Posted in Alzheimer's Disease, Dementia, Working with Elderly

An Alzheimer’s Poem

Leaving our Loved Ones “Sad and Sick…and Lost”

Every time I visit 82-year old Ruth Cuddlepot I read this poem. 

She has it up on a wall in her kitchen near the toaster, just above the bench.  I know it by heart now because it’s so hard to miss and I stand there every Wednesday reading it (at least three times over) – while I’m waiting for her crumpets to pop!  

It’s a short, but popular verse and most experienced carers have encountered it on their travels in and around the Aged-Care industry. To be honest, I always end up feel annoyed after I’ve read it because as far as describing the hopelessness and grim reality of Alzheimer’s disease – it’s pretty spot on.

It is also completely SAD.

We all know this one, right? 

So, the story goes that back in her day, Ruth Cuddlepot forged for herself (and prospered for many years in) an outstanding career as a Headmistress in some posh private school for boys – at the time the only woman on record to obtain such a role.  She never married, didn’t have children and had no real family to speak of.  Therefore, a very well-to-do Ruth had mountains of cash and high-performing investments squared nicely away for that one ‘rainy day’ when she just might need it. 

That drab, dreary, drizzly day came a few years back when Ruth received the official crushing diagnosis of Alzheimer’s Disease.  Being the no-nonsense insightful person that she was however, Ruth decided immediately that she would face her destiny head-on and set herself up for the inevitable; for when she could no longer work or take care of herself.  

Indeed, there would be NO nursing home for Principal Ruth Cuddlepot! 

Without wallowing in self-pity and in typical Ruth fashion, she seized control to ensure her affairs were arranged down to the very teensiest detail. The health services, neurologists, an endless supply of support workers and the most fastidious fleet of solicitors were all put in place so Ruth could be completely looked after and cared for IN HER OWN HOME.

No matter what.  

She knew her condition would deteriorate; that her memory would crumble, and she would eventually “lose my marbles completely!”  Apparently, that’s how Ruth used to brazenly declare it, although I didn’t know her then and have relied on verbal reports from other carers to fill me in on all the background reading. 

Needless to say, she was one very smart woman. Although,by the time I had the pleasure of caring for the well-respected Ruth Cuddlepot, she was no longer the organised and efficient educator I had been told she once was. 

Ruth had, instead, evolved into ‘Ruthie’.  

And thanks to the personality-morphing Alzheimer’s, Ruthie had become a frail, yet openly happy and affectionate elderly woman…. WHO LOVED TO HUG! 

Even when her speech faltered, Ruthie could at least continue to communicate with a nice big welcoming embrace whenever I arrived for my shift.  I looked forward to it in fact!  

There she would be, perched in her favourite place on a big comfy chair in front of her enormous lounge room windows. The spot where she had the wonderful view of her ever-changing garden, the birds flying by to say hello… and where she could keep a watchful eye out for her next visitor whom she could throw her arms around and give a great big hearty squeeeeze to!

Really if it wasn’t so heart-breaking, it would be lovely.

Ruthie at her window...
 – waiting for the next hug-ee!

Recently though, Ruthie had started calling me Wendy.  

Which is fine by me, because you can imagine it happens a lot in this line of work (I’m also known as Debbie, Louise and Margie with some of my other cognitively-challenged clients). Let’s face it, remembering each of your carers’ name, rank and serial numbers is understandably not high on the priority list for some seniors.

Especially when they no longer know their OWN name!

I knew something had started to change in Ruthie when one day – the hugs stopped.  And another cruel stage of the Alzheimer’s curse set in… Ruthie Cuddlepot started to become aggressive.

Without much warning her moods became erratic and it eventuated that Ruthie couldn’t STAND to be touched.  Not even a handshake or a gentle pat on the shoulder.  You just wouldn’t dare in case she would flare up and start screaming and punching the air (or anything else within proximity) in what appeared to be the ultimate frustration within Ruthie’s muddled-up mind. 

This most heartless and indiscriminate Dementia had finally taken hold of her … it has been just awful to watch.

Finally, after accusations that Ruthie had started slapping and pushing her carers, we were told there was a serious incident last week where she had to be whisked away by ambulance and sedated in hospital.  

Quite honestly, it became apparent to us all, that they didnt know WHAT to do with her!

After all Ruth’s organising, having purposely prepared herself and her future to remain forever being tended to in her own home by an army of paid care-working bees and service providers, it now seemed this was no longer a viable option.  

I wonder now looking back, how Ruthie could have possibly planned for this final gloom-ridden stage of her illness?

Perhaps she’d anticipated that by this late phase: 1) she wouldn’t know where she was, and 2) she wouldn’t care? I hoped so for her sake.

The poem was right, and the best of Ruth had gone.  And sadly yes, we had failed in standing beside her.  Basically, it had become too unsafe to do so!  Poor Ruthie had become a danger not only to herself, but to everyone else as well.  And if a support worker is under any threat whilst looking after a client in in their home, then the people in charge needed to move to an ulterior arrangement.  

I was informed only today that the once proud and brilliant Ruth Cuddlepot had been relocated ‘indefinitely’ into a High Care facility.  

Just like the poem had foretold she was now sad and sick and lost.  Her beautiful forward-thinking mind now full-to-capacity on sensory-depriving medication to keep her comatose and manageable (for her own protection, we were told).

I have deliberated greatly about going to visit Ruthie but honestly, what would be the point? And without sounding totally selfish – I don’t think I could bear it.  

The worst part is finding out she doesn’t even have a window.

HAPPY CARING!

Cheers, Dollie

Posted in Aged Care, Dementia

Dementia Diagnosis for Aunty Win

A Letter to my Fam

I received this email from my cousin Rochelle recently.

Thought I’d share it here (because I can), and also to emphasise how shitty and random Dementia is. Not to mention the despair and frustration for families who are left heart-broken as they watch on hopelessly; it is totally NOT FAIR.

Aunt Winnie taught me that girls don’t have to aspire to be receptionists or “office note-takers” or run around after others… “unless you want to, then that’s fine, too.”

Instead, if you’ve got the gumption (her favourite word) – you can make a great career doing something you love, settle down and hopefully find a nice boy “wearing not-too-tight slacks” to make a good enough life together.

It has eventuated that I have done both.

Aunt ‘Winnie-the-Poo‘ – – –  YOU ROCK!

(We miss you so much).

Winnie – younger days
(great hair!)

To my dear family,

I’ve been back from overseas for almost 2 weeks and there have been a few changes with Mum (our Winnie), so thought I’d send a group email update so you all know where that’s at.

Unfortunately, and as predicted by most of us, her mental health has declined significantly.  

I took her to her GP and she completed a MoCA test (half hour competency testing), where the results were not flash:  ie: 10 out of 30 is bad.

Poor mum scored 2…(TWO!)  Is that even a number???

Thank the Lord she defiantly remembered where she was from, although truthfully, I think she must have fluked the second point by just sheer good luck!

We also discussed her anxiety levels and turns out, they’ve put Mum on a little ‘upper’ to assist with her mood.  Arthur is great with mum and loves her to bits which I could cry with relief about cos he’s such a caring wonderful man.  

Obviously, as a retired school teacher, he revels in the role of directing and correcting!  (Plus, the Citalopram will be doing it’s job – keeping Mum calm and ticking along, happy to stay back after class with another special Arthur ‘detention’ !!!)

In the meantime, the Geriatricians will without doubt, assess Mum for ‘Care-Home’ level care, and I assume officially diagnose her with Dementia. This should happen soon.  Hopefully, while I am still in the country – although I may be called up any day now so not sure what we do then… 

Thankfully, in this zippity-do-dah-day (haha another one of her ‘funnies’) most stuff can be sorted online and organised via email etc.  And legally, I don’t need to go to the lawyers- which is just perfect.

Happy family, beachy days
(and the discovery of ginger beer!!)

The best thing is that the staff at the Respite home where Mum is now are all on the same page as I am.  And they have been concerned with her deterioration for a while – the head nurses have an amazing rapport with her, plus they’ve kept me fully up to speed on things. 

I am just SO impressed with the set-up there!

Win gets to stay in her current apartment WITH Arthur – and the Care Team actually comes to her! This includes 3 showers a week, getting dressed daily and undressed, breakfast, lunch and dinner, dispensing medications, clothes washing, housekeeping etc.

At the moment, Mum is just having shower and dressing assistance (extra $100 a week).  Once the new level of care comes through, we will apply for a subsidy as their combined total assets is less than $119k.

This new level of care will be paid from Dad’s deceased estate account (ie: $23k – and then the good old government takes over…PHEW).

I did have Mum come stay with me by herself last week (and my girls too, much to their horror), for a night recently. She spent the WHOLE TIME thinking Arthur would be coming to pick her up at any second – watching out the window, pacing up and down etc. 

I could tell she really would have preferred to go back ‘home’ to Arthur; we had to phone him a few times during the night when the panic set in. 

You should have seen it the next day, though, when they re-united.  I just about died… they had the biggest SNOG I’ve seen in ages….in front of all the staff…everyone…THEY DIDN’T CARE!!!

(I think I was actually JEALOUS!)

Arthur & Winnie’s ‘golf’ wedding cake
FOURRRRR!

Mum’s just fine where she is and like I said, Arthur loves her to bits. So as weird as all this is, Winnie’s definitely safe and cared for. She actually does realise her memory is bad (kind of), but quickly seems to forget she had that flash of realisation and so we just move on.

She happily accepts shower assistance, and for her own dignity and personal presentation, I’m terribly thankful for that.  Physically, Win looks and IS well.

Don’t know what else to say but I really hope this email doesn’t cause any concern for you guys.  I really feel she is in the right place and I think we should all feel blessed that she married Arthur last year – as crazy as that seemed at the time…. WHO IS THIS MAN WITH THE GIANT MOUSTACH WHO IS IN LOVE WITH MY MOTHER? 

Because it certainly takes the load off me – not that I’m complaining…

It’s just hard, you know?

Anyway, I hope all is well with you guys – sorry if I’ve rambled on but I wanted to put you in the picture seeing as you are her family,,, the people who love her the most. 

God, does she even remember?  

You know what…I really don’t know any more.  Today for example, she called me Geraldine.  As in Aunty Gerry, her twin, who died when they were in their 20’s.  And I can tell when she looks at me that she’s not ‘Mum’ anymore.  I hate that the most about this awful disease.

Anyway, I’m waiting for confirmation of my next placement abroad – not sure when or where that might be but I’m loving my Oncology nursing and the fabulous people involved in the industry so that makes it all worthwhile (as well as being the best distraction from the Win & Arthur show!)

Will keep you all updated as the rest of the saga of our gorgeous mum/sister/aunty’s life unfolds. 

Love you guys,

Rochelle

PS: please, don’t worry about mum.  She is fine, really.

PPS: we must all get together in the SAME room one day.  Life’s too short. – I could end up losing my mind, just like Mum.  ARRRGGGHHHH!

HAPPY CARING!

Cheers, Dollie
Posted in Aged Care, health issues, Working with Elderly

The Hard, Dry & Flaky Facts of Ageing Skin

It seems the SKIN… that I’m IN… is terribly, terribly… THIN!”

Ever wondered why you never see a loofah brush, exfoliating mitt, nor any other type of abrasive body-scrubbing device in an elderly person’s bathroom? That’s not counting the mandatory piece of dried-up pumice stone once used to file corns and callouses from busy hard-working purposeful feet of a lifetime ago.

Well, there’s good reason for it apparently.  Summed up perfectly by 89 year old Lizzy Waterduck as I chatted to her during her shower last week:  

“At my age? Crikey, I’d end up skinned alive like a Chinese dog if I used one of those now!”

Understandably, for most of the older adults I visit in their homes, their skin is a fairly pertinent issue.  They know only too well that if something new or unusual appears on their outer – there’s a darn good chance that something more threatening may be happening on their inner.

Physiological changes such as connective tissue breakdown, the lessening of elastin and collagen production, a limited ability to retain moisture, plus an increasingly slower metabolism in general – all contribute to the breakdown of our skin’s integrity as we age.  

And as a consequence of this dermal deterioration, we then get to watch in despair as the inevitable creases, folds and ridges creep leisurely onto our skin’s surface to create that familiar ‘old person’ look…

Come on, sing it with me now:  WRINKLES!

Throw in the exhaustion of the juicy subcutaneous fat layer beneath, too, means the natural oils which once protected us from damage and gave skin it’s firm, voluptuous appearance – are depleted.  Leaving elders with a moisture-less, thinned barrier that’s vulnerable to anything untoward.

Oh yes, defences by this stage, are most definitely down!  

Understandably, with skin that’s as delicate and translucent as Lizzy Waterduck’s, the last thing she’d ever consider doing as part of her shower routine, even if she might have done regularly in her decadent middle-aged years… is to slough off yet another (possibly the last) layer from her precious epidermal.

Of course, other contributing factors such as lifestyle, genetics and diet can also throw a pensioner’s skin balance out of whack.  Interestingly, one of the major roles of our outer dermis is to maintain the body’s natural thermostat.  Which explains why so many seniors seem to spend most of their days grumbling how cold they are, even in the height of a summer heatwave.

“Brrrr… shut the dam door, girlie!”

Progressing into our ‘twilight’ years, means we might also get to grow the odd unsightly skin tags, unflattering strangely-shaped moles and, prevalent on the backs of hands, balding heads, ears, arm, noses and necks… are the browny-coloured ‘liver’ or sun spots we immediately associate with ‘being old’. 

These annoying tell-tale blemishes are a result of spending entire lives being hat-less and factor-less for long periods exposed to the outside elements.  And declaring “but we didn’t know any better”, does nothing to fix the skin damage already caused.  

Sadly, it doesn’t matter how much sunscreen grandad coats himself in now, it’s a case of too-little too-late for these old timers.

Ahhh good times…
Good skin-destroying times!

And there are other less than delightful skin conditions we become more predisposed to as we age.   Dermatitis, eczema and pruritis are afflictions which are all identifiable with dry, ageing skin and will continue to drive itchy, older folk to reach for the tried-and-true camomile lotion by the gallon.

But flaky, scaly skin is a bad thing when you’re an older peep because when skin has become so dry that it’s now irritated and cracking open, there is opportunity galore for serious infection to enter and thrive it’s head off.

With immunity already compromised in sick or frail seniors or those suffering with pre-existing health complaints, the skin, whose job as the built-in protection layer stopping the big bad germ-laden world from entering our bodies and making us unwell, becomes weakened and unable to hold ground when it’s really needed most.

A seemingly small injury to a mature-ager’s cutaneal areas (even the slightest scratch), if not treated appropriately, can easily lead to serious complications and a much longer recovery time leaving an elder either in hospital… or in a very, very bad mood!

Indeed, depending on the state of it – our skin can quite literally mean the difference between life and death!  

More significantly for an anxious pensioner, it can also mean the difference between remaining at home or being despatched to live in an aged-care facility… ie: the dreaded nursing home.

Fresh flaps – most important!

I get to observe a lot of elderly skin when I visit my clients at this stage of their lives. Assisting them to shower and maintain regular hygiene habits is integral to self-esteem, dignity and indicative to the rest of the world (ie: suspicious adult children) that they’re still capable of living independently.

And although not medically trained, an experienced carer can become quite astute in recognising symptoms of potential health issues, merely by observing the condition or noting even slight changes in a naked senior’s skin – especially at shower time.

Bruises, for example, can be discovered during Personal Care shifts and might be the result of a fall, walking into the coffee table – or possibly from something more sinister? A quick mention here regarding Elder Abuse and that ALL suspicions of such should be reported immediately and without hesitation.

Haematoma (bruising) can look dreadful on pale older skin and thanks to sluggish metabolisms, may take months to totally heal and fade. Not helped by certain medications used to control inflammatory conditions so common in old age (stiff joints, arthritis, COPD, diabetes etc) which, as a pesky side-effect, can leave seniors exceptionally prone to bruising.  

Such as one of my clients, 79 year old Hilary Greentree who relies on steroidal drugs to control symptoms of her advancing emphysema.  These powerful meds offer a fabulous quality of life and are literally life-saving for someone like Hilary.  

More importantly (she informs me), they allow her to be top of her game on the golf course!  

BUT… it was discovered recently, that Hilary’s skin had in fact become so thinned and susceptible to even the slightest touch that something as flimsy as the seam on her new golf slacks is enough to cause extensive black and blue marks down both her shins.  

I mean, did you EVER?

Bruises on your SHIN
And you won’t want to GRIN

For obvious reasons, assisting a senior to wash their outer body involves common sense, a good bit of empathy and patience… plus a WHOLE LOTTA care and attention.  Jagged fingernails or solid objects such as jewellery, rings etc can inflict catastrophic damage to paper-thin skin – and often with very minimal force applied.

Cringe-worthy is the story about a carer once who, worrying about getting to her next job on time, ripped an enormous gash in her client’s calf while attempting to yank up his support hose (commonly used to control circulation probs in the lower limbs). In her haste, she hadn’t realised the tag on the garment had accidentally embedded itself into the poor old gent’s skin which then sliced deeply all the way up his leg as she pulled.

Ohhhh, THE HUMANITY!

Which explains why some of my more delicate ladies fear using a standard flannel or wash cloth that the rest of us ruffians take for granted.  Instead, they prefer to wash with a tiny square of baby muslin or light-weight sponge, both of which seem so floaty and flimsy – you wonder if it’s worth bothering! 

There’s certainly no RUBBING or SCRUBBING involved.  Just a lot of gentle circles and tender dabbing to ensure their sensitive aged skin is left suitably cleansed, and more importantly – unbroken.

Thankfully, it turns out that the older you get, the less cleansing your skin actually requires.  With retirement marking an inevitable slump in physical activity, there are now far less occasions to get a big ‘sweat-up’ like we once might have.  Common thought now is that it’s more than adequate for a senior to instead shower every other day (or less), thereby allowing natural oils in the skin a chance to replenish and build resistance against all the nasties.

“And so I can get my GLOW on!” 

As one of my lovelies, Gladys Gigglestick, proudly preaches.

Funnily enough, Gladys swears by sweet almond oil as her choice of showertime lather – and NEVER soap. 

“Because soap is just too harsh and leaves me dry, rashy and itchier than an old man’s tweed vest”. 

Which is fair enough when you’re 95 and you’ve been in this bathing game long enough to know!  Admittedly, the almond oil (which smells devinely like Christmas pudding) does leave Gladys’ skin noticeably well-nourished and ever so moisty.  

Although, when she holds my arm stepping out of the shower, I have to make sure I plant my feet firmly to keep us both steady… blimmen ‘eck, she’s as shiny and slippery as an eel!

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 advertisement while perusing a magazine 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 discover that the extremely chuffed ‘Sylvia’, is actually the proud owner (and driver) of a shiny new Bidet-style toilet seat attachment, secretly installed by her son as a surprise for Christmas.

Indeed, not an advert for your traditional (and kinda terrifying) stand-alone bidet, ahh no. 

Instead, Sylvia 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 “air-dried”. 

And without having to budge – ahhh BLISS!

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’ 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… crikey, I could end up being given 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 haha). And the more I thought about it, the more it seemed there were massive 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 too, I thought) I discovered 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 adult (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 (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 Ripper reasons to get an Electronic Bidet Toilet Seat (EBTS) for your elderly parent:

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

2.   The EBTS means seniors 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 bits!

5.   Issues such as constipation can be eased (or ‘eased out’) by caressing streams of warm water – in all the right places.

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

7.   The EBTS assists elders to depend less on their caregivers – which means preserving self-confidence (and their dignity).

8.   The warm-air dryer of the EBTS means older adults 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