Posted in Aged Care, Working with Elderly

The In’s & Out’s of Constipation

“Because it’s a goddam pain in my butt!”

Being constipated STINKS.

Certainly, nobody likes talking about constipation out loud, let alone having to endure the often excruciating pain associated from suffering with it.  In fact truth be told, and much like being constipated… I’m finding it hard work bearing-down to squeeeeeze out my thoughts and write about it.

Let’s face it, as distasteful (and smelly) as the subject of constipation is… and as much as we might poo-poo it, the fact remains that as human beings sooner or later, we all have to ‘go’. 

The problem is of course when you CAN’T go.

Waiting…. waiting…

And although we are each so physiologically different (and what’s normal for one isn’t necessarily normal for another) most doctors generally consider that five days or more of NOT being able to evacuate your bowels, means you pretty much to some degree, have become constipated.

Unsurprising to me, is how merely mentioning the word constipation in the presence of many of my elderly clients, can result instantly in a frowny screwed-up-nose face or clenched teeth.  Which is a worry because if there’s one thing bunged-up people of advanced age don’t need – is MORE clenching!

Sadly, and unfair as it may be however (and for a whole toilet-load of reasons), it is becoming typical that chronic constipation is more prevalent the older we get.

Oh, the joy!

10 Poopy reasons why Older Adults are more prone to Constipation:

  • Some medications (eg: pain meds) have constipation as a pesky side-effect
  • An ageing colon, as per the rest of an elderly peep’s body, may just not be as peppy as it once was
  • Dehydration from diuretics can cause people to wee more, resulting in an increase in fluid-loss causing stools to solidify
  • Retirement for some people can mean a more sedentary lifestyle (ie: slow down your life = slow down your bowels)
  • Dietary changes (eg: during travel) or a loss of appetite mean a lack of proper nutrition involving ample quantities of fruit n veg.  You can never have too much fibre, Fibre, FIBRE!
  • Drinking less fluids allows for more chance of the dreaded Dehydration
  • Frequent digestive tract issues or the development of diseases can mean the likelihood of constipation is also increased
  • Various medical conditions associated with ageing are symptomatically linked to constipation – eg: MS, Diabetes, Parkinson’s
  • Being sick and/or bedridden for long periods encourages a lower metabolism rate.  You can’t remove it – if you don’t move it!
  • Depression, anxiety, stress, lack of sleep can all contribute to a sluggish bowel due to upset bodily functions and a hormonal balance that’s thrown everything out of whack
  • Blockage in or around the bowel/colon regions can physically prevent the elimination process from occurring…  an indication that something medically sinister may be afoot (a-bottom?) 
OUT, damn plop?

Mind you, it’s not just poo-less pensioners who battle with the anguish of infrequent faecal evacuation.  Most of us at some stage in our lives, have been ‘privy’ to the gassy, smelly delights associated with constipation.  And we know only too well, how much it can disrupt our quality of life by zapping energy levels and leave one feeling uncomfortable, bloated and… well, just SHIT really.

Sadly, it’s the older generation who seem to get struck more frequently with ongoing bouts of chronic constipation – and often it’s a symptom (or a stinky side-effect) of an underlying age-related health condition.

CONSTIPATION STORY TIME!

I’ll never forget the time I arrived at the home of one of my loveliest clients for the very first time.  A charming and gentle lady, Annie Turdsworth was the most-kindly person you could ever wish to meet (note: her Cream Cheese & Banana Nut loaf is pretty fabulous too).

Mmmm creamy, bananery, nutty goodness

On this particular day, I found her pouring over a pile of paperwork at her kitchen bench. 

It turns out, Annie has put up with a lifetime of suffering from various ongoing gastrointestinal complaints and long story short, since the day she turned 65, has been diagnosed with the crappiest lot of bowel disorders imaginable.  Ranging from IBS to diverticulitis and now most recently at age 87, they have decided she may have colon cancer.

And being that the specialist needed to know what her bowels were dishing out, Annie was instructed to keep a Poo diary of every time she ‘went’ to the toilet; how her stool looked, its colour, texture and shape etc. 

Oh dear, you can imagine… the demure and deeply private Mrs Turdsworth was appalled!

Luckily, her doctor had a copy of the Bristol Stool Form scale (BSF) to wave in front of her and put her mortified mind at ease.

As a simple user-friendly picture rating system, the BSF enables people like Annie (who would rather DIE than discuss their bathroom habits) to utilise the handy-dandy illustrations to match up the appearance against their own stools.

So rather than having to say horrific words like “runny” or “hard pebbles”,  Annie could instead work discretely off her BSF guide and record the corresponding number of the day into her diary (once she got over the terror of looking inside the bowl, that is!)

I’m actually flattered that Annie feels brave enough to confide in me about something as personal as bowel movements (or lack thereof)…although it took a while for her to gain confidence.

“I think today Dollie, I’m more of a 2 than a 3” 

Now when I visit, we fill in her ‘log’ book together, along with the food she’s consumed in the last 24 hours all nice and neatly, for the doctor to peruse later.  Annie then pops the diary into an empty chocolate box, twists a large rubber band around it and then tucks the whole sordid package away out of sight in a drawer beside her bed. 

If we can’t see it, then it doesn’t exist, right?

What kind of STOOL am I?

At the other end of the Constipational spectrum, I should definitely make mention of another of my cherished clients, Maggie Cementballs.  Not only does the brazen 94 year old Maggie NOT require a picture chart to categorise her faecal formations, but because she is deaf (and refuses to wear her “posh hearing aids in case I lose one”) – we get to discuss it LOUDLY. 

“JUST SO YOU KNOW, DOLLIE… I HAVEN’T BEEN TO THE TOILET SINCE 1973!”

And we have a good laugh.

All jocularity aside though, it would be fair to say dear old Mags suffers with what must surely be some the most crippling waste elimination woes in the entire universe.

Throw in a blossoming set of haemorrhoids, ongoing colon surgery and a couple of rectal prolapses – there’s not much poor Maggie hasn’t experienced when it comes to digestive complications and the torturous impacted-ness her bowel insists on putting her through. 

And she is more than happy to give me the full detailed account on her constipation problem-o-the-week.  I recall last week’s pooping particulars went something like this (note: this is in SHOUT format):

“WELL, I DON’T LET IT GO ON AND ON, OR I END UP IN AGONY – ONE CAN ONLY PUSH FOR SO LONG!

AND FOR ONCE, THE PROBLEM IS NOT WITH THE ACTUAL GOING… IT’S THE FINISHING OFF BIT THAT’S ALL TOO HARD AT THE MOMENT.

…BUT I HAVE TO GET IT OUT, DOLLIE!  I CAN’T WALK ROUND WITH THE THING HALF HANGING OUT OF ME, CAN I?” 

“CRIKEY NO, MAGGIE, YOU JUST CAN’T!”  I bellow back, with my super-concerned face on.

Unfortunately, there’s not a lot that I or anyone else can do for the long-suffering Maggie.  Due to her advanced years, doctors have advised that further surgery just isn’t viable ie: it would most likely kill her.

And therefore, all they can do is pump her full of pills, top up her pain-killers and assist her to manage the condition at home as best she can. Not much fun when you’re a frail old girl in your nineties and much like every other poor soul having a crappy time in the bathroom – all she ever really wants from life is a happy ending. Literally.

HAPPY CARING!

Cheers,
Dollie

Posted in Aged Care, Working with Elderly

10 Tips for Meeting an Older Adult at their Home for the First Time

An Aged-Care Worker’s Guide

Knocking on the front door of a newly-assigned elderly person’s home for that very first time is always an anxious few seconds, but understandably even more nerve-racking if you are a newbie to this ‘caregiver’ caper.

In fact, I recall many years ago the day of my first shift ever… standing at the top of the steps, staring at a stranger’s doorbell (of someone I would shortly be helping undress for their shower) and wondering if it was not too late to turn and run for the hills!

  • What if they don’t like me?
  • What if I run out of time?
  • WHAT IF I DO IT WRONG?!?!
Ding, DONG!
Anyone home?

I remember, too, thinking how I hadn’t really been forewarned on the reality of what to expect when arriving at a sceptical senior’s house for our first meeting.  I knew that I needed to be confident and professional in order to gain trust, but it turned out to be instinct I relied on to provide my client with a warm friendly vibe, that put them at ease.  I wanted them to know that not only was I was good at my job, but that I was a genuinely kind, empathetic person – and that I CARED too!

Luckily for me, my first client was the most adorably grateful, yet desperately frail gent who didn’t give a toot that I was the new kid on the block.  He was just so relieved to have me there.  

Which I guess at the end of the day is what it’s actually all about… THEM.

And NOT me.

So, I thought it might be helpful to list some essential, yet often over-looked pointers, to ensure the initial meet ‘n’ greet with your new client is as successful as it can possibly be. That brief, but impressionable moment where you get to reveal your amazing self and to plant the seed for a future mutually beneficial and respectful working relationship.  

Beware the twitching curtains…

1.   SMILE!

Appearing at your client’s door with the cheeriest, beaming-est face you can muster, will often be enough to knock the wind out of a potentially grumpy or resentful elder’s sails.  

Include a hearty ‘smile’ in your voice as well, which should nip any bad temper in the bud before they’ve had a chance to remember what they were cross about in the first place! 

Trust me, it works a treat – and what have you got to lose?  

2.   Use formal address – ALWAYS

Make a promise to yourself as an accomplished carer, to always use your client’s official title – especially for that initial intro:

“Hello, Mrs Picklehead, how are you today?

Older generations were bought up believing that this is the ultimate sign of respect – and it’s never to be messed with. If you are unsure of their marital status (you will come across the odd hard-nut spinster out there who’s never married and who will soon let you know if you dare to assume she’s a Missus) –  in this case, it’s best to opt for the full name approach:

“Good morning… Marjorie Jackhammer, is it?”

And as daunting as it may seem, you should always attempt to pronounce your client’s surname, regardless of how tricky it might look on paper.  That’s including the culturally curly ones that contain just about every letter in the alphabet – including all five vowels TWICE.

I will never forget standing outside Mrs Gina Kantezkantopituolos’s door in a cold sweat at the thought of insulting her by ballsing up her name and having her hate me forever.  She actually confided in me later that she’d appreciated me having a try (as feeble as it was) because others never even bothered.  For that reason, she’d eventually become known as ‘Mrs K’ just to save a fuss.

“For efficiency’s sake”, she’d always say.

Ultimately, ‘Gina’ and I got on so famously she insisted I call her by her first name anyway.  Phew…problem solved.

And who are you, Dear?

3.   Introduce yourself  

You’ll discover as you become more experienced and worldly, that some of your more dependant or unwell clients may have a whole army of carers, case workers, nurses, health professionals, specialists and home support people coming and going on any given day of the week – and sometimes ALL AT ONCE. 

So to avoid confusion or client embarrassment it is vital that you clearly state your name, rank and serial number when you meet for the first time.  That is before you launch into your work.  

Also, say where you are from and what you intend to do to them!  

There is nothing worse than arriving with your bucket and mop to do a domestic cleaning duty only to discover your client has since stripped off down to her petticoat in anticipation of having her wound dressing changed by whom she thought was the District Nurse instead.  

Not that that’s ever happened to me. 

No! Not at all, she said.

4. Confirm that your client UNDERSTANDS you

This is not as silly as it sounds.  And an accomplished careworker can determine a lot about someone who appears to be hard of hearing or can’t comprehend what is happening (and has no idea what you are babbling on about.)  

You’ve got several logical explanations:

  • your client is hearing impaired (the logical and most common one)
  • your client is from a non-English speaking background
  • your client is sick
  • your client is cranky and in a very, very, very bad mood (is it too late to run away?)

The answer for all of these situations is to slow your speech down, maintain eye contact and modify your voice and tone accordingly. You can find out later on (when you are friends) what the real story is. 

Use hand actions if you need to – and don’t be afraid to YELL.  I can spend entire days bellowing at elderly clients who have deafness issues only to get home at the end of the day and continue the trend with my family… haha lucky them!

HELLO? WHAT?

5.   Compliment your Client

One of the best bits of never-fail advice I can offer all budding carers (or for anyone trying to be accepted by someone new) is that you need to find something about your new client to compliment them on.  

Something. Annnything.

It could be that the buttons on their cardigan are sweet, you just love the colour of their blouse, they’re wearing a pretty-coloured lipstick or they’ve had a haircut and are looking exceptionally spruced-up.  

Or… if you’re really struggling to find something nice to say about your client, then admire the lovely photo of their grandchildren, the enormous ceramic vase in the lounge room, the beautifully manicured lawn or the fabulous blooms on the Camelia bush.

Whatever, doesn’t matter.  

Most mature-agers feel proud and pleased with themselves when they are told they have something that others might appreciate or find attractive.  It has huge impact and lets them know their contributions are still valued and more importantly – that they are people, too!  

And it’s a superb way to break the ice and show that you at least seem interested in them. Who knows, you might even CARE for goodness sake.

Wow, look at the pink on YOU!

6.   Acknowledge your Client’s Spouse

As an observant caregiver, it’s important to be aware that your new client may live with a husband, wife (or other family member such as a partner, son, daughter, niece etc). These onlookers can offer valuable insight on the person whom you may be about to help shower or spend time with in, say, a Respite capacity while their regular family caregiver has some time away from the house.

It is in your best interests, therefore, to butter-up these people and get them ‘on side’. They have a whole plethora of useful information about their parent, grandparent or great-aunty Doris which will make your job significantly smoother if you take heed of it; information that you won’t find on the Care Plan or in the medical notes.

For example:

When you take Uncle Reg on his walk to the library… he loves going via the paddock so he can say hello to the horses.  He needs to stick to this routine or he will get quite upset and then we will ALL pay later tonight!

Mum only likes using the pink towels… never the green ones as they were (deceased) Dad’s towels and she will get upset if you try and use them during her shower.

Little stuff like that, but it’s important stuff. And it’s stuff that will help you develop a good healthy rapport and eventually, a trusting relationship with your client AND with their live-in family.

7.   Acknowledge Pets

A mistrustful senior will literally GLOW when you show interest in their animals and I can guarantee you, without hesitation… they will instantly adore any visiting carer who does this.  

I’ve broken down many a barrier by patting the mangiest of dogs, admired weepy-eyed cats and even whistled at the odd tatty budgie in its cage. 

Fake it til you make it, don’t they say? It’s definitely worth it in the end, so do whatever it takes to gain your elder’s approval.

Rub the tummy of flea-bitten Ol’ Yella and say something silly to the cat – you’ll win over the confidence of your brand new judgemental client… and you can disinfect yourself in the car later!

Freckles moved in over an hour, Mrs Tittlemouse

8.   LISTEN to your Client

Every brilliant aged-careworker knows that communication is what it’s all about. 
Speaking yes, but possibly more importantly:  LISTENING.

So when you’ve rattled off your initial intro, make sure you take the time to hear what your new client has to say in response.  And if their speech is slow or they are struggling to get words out (for whatever reason) DON’T be tempted to talk over them or pre-empt their sentences. Show patience and be respectful in what they are telling you.  Be open-minded and NEVER make judgement. 

Sounds a bit like the Ten Commandments really…Thou shalt not pass judgement on thine old lady client! 

Let’s face it; most of this is common sense.  

Isn’t it?

9.   ASSESS

An astute and qualified carer should be able to evaluate a lot about their new ageing client in that initial meeting at the door. Body language, the way they talk, their hearing and vision, their coordination and mobility – all can reveal potential physical health problems, mental conditions or emotional issues. 

And all are clues that are handy for you to be aware of even before you’ve entered their home.

Take note of bloodshot or droopy eyes, the condition and colour of their skin, breathlessness, disorientation or confusion, complaints of pain and weakness can all mean something is not right and as their carer you will need to investigate further.  If only to pass it on by reporting your observations to a supervisor for follow-up which may then lead to further assessment or review.

Unfortunately, not only can you hear and see signs, but you can smell them too.

Take note of cigarette smoke, gas, alcohol, rotting food odours (ick) or stinky human excrement smells (double ick) … these are just a few indications of the way your beloved senior lives and that there may or may not be serious health problems afoot.

Been on the gin, Mr Slusher?

10.  You’re In!

Well done! Superb job!

You’ve passed the probing and interrogation stage and your shiny new client has allowed you to enter their world.

It’s now up to you to maintain your exemplary high standard of caring and strong positive work ethic. Enjoy getting to know your most-recent companion, but remain vigilant and remember there are professional boundaries. And don’t be tempted to cut corners – because it will most definitely bite you on the bum later.

Remember your integrity, listen to your inner voice… and feel pride in being able to provide a service to people who need your support to stay living in their own homes. And who on the most part, are actually very, very, very pleased to see you.

Happy Caring!

Cheers, Dollie
Posted in Aged Care, Working with Elderly

To Bidet, or Not to Bidet?

That, is the Toileting Question!

I came across this curious magazine advertisement whilst sitting bored on a plane recently. It caught my eye for two reasons:

  • 1.   I’d only just written an article about the ‘Worst Xmas Gifts Ever’, and…
  • 2.   Why was this cheery, yet smug-looking woman in beige slacks STANDING ON A TOILET???

The Best Xmas Gift Ever!!

“Usually for Christmas, my children buy me towels or pillows or once even a
basket for the cat. Last year, after a wonderful lunch in the park with my family,
we came home and I found that for a Christmas gift my son had organised
the replacement of my old toilet seat with an electronic Bidet toilet seat. 
I had seen them advertised on TV and thought what a great idea.”
After two weeks of having my new Bidet, I wondered how I had ever survived
previously without it.
All I have to do is sit down on my nice warm seat and go to the loo. Once I am
finished I simply press a button and I get a warm water rush and a stream
of warm air dry.
Now almost a year later, it has changed my life. I have saved a fortune 
in toilet paper and, I see going to the toilet as a time of luxury. 
It is the best Christmas gift I have ever received!”
– Sylvia Ross –

***************************************************************

Upon reading the ad, I discovered that delighted ‘Sylvia’, is actually the proud owner (and operator) of a shiny new Bidet-style toilet seat attachment, secretly installed by her son as a surprise for Christmas.

That is, NOT an advert for your traditional (and kinda terrifying) stand-alone bidet.

Ahh no. 

Instead, Sylvia gleefully introduces us to the wondrous Electronic Bidet Toilet Seat! A magical two-in-one appliance that means upon completing her regular toileting ablutions, Sylvia gets to be luxuriously “warm water washed” and then blissfully“air-dried”. 

And without having to budge! Can you even imagine?

I later showed the mag clipping to my own mother just out of interest. Similar in vintage to Sylvia, it was interesting to hear Mum’s views on the whole BIDET topic. From the perspective of someone who, much like most of us who find those ‘odd-shaped water fountain thingies’ usually found only in hotels totally intimidating, she admitted that if she had to use a bidet – she really wouldn’t know where to start.

“It’s more of an upper-class European thing, isn’t it… or is it something the prostitutes in Amsterdam use?”

“My friend from bowls has a bidet – but she washes her Chihuahua in it.”

“I’d be scared it might explode… gosh, I could end up giving myself some sort of a nasty enema!”

What a bidet is NOT for!

All silliness aside, I did start thinking that perhaps Sylvia was ON to something (literally). And the more I thought about it, the more it seemed there were definite advantages to be had by a sensitive Senior considering enhancing their current loo to include a shiny new automatic built-in bidet. 

Interestingly, (but a bit odd) I discovered later after a bit of research, that the word Bidet comes from the French meaning ‘small horse’.

Oh, so you strap yourself on and ride it like a pony?”

Yep, thanks Mum.

And that apparently, it was the Japanese who first invented the modern integrated ‘toilet-bidet’ as a nifty space-saving device. Without need of a plumber, it is supposedly simple to install and something an older person (or obliging family member) could manage without too much fuss.  

Merely replacing the current tatty old dunny seat with a fabulous whizz-bang electric one. Easy peasy… botty-squeezy! 

Being suitably impressed by this snazzy new bathroom gadget (and without sounding like I have shares in the company), I have since started singing the praises of these electronic bidet toilet seats (aka EBTS) to some of my elderly clients. 

Especially for those suffering from never-ending incontinence or constipation episodes; or pesky mobility issues due to frail, weakened bones and stiff arthritic joints. I reckon it would be hard not to appreciate the enormous potential health benefits an all-in-one EBTS might provide.   Not to mention for those in their twilight years being more financially set to ‘splash out’ (ahem) and spoil themselves on a nice bit of luxury during their retirement.

*******************************************

8 fab reasons to get an EBTS installed at your parent’s (or your) house :

1.   You can do your ‘business’, then clean-up, dry-up all in one hit… in one SIT? 

2.   You can stay safe.  Not having to go ‘up down’ twice from a toilet to a separate bidet means less chance of a skate on slippery tiles.

3.   Personal hygiene is improved and more effective due to not having to awkwardly reach around to wipe. Tender, sore and ‘ouchy’ bottoms can stay cleaner – and heal faster.

4.   No hands required. Mission complete – without having to touch your rude bits!

5.   Issues such as constipation can be eased (eased out?) by caressing streams of warm water directed in all the right places.

6.   You can feel ‘shower fresh’ using an EBTS without having to fully strip off and endure the physical ordeal of an actual shower.

7.   There is less dependence on caregivers – which means preserving one’s self-confidence (and dignity).

8.   The warm-air dryer of the EBTS means those with ‘greenie’ tendencies can feel most satisfied that they’re saving “shit-loads” on toilet paper – HOORAY FOR THE ENVIRONMENT!

****************************************************

To summarise: Wouldn’t it be nice to offer the beloved in your life a tiny bit of toileting opulence in their golden years? Not to mention a toasty warm bum in winter.

It’s time to let dear old Mum know just how much you appreciate her and that because she is so special (much like Smug Sylvia) she absolutely deserves to have… THE BEST BIDET-TOILET SEAT IN THE HOUSE!

At least he’s using it correctly…. WOOF?

HAPPY CARING!

Cheers, Dollie

Posted in Aged Care, Working with Elderly

When Old People Help Young People

Can I Return Your Trolley For you, Dear?

As a rule, there’s not much in the way of kindness on offer in busy shopping centre carparks – especially from strangers performing the same tiresome routine as you.

Well today turned out to be my lucky-ducky-day!

Having pushed a way too over-loaded trolley out to my car (I detest the weekly supermarket battle but it’s just got to be done), I was puffing a bit and probably looked as hot and bothered as I felt.

Dollie with a trollie!

Whilst then transferring the weighty grocery bags into my car boot, I remembered a couple of essentials I’d forgotten to buy (why didn’t I make a goddam list?) so my head was miles away when an older man with lush white beard and dainty gold spectacles appeared beside me asking if he could perhaps give me a hand?

Gesturing towards my now empty cart he smiled and said in a most gentlemanly voice, “Can I return that for you, dear?”

My initial reaction was to decline politely this neatly-dressed chap’s offer.  For heaven’s sake, I was the carer who looked after elderly people – it should be ME offering to help HIM!

And he was clearly no spring chicken.  Although still quite sprightly, his light-weight frame and obvious hip issue made him look far too frail to be flinging other people’s grocery carts about.

Not only that, but I had to go back into the shopping centre anyway, which meant walking directly past the Trolley Return bay.  How easy-peasy it would be for me to whip my own cart (with it’s annoying dicky wheel) into the loading bay as I dashed by.

However, something in this earnest senior’s eyes made me zip my lip and realise that this was in fact, not about me.

Shopping Besties
– Dollie & Ray

Turns out that Ray (yes, we got chatting) was having his 90th birthday next week and he was really looking forward to the afternoon High Tea his family and friends (“the ones that haven’t dropped off, yet!”) were holding in his honour.  He told me how he had never felt so good – perhaps he might even have a gin or two on the BIG DAY!

“Gee whiz, I’m excited to be alive, Dollie!”

Ray then went on to explain how having something to look forward to and feel special about, had made such a difference to his life.  Especially after losing his wife Anne last year ‘to the Cancer’ had left him feeling lonely, depressed and quite lost.

Indeed, I recognised there was far more significance in allowing lovely, high-spirited Ray assist with my ridiculous supermarket trolley than there was in me trying to save time and supposed unnecessary fuss.

And it wasn’t because Ray just happened to be passing that he’d felt obliged to make the offer; nor because he thought I actually really needed any real help.

It was just because he could.

HAPPY BIRTHDAY, RAY!!!

Cheers,
Dollie
And now you’re just being silly