Caring for Elders

A Conversation with Dr. Saadia Husain

We speak with Dr. Saadia Ishaq Husain on caring for elders – how to be aware of the subtle signs of illness in seniors, attending to their emotional and physical needs, along with caregiver support issues and resources.

What are some of the unique medical issues you find caring for elders?

Geriatric syndromes like fraility, polypharmacy , mood disorders, fall risk are common in this population.

How about family issues in elder care – what have you seen are common struggles?

There are different kinds of struggles when it comes to family. Some families are very close and wish to take care of their loved ones at home but lack resources. Other times, they have resources but prefer for their relative to move to a long term care setting for closer medical monitoring.

As our parents age, many of us wonder about the early signs and detection of dementia/Alzheimer’s – what are some early warning signs and what are the first steps we should take if we see those?

Early signs in functional elderly are subtle. They are able to, until some point, cover their forgetfulness by other activities that they can still do. We may see them sometimes writing an incorrect check, leaving the stove on, forgetting names, numbers, forgetting or driving directions to a familiar place.

Do seniors have different sleep/wake patterns, and how much sleep should those over the age of 65 get, on average?

Normal aging as well as dementia are associated with major physiologic changes in sleep. Changes can be seen in total sleep time as well as time spent awake after falling asleep. Difficulty with sleep initiation and sleep continuity are most commonchanges . Total sleep time decreases by average of 30 minutes per decade starting in midlife.

Grandmother's Success

What options / resources are there for assistance with caring for elders at home, given our busy lives? Can you also speak to the financial aspects of what insurance may provide coverage for, and what families may have to finance themselves?

It depends on their needs. If they are skilled needs like home IV, wound care, dressing change ,therapy, they are paid by Medicare for nurse or therapist visits at home. However, if we need assistance with Activities of Daily Living like bathing, dressing, toileting, grooming, feeding and transferring, there are home care agencies that provide Home Health Aids who are privately paid on an hourly basis in a common scenario. Typically this is not paid for by Medicare.  Social workers work closely with Home Health Agencies to provide families with the aid they need.

Nursing homes have traditionally been a cultural contradiction in our immigrant community. Is that changing, and have you seen more culturally sensitive centers for those who lack the ability to care for their elder family member at home? What questions should one ask about a nursing facility or home when searching?

With ongoing CMS regulations and changes for improvement, I think overall Nursing Home quality is moving in the positive and right direction. However, for immigrant communities, it can still be a cultural shock. The language barrier is first. At this age we prefer people to communicate in our mother tongue. Activities like going out for dinner, playing bingo, going out for movies, music night,  etc. may not be something elderly from a different cultural background look forward to.

This area is something that needs a lot of work. I would ask about the daily schedule and flexibility in the schedule, food options, visiting hours, availability of a translator on phone or otherwise, if patient needs one. Also one should inquire about accommodation of patient’s cultural needs, religious activities like praying and celebrating their special occasions etc.

I’ve heard that illness in elderly patients can present in subtle ways, different than younger patients. What are a few “warning symptoms” for families to be tuned in to for early detection of serious health concerns?

Anything different than their normal routine. Missing meals, feeling tired, not hungry, falling or gait changes, low moods , low grade temperature (not necessarily having fevers)… Patients with severe UTI or sepsis may present with generalized weakness as the only symptom. Patient with pneumonia may present with loss of appetite and low grade temperatures and no cough. Stroke can present with acute confusion or a fall.

Vintage white roses in clear glass vase with purple background, shallow DOF

What do you advise families to help care for the emotional needs of elders? Many seniors seem to fall into a bit of depression or agitation following the loss of spouse or friends, or as their ability to function independently decreases, for example.

I tell them that the presence of loved ones around the elderly is the most effective medication. Families can take turns to be there for them or visit them. Assist them with their meals and basic needs. Identify early if extra help is needed.

How about advice for children caring for aging parents – certain legal considerations they should look into, and also how to manage the stress of the caregiver role?

Again taking turns and getting extra help is important. Caregivers should not feel exhausted on a day to day basis. If a caregiver is always tired, something is not right and needs to change. Caregivers should not feel guilty or bad expressing their concern of work load to social workers, other family or PCP.

How important is establishing a daily routine/pattern for elders? How about exercise?

Daily routine is important in all ages but crucial in the geriatric population. At the same time we cannot be very rigid if a person is not up to it on a certain day. It is important to do some exercise as a routine for mental, psychological as well as physical wellbeing. Some nursing homes have exercise routines for elderly based on their capacity.

How would you advise helping seniors balance a sense of independence while also maintaining safety? (For example, when it may not be safe to drive alone, etc.)

There is no easy answer to that. Taking away your driving license is taking away all your independence. That is how they feel. It needs a lot of education and reinforcement and replacing that activity with something enjoyable is important. It is a team effort and the decision should be made in collaboration with families and a plan of care should include alternatives.

What is the most rewarding aspect of your job caring for elders, and what would you advise others in regard to this special generation?

I lost both my parents. I have a special place in my heart for elderly patients. Every parent, every elderly person, has the right to be cared for and loved in this time of their lives more than ever before. It is very rewarding when they hug me and feel loved and cared for. Sitting by their bed and holding their hands and listening to them makes my day and theirs too. My advice is that if we get the opportunity to take care of elders, be mindful of their needs as they may not express them like other people. They need company and should not feel lonely. They should be taken care of as a whole person rather than as a list of medical problems.

* Dr. Saadia Ishaq Husain is medical director and attending physician, geriatrician at Crescent Cities Center, a skilled nursing and long term care facility in Maryland. This facility is part of Genesis Physician Services.   Dr. Husain has been in practice for several years and has clinical experience in the assessment and management of geriatric syndromes.



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