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 a mature person’s bathroom? That’s excluding the mandatory piece of dried-up pumice stone once used to file corns and callouses from busy, hard-working feet of a lifetime ago.

Well, there’s good reason for it apparently.  Summed up perfectly by 89 year old Elizabeth 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 peeps 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.  Thus leaving some elders with a moisture-less, thinned barrier that’s vulnerable to anything untoward.

Oh yes, defences by this stage, can most definitely be down!  

Understandably, with skin that’s as delicate and translucent as Lizzy Waterduck’s, the last thing she’d consider doing as part of her shower routine, even if she might have done it regularly in her carefree 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 skin balance right 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, I swear, 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, too, means we might also get to grow unsightly skin tags, unflattering strangely-shaped moles and, prevalent on the backs of hands, balding heads, ears, arm, noses and necks… are the brownish-coloured ‘liver’ or sun spots we stereotypically associate with someone ‘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 in your advanced years 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 perilously 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 skin, in varying condition, 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 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 Crabtree 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
You don’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 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 even 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 we get, the less cleansing our 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 shower time 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

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

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 –

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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