“Arthritis and old lace” – attending to the frail and aged.

 So…what do you call writing an entire book, announcing it to be finished, finally reading it through, only to discover that you’ve forgotten to write the chapter that was the reason for the book in the first place?

 Yep that’s right! Stupidity! Although relatively speaking it could also be known as being part of the ageing process! This is something to keep in mind when caring for the frail and elderly folk - the ageing process is quite relative.

Some people in their mid nineties are similar physically and mentally to some in their mid seventies…although not usually. It really depends on someone’s state of health. Often chronic illness contributes to rapid ageing as much as genetics.

A lot of things happen to us as we age. Apart from wrinkles appearing, our vision, hearing and sexual function often deteriorate along with some memory loss and slowing of metabolism. There is proof (Botwinick, 1977) that as we age only our fluid intelligence shows a slight decline, i.e. our ability to learn quickly in lieu of our verbal ability, which is known as crystallized intelligence. Our I.Q. scores depend a lot on our education, therefore as we age it is often thought that our I.Q. scores decline perhaps because each subsequent generation receives more education, and it is argued, a better education. However other aspects of intellectual functioning are superior in older people, for example, wisdom, which according to Baltes, 1990, is the “expertise in the fundamental pragmatics of life”. It is generally agreed that individuals vary greatly in later life intellectual performance.

Some folk in their eighties can still hold positions such as Supreme Court Justices and others begin to show decline a lot earlier. Psychologists now lean towards “disuse” rather than decay, being responsible for isolated deficits in intellectual performance.

It is generally thought that only around 5 percent of the aged become senile and experience major losses in cognitive functioning. The majority of folk do not experience any dramatic changes to the way they think or remember things, although they do find it difficult to acquire new information and may find it difficult to form new associations.

 The motto of the aged, “use it or lose it” does provide evidence that the aged that pursue high levels of environmental stimulation such as taking on courses, either formal or informal, do tend to maintain higher levels of cognitive ability.

Favourable cognitive ageing can be predicted by six variables:

• The absence of cardiovascular or other chronic disease

• An environment of higher levels of socio-economic status

• Involvement in intellectually stimulating activities

• Being a flexible personality type around mid-life onwards

• Having a spouse or partner with high levels of cognitive function

• Maintaining a level of perceptual processing speed

(Schaie, 1989)

There are other changes also; Social changes such as losing friends and family members if they outlive them as well as finding difficulty in getting out to socialize because of physical impairment, mobility, illness or disability.

Aged folk tend to choose their contacts more selectively and often maintain only the most rewarding social contacts, including family members and long time friends.

 Many of the aged in my care have been totally devastated because they have lost their driving license and therefore feel they have lost their independence, freedom and a fundamental right. It can be the beginnings of a downward social spiral. As the aged eyesight fails, frustration, alienation and fear can take over, leaving some housebound and increasingly dependant on neighbours, friends and family to do the chores they once did and enjoyed such as shopping, mowing the grass and gardening.

As eyesight further deteriorates for some, small daily delights like watching television, a movie, drawing, knitting, reading a newspaper or a book sometimes disappear. This can bring on a profound depression for some folk, as they may no longer feel their life worth living if they can’t pursue even the basic enjoyments of life.

There may also be those who are going blind, e.g. Macular Degeneration, which is a common disease today (1 in 7 people over 50), who may appear to find acceptance of their situation a little easier. They can discover a new world of reader books and a variety of aids from the Blind Society or Vision Australia which can make their day to day living somewhat easier and the world generally more accessible. Some of these folk stride out into the world with white cane or seeing eye dog in control as if they were fearless. Some also go arm in arm with a carer who may take them shopping or accompany them wherever they need to go.

In this instance if you are someone’s accompanying carer remember not to walk too fast or too slow, allow him or her to set the pace. Keep clear of awkward passageways, gutters and uneven ground and remain vigilant for moving vehicles, dogs, obstacles on sidewalks, kids on bikes or rushing pedestrians.

When in the car, put their seat belt on for them and allow time for them to alight your vehicle with your help and watch that they don’t bump their head getting in and out. If they are using a rollater (walker) allow plenty of room for it by parking your car further out from the kerb than usual and, as much as possible always use a crossing to get to the other side of the street rather than jaywalking and taking a risk.

If you take your client to the bank or shops you may have to help them pay money, hold their chequebook or take or count change. Ensure safety for your client at all times where money is concerned. Don’t allow a lot of cash or a credit card to be seen or waved around in front of the general public and ensure that their handbag is always safe and within your view.

Another change that takes place that is common among those aged sixty and older is hearing loss. (see article on hearing loss)

Generally however you will give personal care to those who more often than not are likely to be frail and aged yet still able to dress themselves and shower themselves with assistance. Your personal care may extend to giving assistance with a “Webster” pack, which is made up by a pharmacist and contains all the medication necessary for each dosage for a week, washing their hair, making their dinner, lunch or breakfast, making and changing their bed or soiled underpants or pad to gently rubbing cream on a dry or itchy area of skin. Later you may be applying basic wound care to scratches or skin tears, pulling up support stockings on your client’s legs or arms, taking blood pressures and pulses, administering nebulisers, even giving a gentle therapeutic massage to areas of soreness.

When assisting someone to have a shower, give particular attention to the heat of the water, ensuring not to burn or freeze your client. It is always a good idea to allow the water to run for a while away from their body and ask them to feel the water temperature with their hand first before spraying the rest of their body. Try not to drop the soap to the floor as this makes the tiled shower surface and even a non-slip mat quite slippery. Each client has his or her own unique regime for showering and dressing. It is always best to ask how they wish it done and as much as possible try to adhere to their needs and preferences.

When drying your client ensure the space between their toes, in the deep folds of their groin, under their tummy overhang, breasts and arms is very dry as these areas if left moist are prone to rashes and body odour.

 On the subject of odour, if your client wears some form of disposable pant with or without an extra inner pad or just a panty liner or pad inside their underpants, ensure it is changed frequently, wrapped up in a plastic bag and disposed of into the outside garbage bin as soon as possible. If your client gets out of bed each night to use the toilet, you may wish to leave an extra fresh disposable pant and/or pad somewhere within their reach so they can change if they need to.

When making your client’s bed, if the sheets and/or the kylie are wet, change them and transfer the wet or soiled sheeting to the laundry immediately. Definitely don’t dump anything soiled on the floor and leave.

 Try to remember how you would wish things done for you. I’m sure you would be unhappy if someone left your wet underwear and sheeting on your floor, especially if you couldn’t walk properly and found it impossible to reach down. Besides being unhygienic it is disrespectful to leave someone sleeping or sitting on soiled sheets or in a wet nightdress or wearing soiled pants for any length of time. Likewise with clothing, anything dirty should be changed even if only worn for one day.

 Often it is hard for a client to tell if an article of clothing is soiled by food or drink if they have dementia or are nearly blind. Therefore it is up to the carer to ensure that their client is clean from head to toe, freshly and smartly dressed after their shower and ready to face the outside world with pride and confidence not embarrassment.

If you treat your clients whether they are aged, youthful, disabled or mentally challenged, with love, kindness and compassion you and they will be much rewarded. The value of your work is not just monetary gain; it is also in the immense value of humanities’ teachings.