By Eva Briggs, MD
Over the years I’ve seen elderly patients who were cared for and loved by their families, yet who still managed to develop serious medical problems that were neglected and missed for very long times.
It’s not because their families were uncaring or neglectful. Rather it’s a slow combination of factors that gradually creep up on aging individuals.
There is the independence factor. People may insist that they don’t need help with anything such as dressing, bathing, laundry or grooming.
No one wants to make their parent or family member feel helpless or dependent. In the past, it has always been the parent who was in charge.
There is the embarrassment factor. It can seem strange, or weird, or intrusive to examine a parent’s body — especially if it’s the private parts of an opposite gender parent.
But over time, many people’s vision deteriorates gradually. They can’t see the skin changes of infections, cancers or rashes. People become less flexible. They struggle to reach their feet for proper foot or nail care. Loss of sensation from diabetes, poor circulation or other conditions means that people may not experience pain from sores, skin ulcers or skin infections.
Problems that a younger person might notice immediately may go unnoticed in later years. Some people resist change. Favorite comfortable clothes and shoes slowly fall apart and lose their protective function.
Here are some examples I’ve seen over the years.
Early in my career, my patient Mrs. X lived alone. Her memory was fading. Her equally elderly friend helped her with finances, meals and transportation to the doctor’s office. When Mrs. X changed into a gown for exams at the doctor’s office, her underwear and bras were stiff and yellow with age, full of holes. The elastic was shot. Eventually I realized that the friend wasn’t doing her laundry or helping her dress, so she had no idea of Mrs. X’s deplorable undergarments. I discretely clued her in, and at subsequent visits Mrs. X was wearing new underwear.
My patient Mr. Y had mild dementia. He lived in an assisted living facility with minimal help and supervision. He had always enjoyed walking and slipped out one day for a long winter stroll. He wound up with frostbite (fortunately minor and he made a good recovery) on his feet because the soles of his favorite shoes had holes worn through. No one in the family had thought to inspect them.
Mrs. Z’s memory was poor, but she needed minimal help from nearby family. She was one of those people who never went to the doctor. She never complained about anything and insisted to her family that she didn’t need to see a doctor for checkups. Her normal activities were sedentary. She did nothing difficult or strenuous and seemed fine to her family. Until the day she was too weak and short of breath to walk to the bathroom. She turned out to have an advanced cancer that would probably have been discovered much earlier with regular exams.
X, Y and Z all had loving and caring friends and family. But their caretakers didn’t realize that that they needed just a bit more supervision.
So, my recommendations for caretakers are:
Inspect your loved one’s shoes, clothes and home. Fix, replace or repair items that are broken, dangerous or just too worn out.
Make sure their body is examined or checked out. You don’t have to look yourself if it is embarrassing. See an appropriate primary care provider and any needed specialists (dermatology, podiatry, etc.) at least once a year. Make sure their doctor gets them undressed for exams and inspects for problems. Consider hiring an aide to help with regular bathing and grooming if needed.
Even if the person you are caring for protests, be persistent and insistent. These simple measures can prevent little problems from spiraling into big deals.