Wednesday, June 13, 2012

Elder Care Wonder

There's something I wonder about sometimes. The quick is: Is it mean or kindly to let the elderly do things, even difficult things for themselves.

Specifically, it's late right now, and I'm getting my mother to bed. It's our normal bedtime, if not a bit early for her. She's in the bathroom struggling to get out of wet clothes from incontinence and put on clean dry ones.

Of course, I can go in there, order her around, hold the pants, guide her feet into the holes, etc., to help and hurry her along. It would ease her body and certainly quicken things up.

The question is: If you start doing everything for someone, how much do you hasten their inability to do anything for themselves.  My intuition is that you certainly hasten that inability. That's the tack I've been taking with caring for my mother. Yet there's a bit that nags at you; it makes you think that it's kinder to ease the ache by helping.

On the gripping hand, however, you can't predict the future, which includes how incapacitated the elderly will become nor how long it will be before they finally die. The reality that seems nasty to ponder is: If I do everything and they become immobile, will they linger immobile for years, or if I don't do everything and they remain somewhat capable, will the remaining years be okay for them, even if easier for me?

Wouldn't it be nice if there were some master teacher to hand you the path to follow.

So mother finally got dressed and made it into the bedroom. After she lay down, she asked me if Joe (her husband) was dead. I replied, "Yes, he's been dead for 7 months now." She paused then asked me if he was a Christian. So take me aback there. First, who am I am to judge who's a Christian. That's a purely personal deal between you and your God. Second, shock that she's lost her whole life - she's known the man for nigh on to 85 years, and was married to him for over 60 years, and she's lost that bit that is a basic principle to her life? Like she'd marry someone who wasn't?

Okay. So I know it makes no sense in what shocks me. As if you can expect someone who's lost the ability to recognize herself in photographs unless they are from 1950 or earlier to remember the guide posts of their lives. It does, though. Each new thing she loses still shocks me. Each time I encounter one of these things, I still stagger at the loss and have to search frantically for a kind way to respond.


Alex Dragon said...

The truth is that dementia is generally a downward trend. It can be slow, or surprisingly fast. There are people I care for who six months ago were able to be prompted to do something and required no assistance, but now they require full assistance with everything. No-one can predict from today what the ability of a given person will be tomorrow. If your mother needs assistance because otherwise she would sit there and do nothing, then she needs assistance. If you need her to be dressed for a particular event (doctor's visit, for example), then you can assist even if she normally doesn't need much assistance. Only you can judge how much assistance Lola needs, and it may vary day to day.

It's a lot like raising children, but in reverse. As a child grows she gradually masters more and more tasks and needs less and less assistance, then just prompting, and then finally can manage to see what needs doing for herself and do it. The elder with dementia starts off capable of doing whatever for herself, then she will require prompting, then assistance. I don't think that providing assistance *makes* this process hasten, as it just happens in its own time - for some people the process goes very swiftly, and for others less swiftly. By verbalising the prompts and the tasks as you perform them you may help her remember the order or process. At the very least, you are giving her the opportunity to participate, or at least a warning of what you are about to do.

Alex Dragon said...

When prompting, don't give your mom too much information at once. Better to take it step by step:

"It's time to get up, Mom."
"Now let's go to the toilet"
"It's time for your shower - can you take off your nightie, or should I help?"

Give her a chance to respond, either verbally or by initiating the action. If she has trouble getting started, you might initiate - by pulling back the curtains or bedclothes for her to prompt her into "getting up mode". You might need to do everything anyway, but a kind of running commentary as you go will help her feel like she's following a familiar pattern.

Don't overload with too many instructions at once - the demented brain is easily overwhelmed.

Sometimes the part of the brain responsible for "starting and stopping" of actions is affected. You may need to start her off but she is able to continue on her own. You might need to tell her "ok, you've washed that foot, now wash the other one" to prompt her to move on to the next task. If you're showering her, then give her a washcloth to wash her face while you wash the rest of her with another one. Same thing with drying - give her a small towel and let her dry whatever she can reach. Even if she simply holds the cloth or towel and you actually complete the action using your cloth, it gives her a feeling that she is doing something. It helps her retain dignity in a situation which inherently has very little dignity about it.

Jola Gayle said...

Thank you, Alex, for your comments. They are important and helpful. So please realize, even if I don't reply to each one, I read them, others read them, and they help. I am always grateful for your comments.