Such escapes do not solve the problem and are harmful to health.

    If the strain results in neglecting or abusing the care-receiver, it is a vary serious problem. It is also against the law! You do not have to go it alone. Turn to family members, friends, clergy members, professional counselors, or a caregiver support group for help and support. Continue to pursue activities and social contacts outside your home.

    Do what you enjoy. Go to a movie, play a musical instrument, or get together with friends for a card game. It may not be easy to schedule these activities, but the rewards for having balance in your life are great. Taking care of yourself benefits you and your care-receiver. Meeting your own needs will satisfy you and give you additional strength and vigor to bring to your caregiving tasks.

    You have rights, too. Below is a Caregiver's Bill of Rights. After you read them, post and keep them fresh in your mind. Personal care activities include eating, bathing, shaving, caring for the skin, hair and mouth, and transferring moving from chairs, toilets or bed. During the course of our daily lives these activities are taken for granted until weakness or a disability makes them difficult to accomplish independently or safely. Providing assistance requires knowledge, patience, skill and physical strength. Bathing an older person may require strength, special equipment and skills.

    It is advised that caregivers ask the elderly person's doctor and. Visits to a barber or hairdresser are very positive experiences. Individuals who provide this service will often come to the home. Wetting hair with alcohol or cream rinse helps to remove the snarls. Dry shampoos are available if your family member is bed bound.

    People who are diabetic or on medication to thin the blood anti-coagulants, i. It is much easier and safer to shave another person with an electric razor. Eating can be very time-consuming, especially if the older person must be fed. Encouraging independent eating saves time for caregivers, and promotes the independence and self-worth of the older person. Try to relax yourself and enjoy the time spent with your care-receiver.

    Here are some suggestions for encouraging independence:. As we age, our sleep patterns change. The elderly require less sleep time. It takes longer for them to fall asleep. Also, awakenings during the night increase. Scheduled rest times are important. A few naps during the day can refresh and revitalize the care-receiver. However, if you notice that your care-receiver is sleeping for brief periods during the night, it could indicate a problem.

    Notify your doctor and discuss your concerns. Good nutrition is important in order that people live life to its fullest.

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    Good nutrition is a balance of proteins, carbohydrates, fats, vitamins, minerals and water in the foods we eat. A healthy diet helps to 1 provide energy; 2 build, repair, and maintain body tissues and s regulate body processes. When meals are eaten in the company of others, people not only benefit from the nutritious foods, but also enjoy the chance to socialize. This encourages good eating habits and promotes good mental health. The table that follows summarizes essential nutrients which you may also finds listed on food labels and their functions. If an individual is on a special diet low salt, diabetic or low saturated fat , the Basic Four Food Groups Guide which follows can still be used.

    However, because diets are prescribed to control a specific medical condition, certain foods may have to be eliminated, modified in the preparation, or limited in their intake. It is important that caregivers obtain specific instructions from a registered dietitian or their doctor on which foods are allowed, how much, and how they should be prepared. Meat Group: Provides protein, niacin, iron, and Thiamin-B1. Dry beans and peas, soy extenders, and nuts combined with animal or grain protein can be substituted for a serving of meat.

    Grain Group: Provides carbohydrates, Thiamin-B1, iron, and niacin. Whole grain, fortified, or enriched grain products are recommended. Milk Group: Provides calcium, riboflavin-B2, and protein. Citrus fruit is recommended daily for vitamin C. Illness, disability and depression can affect an older person's desire and ability to eat properly.

    The following suggestions deal with common problems that interfere with good nutrition. In addition to books, recipes and literature, the organizations listed below are valuable in providing tips, ideas, counseling, and reminders that you are not alone. They can help make the gradual transition to improved eating habits: Addresses listed were local San Diego. As a caregiver, you are in a position to help your care-receiver along the road to good health care by encouraging routine physical examinations. You are valuable in helping the care-receiver talk to their doctors and other medical personnel.

    You can follow through with their medical treatment at home.

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    • However, it is important to remember that the primary responsibility for medical treatment rests between the doctor and the patient. If there is any doubt about what you should or should not do, the doctor should be consulted. In medical treatment, it is often tempting to decide what is best for the patient, but it is best to recognize the care-receiver's need to choose. We all need control of our lives, and this is especially true for a person who needs the help of others. If there are serious concerns about decisions being made, caregivers should discuss the matter openly with the doctor.

      Caregivers can help older people maintain medical records for use by the doctor. Arrangements can be made through the doctor's office to send for previous records that could be helpful in treatment. This may require getting Releases of Medical Information signed by the care-receiver. You also should keep a list of all medications both prescribed and over-the-counter being used. The same medications that are helpful in easing pain, stopping infection, controlling heart rate and keeping people healthy can also cause serious problems.

      Because many older adults take several medications at one time, it is possible that these drugs can interact with one another and be a danger. If more than one doctor is prescribing medications, it is important to keep each doctor aware of the drugs that are being taken. You can keep them informed by taking all your drugs in a paper sack or a list of all your drugs to each doctor. Having one pharmacist that fills all of your prescriptions is a way to prevent taking drugs that interact and cause problems.

      Over-the-counter or non-prescription drugs also can cause problems. Talk with your pharmacist before using them. If you find the medicine schedule confusing or difficult to follow, ask your pharmacist about preparing all medicines in blister packs. Below is a sample of "current medication list" which includes the essentials: name of medication, sample of the medication taped beside its name, the reason for the medication, the dosage and the time the medication is taken:.

      If your care-receiver is taking several medications at different times throughout the day, it may be helpful to develop a second list to assist you with daily medication set-ups; this list may be color coded, or may have the names of the medications grouped in the times to be taken each day. For medications taken several times a day, their names will appear several times on your list as in the example below:.

      If you don't have a doctor, choose one carefully. The doctor is a valuable resource. If you are having a difficult time managing your care-receiver at home, or an acute illness occurs, the doctor may assist with related health care concerns. Your care-receiver may have to be hospitalized. The doctor may assist by making a home health care referral. Once hospitalized, the doctor can assist in placement issues or home health care upon discharge.

      Arranging the Doctor Appointment. Some questions to ask when you make a first appointment:. Each human being is a combination of body, mind, and spirit; we should be aware of how these parts interact. For example, people may have powerful emotional responses while facing the many challenges which life presents.

      Thus, some may often appear cheerful and optimistic while others are anxious and unhappy. In later years, we usually continue our basic moods, but the ways we express our feelings often become more obvious. In the midst of losses, such as physical changes, death of friends or loved ones and reduction of income, older people may begin showing signs of depression. Some things to look for are:.

      If older people brood about their unhappiness, much of their energy is focused on worry. Part of that worry may relate to the fear that they will become forgetful and unable to manage their affairs. This worry can lead down the path to more depression, which may cause physical problems. Once these questions have been answered, steps can be taken to relieve the depression.

      It will take some work from both the caregiver and the care-receiver to change habits and routines. Prolonged depression causes biochemical changes in the brain, usually requiring treatment with medication. The doctor is a good person the contact to find help for treatment of depression. Other resources are County Mental Health Centers, psychologists, counselors or clergy. Suicide among the elderly is a significant and ever increasing problem.

      Statistics show that 27 percent of all suicides in San Diego county were committed by people 60 years of age and older. Elderly complete one suicide every 1 hour and 21 minutes, or each day Unlike other segments of the population, the elderly do not often make threats or mention suicidal thoughts to others.

      Therefore, it is important that caregivers also know other warning signs:. Death and Dying Interventions Elderly terminally ill encounter anxiety and fear regarding death:. Also attempt to have the person and family involved discuss the situation. Truly, no person is an island! It is important to help the elderly remain involved in decision-making as long as possible. You must stress that needing help with everyday activities does not mean that they cannot make decisions for themselves. Also, granting others the right to decide does not mean you are ignoring or abandoning them.

      Caregivers need to be sensitive to the right combination of giving just the right amount of assistance and no more. Research shows that reaction time may be slower in older people but they can still learn. Families and friends may need to be patient in waiting for responses. It is also important to remember that short-term memory may not be as good as it was. The brain helps link people to the world. If we are able to process and understand what we see, hear and absorb from our senses, our experiences will become more meaningful.

      Sometimes older people are incorrectly labeled as "senile"; the misconception is that they are no longer able to think for themselves. However, for the most part, older people continue to make good use of their creative powers, and as is true for all parts of the body, the brain usually will function better if it is used regularly. Lifetime learning means exploring new ideas, whether this is from reading, listening to radio or television, trying a new hobby, or trying a new recipe. It can include lively conversation with friends and family. What it boils down to is a willingness to keep exploring the many adventures that life has to offer.

      The benefits of lifetime learning include more enthusiasm for life, less boredom and depression, increased feeling of self-esteem and self-respect, more interest in the surrounding world, and new ideas to share with family and friends. Memory loss can be one of the hardest problems for both the care-receiver and the caregiver. Some memory problems are treatable, some are not. Therefore, it is important for the doctor to determine the causes of memory loss in the individual.

      Forgetfulness, even inability to recognize familiar faces and places, might result from such treatable causes such as malnutrition related to improper eating habits, alcohol, side effects of medications, loneliness, isolation, few chances to socialize with others, sensory impairment decreased vision, decreased hearing , surgery or accident resulting in injury to body, viral infections or other illness, or depression or other mental illness.

      People who have losses in hearing and vision may have trouble understanding things consequently negatively affecting their emotional well-being. Basic aids to hear and see are vital. At times an older person may be cut off from the world because of wax in the ears or worn out hearing-aid batteries.

      Glasses may need to be adjusted or perhaps just cleaned. Good lighting, without glare, is important. Magnifying glasses or large print can make reading easier. Because many older people enjoy recalling events from past years, families and friends should encourage the sharing of stories. Activities which stimulate the brain visiting with others can contribute to the goal of continued lifetime learning. Often, older people can become happier, more productive individuals when they are encouraged to perform fun, brain-stimulating activities.

      The following activities are especially good for homebound elderly:. Older people continue to be concerned about management of their assets and property. However, they may be unable to participate because of illness, confusion or loss of memory. It is important to involve them whenever possible. Develop an inventory which lists all assets and liabilities of the older person.

      The following items should be included: bank accounts, pass books, certificates of deposit, money market funds, stocks, bonds, precious metals, jewelry, real estate deeds, promissory notes, contracts, insurance policies, safety deposit boxes including location of the key , and retirement or pension benefits. Location of the records for each asset and liability also should be included. Other important documents, such as birth and marriage certificates, social security numbers, divorce decrees and property settlements, income tax returns state and federal , death certificate of spouse if any , and wills including the attorney's name and executor or trust agreements, should be listed and the locations designated.

      If able, the older person should compile the list. If unable, a family member, attorney, banker, accountant or certified financial planner can help compile the inventory which should be copied and kept in a safe, obvious place, possibly with a relative or friend. It is important that the document be updated every year.

      An objective of financial and estate planning for older people is to plan for the orderly distribution of the estate upon their death, according to their desires. Consequently, it is important for people to have a will drafted, which incorporates the above inventory and states how property is to be disposed of upon death. Everyone over the age of 18 should have a will or a similar legal document.

      If a person does not have a will, an attorney should be consulted immediately. Proper planning is essential and powers of attorney or trust agreements should be executed while a person is still competent. Otherwise, transfer of responsibility for management of the person's financial affairs to someone else must be completed through a court action, and costs spent in clearing up Probate problems come directly out of the person's assets, diluting whatever estate is left after death.

      Remember, as caregivers concerned about the financial affairs of a care-receiver, you should not get directly involved without legal authority. Acting without clear legal authority, even with the best intentions, can cause serious problems. The legal mechanisms available for surrogate decision making are: durable power of attorney DPA , probate conservatorship, durable power of attorney for health care DPAHC , and California only -- check to determine if your State has comparable laws. Durable Power of Attorney is a written legal document giving someone other that the Principal the authority to handle the Principal's financial decisions.

      It must be signed by the Principal while the Principal is still legally competent. The preferences of the Principal regarding the management of assets can be specified. This power to manage assets can be transferred immediately or can be designated to go into effect when it is determined that the Principal has become mentally incapacitated. Court proceedings to designate a conservator are required. The DPAHC gives someone other than the Principal authority to make medical treatment and health care decisions on behalf of the Principal for up to the maximum of seven years after the document is signed.

      Wishes regarding extraordinary supportive care, including breathing machines and tube feeding, can be addressed in the Durable Power of Attorney. The court determines if the Conservatee, in addition to receiving the necessary psychiatric treatment, may also retain or be denied the right to vote, possess a driver's license, enter into contracts, or refuse non-psychiatric medical treatment.

      The Conservator may be a relative, friend or an appointee from the Conservator's office. An individual has to be adjudicated to be gravely disabled before being placed on an LPS conservatorship. Grave disability is defined as the inability to provide for one's food, clothing, shelter and proper medical care due to a mental disorder.

      It is important to select an attorney who is knowledgeable in the areas needed estate planning, will drafting, probate or conservatorship. Anyone who accepts the responsibilities of a caregiver must also understand that there are a number of legal duties or liabilities that come with it. Many states including California have passed elderly abuse laws. Caregivers are bound by these laws in two ways: not to abuse the elder person physically, mentally or monetarily and report any incidents of abuse or suspected abuse to California residents only -- the Adult Abuse Reporting line or Residents of states other than California : Check you local telephone directory for the Adult Abuse Reporting telephone number or contact your county mental health services for guidance.

      As a caregiver, you must provide a clean and safe environment, nutritious meals, clean bedding, and clothes. At the same time, if you are in charge of the elderly person's finances, you must use that money properly, purchasing necessary services for the benefit of the person to whom care is given. Failure to provide care, failure to get care, and failure to purchase care are all forms of abuse or neglect.