I am writing this to help those who have to look after their elderly parents (frankly most of us would have this opportunity sometime in life). Our elderly parents are individuals and they are all different. However, certain aspects of care for them should be quite universal. I hope this post will start a conversation and sharing amongst friends and others who are in similar situations. Through it, we make our collective journey more bearable and theirs, easier too.
Mum's medical history- a hypoglycemia (low sugar level) episode
Mum is 84 years old. She has had a few hospitalizations lately - mainly for infections of the urinary tract/kidneys etc. She has been a diabetic since her 40s - we are grateful that with her underlying conditions, she is in the main good for her age.
This is in large part due to Dad's meticulous care - after she had a hypo episode when I was in my late 20s. I still remember vividly what happened. While sleeping late one Saturday morning, I was awoken by a commotion in the kitchen. Dad was washing a small towel at the sink. Mum was sitting on a chair - extremely pale and had a deep cut on her forehead.
Dad told me Mum fell and hit the raising on the floor of the kitchen. I changed and quickly brought her to her doctor. She had apparently not been monitoring and had low sugar. One of the more serious symptoms is fainting spells and the worst is of course shock and death.
Anyway, after the scare - Dad took it upon himself to very closely monitor Mum's medications and conditions. Of course Mum had a few other health issues during those years - she had diabetic retinopathy - bleeding of the veins in her eyes (which if untreated would have caused blindness). Her diabetes was so badly managed earlier on - at one point her reading was close to 40 (?) (our normal is 7).
After Dad passed away, I have kept her medical appointments and established a routine so our helper is able to assist in doing the necessary. This includes getting a medicine box with day/noon/evening/night slots as well as a list of her medications with instructions on the dosages. I also made sure she understood the purpose of each type of medicine.
Our helper is really a great help indeed. She also administers the insulin jabs for mum. I could never bring myself to do it :(
Mum had a fall
Mum had a fall two years ago while going to the toilet. She had walked and slipped. Luckily she did not fall backwards. Our helper was behind her and took her fall - Mum sat on the floor and fell on her.
She did not feel any pain and went back to bed. At about 3.40am, the helper woke me to let me know that Mum complained of pains in her groin.
I had returned from a late meeting and went straight to bed - so I slept through the fall too. I was afraid it was organic and quickly asked if she had any blood discharge or medical conditions during the day. The helper then told me about the fall.
I called for the ambulance and got her admitted right away. At the A & E, doctors did an x-ray and it showed a hair line crack of lumbar one - her back bone. Pains had surfaced in her groin/hip area. The only thing they could do for her was pain killers until the ward doctors took over.
I consulted my cousin who is an ortho surgeon - he gained access to mum's x rays and told us that she was lucky as ordinarily, a fall like this would have caused many splinters of the bones in her body. Given her age - her bones have in fact collapsed due to osteoporosis. I attribute her 'protected' condition to her regular intake of milk - that gave her ample calcium to ward off more serious damage from the fall.
After the fall, mum did complained of backaches - but she recovered quite quickly and well. We decided to let her wear adult diapers to avoid the risks of her waking up and falling in the middle of the night. She at first resisted but after our explanation, she relented.
How culture and superstition works on an elderly
Mum is not educated and her behavior is also driven by superstitions and old folks' tales about western medication etc. After we started chanting and became Buddhists - we began the process of letting her unlearn many of these - for example, not taking medicine during festive occasion like CNY. Not taking medicine for fear that it is too strong and damaging to her organs.
Her glucose readings now fluctuate between 7.7 to 8.6 now - with her regular insulin jabs and medicines. She goes for her quarterly polyclinic check-ups and yearly eye check plus kidney & liver panel tests. Everything being equal, she is good.
Beliefs and superstitions play a major role as far as medical care is concerned - particularly for the elderly and unfortunately also passed on to their care of their young too. The refusal of medication by caregivers for their loved ones has caused much anguish and unnecessary pain to everyone. This is something that education and hopefully wisdom will prevail.
Family's wish, Doctors' mandate
Our mandate to her doctors whenever she is admitted for any condition is simple - she must not be in any unnecessary pain - or major discomfort. If these are unavoidable, then whatever is allowed medically must be done to alleviate it.
Hallucinations
As she ages, Mum's sense of her surroundings and her timings are not in-tuned. She has lapses of memory and her lucidity also waxes and wane. After her recent two bouts of urinary tract infections, she had started to have episodes of wakefulness in the middle of the night (rather early hours of the morning). Our helper who sleeps with her told us she woke up and asked to go home (Paya Lebar - her childhood home). At times, she would asked for my Dad and mistook her for Geok.
In the morning, she would be lucid again - and was unable to recollect anything about the night before. We are monitoring the situation and am prepared to activate night care if this worsens. In the meantime, she is her smiley self during the daytime.
Her routine, gadgets and all
She still chants twice a day and goes for her garden strolls in the evening. Her weekday visits to the Foo Hai Elderly Lodge at marine parade still continues. This is where she has her fellow elderly friends and her exercises. We explored this some 8 months ago after she became restless at home and have been pleased with this arrangement. She goes there from 930am till 4.30pm, weekends and public holidays excluded. This has given me a good 6-hour respite. Geok plays cards with her every Sunday. We also give Mum a deck of playing cards to play by herself and occasionally she gets to do that with her elderly friends at Foo Hai. We also bought her a Acer tablet to let her watch her Hokkien drama series (with headset as her hearing is quite hard now).
Home-doctor care
During her recent hospitalization, the doctor at her ward discussed with us about getting home care - via the Agency For Integrated Care (AIC). Nurses and doctors (St Andrew's is her assigned hospital - the other available is Home Nursing Foundation) will make periodic visits at home to monitor her chronic conditions such as diabetes and high cholesterol. She would not be required to visit the polyclinic for her check ups and medicine. These would be done at home. I think this is a good measure and certainly helps to lighten the load of caregivers.
She receives subsidies based on means testing done some two years ago - so the costs of these are manageable.
Thanks
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