How to care for elderly family members

January 16, 2019 Dementia, Dr. Angela Catic, Healthcare, Huffington Center on Aging, Nicole Blanton

Baby boomers are the fastest growing segment of the U.S. population and by 2030, all baby boomers will be over the age of 65. As the population ages, the number of family members who are becoming caregivers continues to increase.

“Sixty-seven percent of Medicare beneficiaries have two or more chronic conditions,” said Dr. Angela Catic, a geriatrician with Baylor College of Medicine. “As a result, elders often have what we call ‘polypharmacy.’ Depending on age, they are taking between 14 and 16 prescriptions per year on average.”

Managing hospitalization and delirium

Elderly patients are also more vulnerable to common colds and infections, which can lead to frequent hospital stays and complications.

“Hospitalization is a pivotal event. Not only think about why they were admitted, but consider all their chronic conditions and how to can keep them as functional as possible during the hospitalization.”

One such complication is delirium, which is an acute state of confusion. Predisposing factors for delirium include:

Impaired cognitive status
Impaired functional status
Sensory impairment (lack of hearing, vision problems)
Chronic medical illness

Catic says these tips can help caregivers better prevent or manage delirium:

Discuss prior to hospitalization: Delirium is often a marker that something serious is going on. If a hospitalization is planned, talk to the primary care provider about how to reduce their risk of delirium beforehand.
Consider medications as common cause: Keep track of medications, including where they’re coming from and which ones they are taking over the counter.
Involve family: Patients are often unfamiliar with care providers. Having the face of a family member there can be a calming, reassuring presence.
Frequent reorientation: Hospitalizations can involve frequent changing of nurses, providers and environments. Remind them of where they are, what day it is and other details that are reorienting.
The art of medicine: In consultation with providers, decide if the patient would be better off at home. Is their delirium so severe that they should stay in the hospital or will they recover more efficiently in the home environment with caretakers reorienting them?

Driving safety

When should an elderly family member stop driving? While this can be a difficult conversation to have, Catic says it’s important to address signs of poor driving performance. Providers should:

Start the conversation early
Offer road testing and simulation
Share alternative modes of transportation
Remain calm and respectful. “We can agree to disagree.”

“Elderly drivers with dementia have a two-fold greater risk of being involved in car accidents compared to cognitively intact peers. Physician advice is crucial and one of the most common reasons for driving cessation,” Catic said.

End-of-life care

If you are caring for an elderly family member, there is a high likelihood that you may eventually be asked to make life-or-death decisions for them.

“It’s a conversation most patients are uncomfortable having. However, the best gift you can give your family members is to document who you want to make medical decisions on your behalf,” she said. “Have a conversation with that individual about your wishes so that when the day comes, they won’t feel guilt or doubt.”

Dr. Catic is an assistant professor in the Huffington Center On Aging at Baylor.