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My Mother, Your Mother

My Mother, Your Mother - Dennis Mccullough 8 stations of late life.1. stability. Everything is just fine dear.2. Compromise. Mom is having a little problem.3. Crisis. I can't believe she's in the hospital. 4. Recovery. She'll be with us for a while.5. Decline. We can't expect much more.6. Prelude to dying. I sense a change in her spirit.7. Death. You'd better come now.8. Grieving/legacy. We did the right things.Practical tasks at the station of crisis: learn about the ambulance ride. What hospitals do they serve? What are their protocols for reviving unconscious patients? Are they covered by your parents' insurance?Communicate & coordinate with the ER. Get in the loop as soon as you can. Call your parents' doctor is the doctor hasn't called you first. The dr's office should fax over a current list of parents ailments and medications. Ask the ER nurse to you talk to your parent on the phone. Your voice can be very comforting. Get there as soon as you can. Appreciate hospital culture. Get the story right. Get to know the names of the hospital staff. Prevent more harm. Push back against the system. Don't become the problem. The healing power of touch. Stay overnight with your confused elder. Pay attention to basic bodily functions. Get your parents eating started up as soon as possible. Once an elderly person loses their appetite, it can take weeks or months to get it back. Keep your parent moving. Resist overly aggressive treatment and its hazards. Elders in late life do not have a physiology resilient enough to withstand aggressive interventions beyond what is needed to stabilize them for the immediate situation. Be sure to get exact details on what each test involves (physical requirements and negative side effects) and thus, how such a procedure might further deplete your parent's stores. Could a test be as easily done 2 wks from now, when your parent is stronger?Address the quick discharge problem -- make sure you are set with where your parent is going and that situation is ready to receive your parent. Avoid premature long-term decisions. Recovery -- a parent often feels demoralized. It seems like a long way back to where they were before the crisis. However, rehabilitation is formal and demanding. It is an opportunity -- don't let it slip away. Nursing homes all try to attract rehab patients because payment rates are higher than for those who need custodial care. Those of us in the medical profession know that many elders have allowed themselves to slip out of good health by neglect. Strength, stamina, mobility and flexibility are lost because of insufficient daily physical activity. Isolation has led to emotional vulnerability and perhaps poor nutrition. Cognition is dulled by too much television and too few challenges for the mind and emotions, too little practical problem-solving, and too few personal interactions, even on the level of simple card or board games. -- Everyone must offer unstinting support. On average, a healthy young person put on hospital bed rest loses 1-1.5% of measurable strength daily, an elder's losses run in multiples of those numbers. Is her chance of falling going up? You bet. She is 3 times more likely to fall after 1 month of bed rest. Get to know (and influence) your parents' roommates and rehab partners. Encourage positive relationships, try to break up or separate bad influences. Expect that your parent sill not have recovered to his or her full potential before eligibility for formal financial support comes to an end. Don't waste all your energy trying to extend. Keep in mind that most elders end up needing a continuing informal program in order to get to their maximum potential. Prepare yourself for new financial and personal costs. FOCUS ON MOBILITY ABOVE ALL. The absolute foundation for your parent's future resides in continuing mobility. Put a sign on the door -- health requires walking. Try the stairs with your parent. Don't lose mobility prematurely. Decline -- balance concerns for physical safety with fairness in risk-taking. Doctors ask "when was your last fall?" rather than "have you fallen?". Consider care managers.Keep track of medical records.Learn to practice "watchful waiting." Listen for your parents' life review. Resist withdrawing when things are stable. Stay connected to your parent's doctor. Every study done on fall in late life ties this risk to the number of medications being used. Many drs hesitate to reduce an elder's medications. Ask detailed questions about the need for each medication. Taking stock. And underlying it all is sadness, which weighs on you daily as you see your parent's life become more constricted, foreshadowing the inevitability of what's to come. Prelude to dying. Allow arts to enrich days -- music, visual arts, looking at photos, whatever they can engage with at this point. Focus on symptoms when dealing with medications. For instance, at some point for an individual, continuing preventive blood-thinning medications may cause more crises than their discontinuation would. Focus on medications that relieve troublesome symptoms. Good death -- an expected, supported, well-attended death in the location of choice. The slow shutdown. Many of us caring for dying elders continue to be astonished by the slow course of dying, even when all medications have been discontinued and food and fluid intake is at a minimum.