Sunday, January 31, 2010

Impairments = Missed Opportunities

Reduced mobility creates hardships for seniors interacting with the world around them. When one experiences falls, broken hips, broken wrists, lower back pain and or a reduction in or cessation of driving, opportunities for interpersonal communications diminish.

My grandfather developed severe back pain brought on by a crushed disc in his lower back earlier this year. Lower back pain in the elderly is common, as a recent national survey proved that in “patients aged 75 and older…back pain is the third most frequently reported symptom” (Bressler, et. al., 1999). His back pain caused him trouble walking and difficulties rising from chairs, walking up stairs, walking to the phone, and getting in and out of vehicles. Additionally, just a few months prior, he suffered a fall that resulted in a broken wrist. The broken wrist reduced his ability to write and in combination with the loss of mobility from the lower back pain, he experienced a lack of communications with family and friends.

While the impairments in the ability to walk and write do not initially sound related to traditional communication barriers like hearing or vision losses, they have affected my grandfather’s ability to do many things related to interpersonal communication. He is no longer able to walk to the phone fast enough to answer it. When he finally does receive a phone call, he seldom holds the phone for long because of the pain in his wrist. When someone comes to his front door, he seldom makes his way across the house to open the door quickly enough. He no longer writes letters or sends birthday cards to friends and family. These impairments have led him to hire a caregiver to run errands for him, drive him and write out checks for him, though the caregiver’s assistance does not improve his communications with outside family, friends or society.

Further compounding the lack of communication that my grandfather experiences with avoiding calls and not writing, is the fact that he has ceased driving due to the lower back pain. Now that he must rely on the caregiver’s schedule for transportation, it has lessened his opportunities for outings and social interactions. “The older person who reduces or ceases driving bears the brunt of the changes that occur in terms of monetary, social, psychological, and emotional costs” (Burkhart, 2007). Knopp (2009) notes, that “isolation and loneliness experienced by nondriving seniors can result in deteriorated physical and mental health.” Plus, older drivers who generally drive on six outings per week usually reduce outings down to two per week when they become reliant on receiving rides from others (Burkhart, 2007). Hence by discontinuing driving, my grandfather has lost additional opportunities to engage socially with others outside his home.

Sadly, the number of seniors who do not drive is not as uncommon as one might think. “SCOPE, the community planning group, cites national research indicating that about 21 percent of Americans age 65 or older don't drive and that, on any given day, 50 percent are home-bound due to lack of transportation options” (Knopp, 2009).

Falls in the elderly are also not uncommon. Warshaw (2006) reports that “after age 85, over half of women will suffer a fall” while “31 percent in the 80- to 84-year age group” of men experience falls. The complications from falls include fractures of the hip, and forearm [or wrist] (Warshaw, 2006). Earlier this month, the Pope at age 82, fractured his wrist when he fell (B92.net, 2009). A good friend, Marie, who was in her mid-70’s when she fell on pavement broke both her wrist and hip. “Because bones become brittle with age, fractures are common among the elderly” (Joseph, 2008). Interestingly, Warsaw (2006) also points out that “after a few falls, some people become so frightened and anxious that they will not attempt to stand even when there is adequate help and support.” As people become afraid to stand or walk after falls, they are not likely to return to outings that require walking or standing which also decreases their opportunities for interpersonal communications with friends, family and society.

When Marie experienced the impairments of a fractured wrist and broken hip, I witnessed a loss in her interpersonal communications. Like my grandfather’s experience, Marie’s reduced mobility in walking and writing, resulted in her not taking telephone calls, seldom answering the door and the end of her writing to friends and family. Additionally, Marie had been a very social person before her accident and had engaged in many senior group tours overseas and spent much of her time out with friends shopping and dining out. Her reduced mobility led to the end of her overseas vacations as well as her social outings with friends.

When looking at the losses of mobility from back pain, falls, broken wrists and broken hips, compounded with the cessation of driving, it becomes clear that seniors and the elderly lose opportunities for social engagement as mobility is reduced and they become increasingly homebound. Thus, even impairments unrelated to hearing and sight can equal losses in interpersonal communications for seniors and the elderly.

References
Bressler, H., et. al. (1999, Sep., 1). The Prevalence of Low Back Pain in the Elderly: A Systematic Review of the Literature. Lippincott Williams & Wilkins, Inc. Retrieved from: http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=1999&issue=09010&article=00011&type=abstract

Burkhart, J. (2007, Jan. 30). Mobility Changes: Their Nature, Effects, and Meaning for Elders Who Reduce or Cease Driving. Ecosometrics Incorporated. Retrieved from: http://trb.metapress.com/content/dlk6vw1r15245554/

Joseph, T. (2008, July 28). Colles’ Wrist Fracture. Medicine Plus. Retrieved from: http://www.nlm.nih.gov/medlineplus/ency/article/000002.htm


Knopp, T. (2009, July 12). Nonprofit service helps seniors retain mobility. Herald Tribune. Retrieved from: http://www.heraldtribune.com/article/20090712/COLUMNIST/907121023/2080/OPINION?Title=Nonprofit-service-helps-seniors-retain-mobility.

Pope Falls and Suffers Broken Wrist. (2009, July 17). B92.net. Retrieved from: http://www.b92.net/eng/news/world-article.php?yyyy=2009&mm=07&dd=17&nav_id=60560

Warshaw, G. (2006, Apr. 10). Falls and the Elderly. University of Cincinnati. Netwellnes.org. Retrieved from: http://www.netwellness.org/healthtopics/aging/faq9.cfm

All content © Village Memorial. 2009-2010.

Saturday, January 16, 2010

Selecting In-Home Caregivers

Marion is in her 90’s. She lives alone, but is across the street from her son and his wife. Her children have hired many caregivers for Marion. However, Marion is never invited to interview or choose her caregivers. So, the result has been that Marion often goes without care because she frequently dislikes who has been selected to care for her and usually fires the person or drives them away with menial tasks unrelated to caregiving (i.e. pulling weeds). This has left Marion in an unsafe situation - without regular care.

Once when Marion was chosen a caregiver she got along well with, the benefits of good communication were obvious. Because Marion was instructing the caregiver in what she wanted and needed done, Marion was happier and more responsive during visits. The caregiver made sure she got up and dressed every day (as opposed to sleeping in bed all day in pajamas). She helped Marion to look presentable, even helping her to dye her hair red. Marion was eating regular meals, looking healthier and feeling better. She boasted how good it felt to have her back scrubbed during her bath. She stopped falling trying to use the restroom during the night (perhaps because she did not sleep all day, she had more opportunities to go during the day.) This caregiver contentedly worked with Marion for over a year until Marion’s son cut her hours back and she was forced to move on.

The lack of communication between Marion and her children has been a losing situation for Marion’s health and wellbeing. Marion does not communicate her wishes to her children because she feels they do not care (likely because she is never included in the decision making). Marion does communicate her concerns to her grandchildren, but they have no control over the finances, Medicaid, or care giving decisions.

As in-home care is highly personalized, communication is key. If a senior is of mental clarity and can communicate for herself, this is ideal. This gives the senior a voice and a decision in the administering of her own care. However, when family members step in and make decisions without the senior’s input or consideration, as Marion’s family did, this is highly destructive to the senior’s sense of independence, as well as the quality of care she receives.

A properly placed caregiver, sensitive to the client’s personal needs, would ensure better care and a greater longevity of caregivers. Simply working in firms that had high turnover rates, one gets a glimpse of the stress that training new people or adjusting to changes in staff creates. I cannot begin to imagine how just how stressful it would be to add a turnover in caregivers to dealing with one’s own personal disabilities or unattended needs. It cannot be healthy for seniors to deal with such turnover, which makes the initial proper placement such a vital step in the care giving process.

Benefits of In-Home Care
• Significant financial savings to seniors and Medicaid
• Staying in one’s own home is generally preferable to entering a retirement community.
• People tend not feel sick if they are cared for at home.
• People are able to maintain some forms of independence, as they address some of their own needs themselves or by delegating difficult tasks to an in-home caregiver.
• Seniors do not have to lose the community they have grown comfortable with.


All content © Village Memorial. 2009-2010.

Wednesday, January 6, 2010

Green Departures

“Americans put 827,060 gallons of embalming fluid, 1,636,000 tons of reinforced concrete, 104,272 tons of steel [for caskets and vaults], 2,700 tons of copper and bronze, and 30 million board feet of hardwoods into the ground each year...the concrete alone…[is] enough to build 13,573 American houses.”
A growing trend is the practice green or natural burial, which compassionately cares for the deceased and protects the earth. However, this natural and safe method has been practiced for centuries.

Muslims wrap their dead in “white wrappings” and bury them directly onto the dirt of the grave (Jonker, 2006, p. 158). As Jonker (2006) explains, “No coffin is needed or wanted” (p. 158). The body is lowered into the grave “with shawls or lengths of cloth” and is “positioned as if sleeping” (Jonker, 2006, p. 158) with either a stone or pile of mud placed under the head for support (p. 158). The natural burial of the body in Islam (wrappings of just a shroud, no embalming and being placed directly in contact with the earth) allows for a more natural return to the earth. There is no use of unnecessary embalming fluid and coffin to slow the recycling of the body to the soil.

The Jews also bury directly in the ground, and do not allow interment in mausoleums “as this is not returning the body to the dust from whence it came” (Levine, 1997, p. 107). Additionally, like Islam, Judaism prohibits both cremation and embalming (Levine, 1997, p. 107). This law was designed to prevent destruction and or altering of the body, however it is also done for the compassion of the surviving loved ones (Levine, 1997, p. 107). Because “embalming…creates an illusion of life…[it] may hinder the bereaved from acknowledging the death of their loved one” (Levine, 1997, p. 108). These compassionate Jewish values honor the deceased, assist in the healing of loved ones and protect the planet.

Ecohumanist beliefs also support natural burial for the preservation of the planet. One of the principles shared on the Council for Secular Humanist (2009) is to “protect and enhance the earth, to preserve it for future generations, and to avoid inflicting needless suffering on other species.” When one considers all the pollution and waste from common contemporary burials (embalmed body in casket), one cannot ignore the significant and devastating effects upon the earth. Cullen (2006) presents some very startling statistics on contemporary burials.
“Americans put 827,060 gallons of embalming fluid, 1,636,000 tons of reinforced concrete, 104,272 tons of steel [for caskets and vaults], 2,700 tons of copper and bronze, and 30 million board feet of hardwoods into the ground each year...the concrete alone…[is] enough to build 13,573 American houses” (p. 52).
“Like the contents of any landfill, the embalmed body’s toxic cache escapes its host and eventually leaches into the environment, tainting surrounding soil and groundwaters” (Harris, 2007, p. 38). This happens because coffins are not leak-proof. Harris (2007) explains that the “combined body fluids, liquefied tissue, formaldehyde, bacteria, and corporeal acids…collect at the lowest spot of the casket, pooling in a…toxic soup” (p. 37). Wood caskets are porous offering minimal resistance to such toxic liquids, which can easily leak out (Harris, 2007, p. 37). While “metal caskets are more resilient…acids work to breach them as well” (Harris, 2007, p. 37). Cullen (2006) notes that green (natural) burials can “cut that waste [and pollution] dramatically” (p. 52).

Embalming and caskets are not only unnecessary, they are wasteful and harmful to the planet. Obviously the pollution of the earth and the waste of precious resources do not help to protect the purity or safety of our planet. Natural or green burials, as supported by Ecohumanists, are clearly the most ethical and compassionate methods of burial. They help protect the planet for future generations.

References:

Cullen, L. T. (2006). Remember Me. New York: Harper Collins.

Harris, M. (2007). Grave Matters. A Journey Through the Modern Funeral Industry to a Natural Way of Burial. New York: Scribner.

Jonker, G. (2006). The many facets of Islam: Death, dying and disposal between orthodox rule and historical conventon, in, C.M. Parkes, P. Laungani, & B. Young (Ed.), Death and Bereavement Across Cultures (pp. 98-130) London: Routledge.

Levine, E. (2006). Jewish Views and Customs on Death, in, C.M. Parkes, P. Laungani, & B. Young (Ed.), Death and Bereavement Across Cultures (pp. 98-130) London: Routledge.

The Affirmations of Humanism: A Statement of Principles. (2009). Council for Secular Humanism. Retrieved June 2, 2009, from: http://www.secularhumanism.org/index.php?section=main&page=affirmations
All content © Village Memorial. 2009-2010.