It Takes More Than Love: A Practical Guide to taking Care of an Aging Adult with Anita Beckerman

WebMD Live Events Transcript

Gerontology expert Anita Beckerman discusses her beliefs on the issues facing caretakers of older adults.

Event Date:  05/25/2000.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live's Senior Vitality Auditorium. Today we are discussing It Takes More Than Love: A Practical Guide to Taking Care of an Aging Adult, with Anita Beckerman, EdD. Anita G. Beckerman, A.R.N.P., C.S., EdD., has more than 20 years of experience in the field of gerontology, both in clinical and academic settings. She is the founder of two continuing education programs in the College of Nursing, Florida Atlantic University. Dr. Beckerman is a frequent contributor to journals and an in-demand lecturer in the community on older adulthood. She is the co-author of  It Takes More Than Love: A Practical Guide to Taking Care of an Aging Adult.

The opinions given by Dr. Beckerman are hers and hers alone. If you have specific questions or are concerned about your health, please consult your personal physician. This event is for informational purposes only.

Dr. Beckerman, welcome to WebMD Live.

Dr. Beckerman: Thanks for inviting me; I'm looking forward to this hour.

Moderator: In what ways do clinical trials fail to account for the needs of older adults?

Dr. Beckerman: Most of the clinical trials are usually geared to the needs of younger adults, or the participants are younger adults. One example is medication: Most most doses are based on clinical trials with younger, well adults. So the bottom line is that older adults should be started with the lowest dose possible, and that dose should be increased over a longer period of time, so that the normal changes of aging can be taken into account when you want to know how long the drug is going to stay in the body.

Moderator: What types of medications are you referring to?

Dr. Beckerman: Diuretics, hypertensive medication, any kind of antidepressants, many drugs -- I would say all drugs need to be started with the lowest dose possible, and then slowly increased.

Moderator: How can older adults tell if they have an actual malady or their illness is in fact drug-induced?

Dr. Beckerman: If it's something that's new that has happened after taking the drug, you can guess it's due to the drug. Disease usually happens over a period of time, and doesn't happen acutely, although heart attacks can have acute signs and symptoms. Side effects from drugs are experienced in something you haven't had before.

Moderator: What do most people not know about the potential dangers of drugs that they should?

Dr. Beckerman: They don't know that all drugs are drugs. Over the counter, prescription -- these are all drugs. Drugs need to get to their target organ to do their job, but also have to be excreted. As you get older, kidney functions have decreased somewhat, and most drugs are excreted through the kidneys. Older adults practice poly-pharmacy. They take many different drugs, don't get a full list to their health care provider, and don't include what's over the counter. Anti-inflammatories have side-effects. Many drugs given by prescription years ago can now be bought over the counter.

Moderator: How do our bodies process drugs differently as we age?

Dr. Beckerman: Our kidneys are mostly involved in that the blood flow to the kidneys, which has to do with how drugs are excreted, decreases somewhat because our cardiac functions decrease somewhat. So we tend to build up drugs in our body, so a decreased level of functioning of the kidneys, and a decreased level of functioning in the liver, which is responsible for metabolizing drugs, tends to result in an increased level of drugs in the person's body. If you continue the same dose, a person can experience many side effects that they hopefully wouldn't experience if they were given lesser amounts of the drug.

Moderator: This harkens back to proper dosage for older adults?

Dr. Beckerman: An example: Last year, I experienced Hodgkin's lymphoma, and my thyroid was affected by treatment. I was given a prescription for a thyroid supplement, and was given a dose too much to start with. I was told it's the usual dose, but I was an older person and that wasn't taken into account. So, it was decreased to one-third of the normal dose.

Moderator: When we talk, in this forum, of "older adults", which age bracket are we referring to?

Dr. Beckerman: That's a confusing kind of question, because at 69, do I consider myself old? No. But 65-plus, and then the older old, from 85 and up, a group of which we have more today and will have in years to come.

Moderator: How will geriatric care change in the coming years?

Dr. Beckerman: I think it's a happening that we can't do much about, and it's a positive happening. The Social Security Administration has recognized that factor, because they've done away with the amount of money that an older person can earn when they start getting social security. Older people are working later in life, and contributing more to society. There'll be an increased need for health care that will take into account the older adult's need. This focuses on the needs of the older adult, and the changes that take place, which are the normal changes to aging. The diseases usually encountered chronically need to be more acknowledged in how you treat and assess that person. Community resources as well. A lot of money will be needed to help the older adult live better, because they will live longer. They are now.

Moderator: Do you feel that the current medical establishment is adequately trained in gerontological medicine?

Dr. Beckerman: I feel both the medical and nursing establishment need more training in gerontology. There are more geriatricians available, but you have to look for them. There needs to be more specific courses in gerontology; not just added onto the program but focused on the needs of the older adult, just like pediatrics.

Moderator: How important will the need for geriatric care, or assisted-living facilities, become?

Dr. Beckerman: Very much, but it's getting a little over crowded. Most older adults live in their own homes, at this point in time, and are taken care of by community resources or family members. That was one of the reasons for this book -- that most of the caregivers are women. What happens is that the sandwich generation, or the children of the older adult, are getting older and have their own needs and stresses. Many are working later in life, and have children who are adult and growing up, so that the old older adult may need to go into a nursing home or assisted living.  And that's very costly. Not all are able to go into Medicare or Medicaid, because most are private pay. The book discusses very clearly what you need to look at to judge a facility's quality, because many are very good.

Moderator: And conversely, some of them aren't as good?

Dr. Beckerman:  In the book, we discuss the 10 most important indicators of a facility's quality, for example, the attitude of the staff towards the residents. Does the staff feel this is just a job, or is there a caring observed? Regarding the condition of the resident's rooms, and the quality of the care given, is it given with a friendly touch, or given kind of rough? As to adequate staffing, is there an RN (registered nurse) onsite at least eight hours during the day? Are the staff licensed certified by the state? The quality of the food served -- you may need to appear and ask if you can have a meal there, and see how it's served, and the environment where it's served. If the facility isn't located where the caregiver can travel to see if the person is there, then everything doesn't matter too much. And the cost -- is that within your budget? Some may need private pay; some Medicaid or Medicare will cover them. How are the public areas? When you walk in, is it lit and pleasant? And your overall impression -- gut feeling, most important. What was the impression you received of the place? You want to take a trial visit with the person you are thinking of having this facility as their home.

Moderator: What options are available if someone doesn't have a lot of money for geriatric care?

Dr. Beckerman: The options are, for the person who is the care receiver and needs to have the care, perhaps they need to go on Medicaid. This is something you may need to explore with a social agency of the state. That's one of the things our government needs to get more involved in, and make sure it's available on an equal basis to all older people. It should be that the resources are on an equal basis for all older people.

Moderator: What does care-giving for an older person entail?

Dr. Beckerman: It involves both physical involvement, emotional involvement -- and one of the things about this book, is that it's very comprehensive -- it takes in all areas of care-giving, and we want to make the task easier. We want to make people feel good about what they're doing, and to help them take care of themselves. We give advice on managing medications, aspect of dating, moving, incontinence, emotional support, and very importantly, the book starts out with emphasizing communication skills,  and resolving care-giving issues. We give practical advice, and hopefully enough detailed instructions so the caregiver can give good care. It gives guidelines to balancing your own life. It's so important for the caregiver to look at the same area of nutrition. You also need to eat well and make sure you have a relaxing time for meals. If you can, get a neighbor or friend to perhaps sit with the person while you're eating your meal, or put a favorite movie on the VCR while you're eating or cooking. One of the things I say is serve on paper plates. You have to do things as they maybe were not done before, but know that's okay. Make these changes and know they're okay. Most caregivers are still working, and if you're juggling time constraints and personal needs, you need to know what to do, and to know that it's okay. You don't want to feel guilty about doing it.

Moderator: Can we address the role of adult children in this? What are some tips for balancing the needs of an aging parent and the needs of your immediate family?

Dr. Beckerman: One of the things is to try to have open communication between family members, and sharing of responsibility. What happens is that one person in the family is designated the caregiver, and others will lend support, but not as the ultimate caregiver.  Open communication is important, and to include the person like your father in the discussion. Who will visit the person in the nursing home? Know that what you do, if you do it with love and caring, is the best you can, and don't feel guilty. More guilt comes about when children are involved with older-aged parents, when the family members don't sit down and discuss what the older person needs and wants, and the resources to provide this. The discussion can be opened up, and ask "can we share?" and "who's best at this and that?" Family members often don't have good communication. We suggest trying to have family meetings. It can be done by the phone. Sometimes with technology now, you're in California and he's in Canada. There can be conference calls.

Moderator: Isn't it difficult to accept the role of caregiver? For so long there was a parent-child relationship, and now it begins to change. How does this affect the family dynamic?

Dr. Beckerman: There is a growing and change in roles. You want the person receiving the care to maintain as much independence as possible. One way is to include them in discussions concerning them. It's very difficult when the roles change. Parents take care of the children,  then the children take care of the parents, and it's very hard. Including them in the decision-making is important. One chapter in the book is about protecting your own health and not feeling guilty about it.

Moderator: Do you feel that enough attention is paid to the psychological impact of aging, both on the receiver of care and the caregiver?

Dr. Beckerman: I would say probably not, because many times it's like the person is getting old, so we write it off as emotional. When somebody is in their eighties or nineties, and tired and discouraged because they can't do things for themselves -- if it suggests signs of depression, there is medication that can be given for that. One of the things that society doesn't deal with is death. We are born to die, and death should be made as pleasant an experience as when someone is born, with family members around, allowing the person to talk about it. Most of the time, we don't want to talk about it. When talking about signs and symptoms of depression, changes in sleep pattern, weight loss or gain, restlessness or irritability, feelings of worthlessness or self-reproach, or just losing interest in other things, sometimes those are signs and symptoms of depression. For that, you need an assessment from the health care provider. If the person wants to talk about the end of life, you need to allow the person to do that too. Usually, the caregiver can't deal with the end of someone's life. It's often very difficult, stressful, and straining, and we tend not to talk about these things very much.

Moderator: How can you tell if an older person is experiencing the onset of dementia?

Dr. Beckerman: Dementia is usually something ? Alzheimer?s being the most common. It's decreased blood flow to areas of the brain, and it's usually progressive. Somebody is forgetful, but if somebody becomes more forgetful, and mental aspects aren't working appropriately -- the major thing is that it progresses, and not something that just acutely happens. There is delirium, and that's different than dementia, because that's caused by medication. That can cause you to seem to be forgetful, or you seem to be confused. Dementia is usually progressing over time.

Moderator: In your experience, what do older adults fear the most?

Dr. Beckerman: They fear not death, but the pain of dying. Many associate dying with pain, and the study I did on hope a number of years ago -- that was the constant comment of participants. It wasn't death itself, and they didn't have any regrets, but they fear any pain that can be associated with the process of dying. This is something health care professionals are able to address.

Moderator: What can we, as caregivers, do to alleviate those concerns?

Dr. Beckerman: Forcing the topic out into the open, and if the person has a particular illness like cancer, and there's pain associated with that, to make sure appropriate pain medication is prescribed, and to work with the health care provider. To make sure that the person knows that they will not have pain --  this is not doing a Kevorkian, or helping someone to die, but making sure that the end of their life is pain-free.

Moderator: A very uncomfortable topic we sometimes hear about is elder abuse. How common is this?

Dr. Beckerman: It is there, and most of the time it'll be there because of frustration from the caregiver, if the caregiver has a lot of stress. One chapter of the book goes into the resources available. That person, in getting stressed out, can react physically, mental abuse, they can handle the person roughly, or talk to the person very coarsely. That can happen, and usually will happen when the caregiver is very stressed. It may be because there isn't enough staff available in the institution. This is where the caregiver needs not to just say "okay, this is the particular place I brought mom or dad here to live, and they seem to be fine", and then just walk away from the situation. You always need to be involved. Constantly ask questions. Observe if they seem to be bruised, or do not seem to be eating, or refusing care. There are reasons why people refuse care. They're not used to the shower because they always took a bath. Older people do bruise more easily. You need to be the eyes and ears of the person while that person is in an institution. In home, stress needs to be reduced by looking and asking for help. In the book, we give the resources you need to go find help. Most caregivers tend not to ask for help. My husband had a stroke six weeks ago, so now I'm the caregiver, when last year he was the caregiver. When I need help, I don't hesitate to ask my children for help.

Moderator: What about forms of abuse by elderly adults? Either through emotional abuse toward caregivers, or perhaps by abusing medications?

Dr. Beckerman: Emotional abuse to their caregivers -- that is frequent. Take an example of a parent moving in with the child, and the parent becomes very demanding with certain foods and schedules. That can be overwhelming to the caregiver, and what needs to be done here is open communication, and a contract set up where "I can't be here all the time for you, can't do it your way, so can we get to a compromise?" And not to feel guilty if things cannot be exactly the way they were before. Older people practicing abuse happens more frequently in an institution, where if they are in pain they will hoard pain pills, so when they feel a lot of pain, they can take them. Elderly people abusing alcohol -- many times, this happens when the person is living alone. Family members have died, their spouses have died, or their children live some distance. That does happen.

Moderator: How common is suicide amongst the elderly?

Dr. Beckerman: It does exist, and when you have the feeling, with the symptoms and signs of depression, find out if there are suicidal thoughts or attempts. When someone is alone and experiencing a deep sadness because of a loss, they're much at risk for taking their own life, and it does happen. You have to be aware of changes in the person's emotional behavior or thought. If they've had a significant weight loss or gain, too much sleep or too little sleep, irritability, thinking process, losing interest in themselves and not dressing the way they used to -- do they have suicidal thoughts? Are they hoarding pills in their home, so they can take an overdose?

Moderator: What are some good ways to stay active and interested as an aged adult?

Dr. Beckerman: There are many exercises they can do, but make sure before they start to have clearance from a health care provider. Older adults need to feel needed within society, and society tends to feel that older adults aren't contributing participants. There are older adults who live at home, and can make phone calls to other older adults in the local community. This is a wonderful way to feel needed. There are schools with intergenerational programs, where they bring older adults in nursing homes into the school. Children learn about the older adult by being involved with them, and interacting with them. Other volunteer work -- sometimes they can go to senior centers, if the caregiver has resources to take them there. Being entertained, perhaps, by people that come into the centers. There are things to do. It's a question of finding out. A good place to start is the Local Office Area of Aging. You can find them listed in the phone book.

Moderator: What types of services does an area office on aging offer?

Dr. Beckerman: They serve as the clearing house of what would be available in your community for you to seek out, to help you with providing care to the older adult. Sometimes that's not easy. Different health care associations having to do with diabetes, or council to the blind will tell you what's available in your community that you can access, transportation in different states, different resources to transport people to a doctor's office or to senior centers. Usually they're a clearing house, because service is very fragmented. The Internet is a wonderful resource for looking for different support groups to help the older person. That's something that, if you're familiar with using the Internet, would be very good.

Moderator: All kidding aside, is Florida particularly well-suited to aging adults, and if so, why?

Dr. Beckerman: One of the good reasons is weather. People aren't homebound during the winter months, and this allows them to get out easier and feel part of the community. There are a lot more resources in southeast Florida, because of the large population of older adults, and the demand for resources. Transportation is a big area. I don't know how it is in other states, but in southeast Florida, transportation isn't readily available. But the services here are particularly good for the older adult, because of the large number of them retired here. There is an overabundance of assisted living facilities, and other facilities for the older adult. At the college of nursing at FAU (Florida Atlantic University), we offer services for elderly living in the community. They need their own transportation, but we can take blood pressure, offer advice on medication, etc. I'm involved as the coordinator of a gerontology certification program. One of the courses is geropharmacology, the aesthetics on aging, sensitizing the younger adult or caregiver to the older adult. We offer a lot.

Moderator: Finally, as we near the end of our time today, do you have some final thoughts you would care to share with us?

Dr. Beckerman: Go into this particular task of being a caregiver with an open heart, a lot of caring, and knowing that there are support systems, resources -- and knowing that what you've done, you've done your best, and to not feel guilt about what you're doing. A long as you're involved, you've done your best.

Moderator: Thank you for joining us today, Dr. Beckerman.

The opinions given by Dr. Beckerman are hers and hers alone. If you have specific questions or are concerned about your health, please consult your personal physician. This event is for informational purposes

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