"All diseases run into one, old age."
--Ralph Waldo Emerson
Finding oneself in the hospital can be trying at any age. But for the elderly such an experience comes with a host of separate issues, both mental and physical, that need to be addressed in conjunction with prompt and professional care for their ailment. As our nation's baby boomers begin to retire and medical advances increase life span, the average patient age continues to rise, a trend that appears to have no end in sight. In our efforts to assist an aging friend, relative or loved one, it is important to keep in mind that patience and perspective rule the day.
In this fast-paced modern age, when a young or middle-aged person gets sidelined through illness or accident, his or her thoughts often refer to the quotidian: school or work responsibilities, upcoming social events and family obligations. While the elderly entertain these thoughts as well, in many instances their priorities and focus will differ considerably. What may seem trivial to a 25-year-old may be of great importance to a patient of 85, be it paying the phone bill, watering the plants or feeding the cat. As a result, one of the most helpful things we can do when visiting sick, elderly patients is to ask them what they feel needs to be done. Through the simple act of listening, the caregiver or friend offers the understanding that the patient is not alone, and the needs of their life outside the hospital are being met. This frees them to focus their attention on the illness at hand and offsets the feelings of loneliness and helplessness that come with any hospital stay.
Rumination and Recuperation
When one is in the hospital, there are often great waiting periods between doctor visits, tests and procedures. Unfortunately, this gives the elderly time to reflect on a plethora of age-related issues relating to mortality and failing health. In addition to the many physical changes that remind us that the body is gradually losing strength, such as incontinence, limited mobility, slowing metabolism, and a decrease in the abilities of all five senses, older patients are often forced to face a number of psychological developments. Concerns over these issues can sometimes snowball out of control if not met at every turn with patience and understanding, be it from a family member, caregiver, or friend.
- Coming to Terms with Death: Regardless of illness or condition, for many of our nation's elderly patients the simple fact of finding themselves in a hospital is enough to remind them that no one lives forever. In these circumstances, it is important to let the patient set the stage for discussion. Some may not want to address the topic aloud at all, while others benefit from having someone to listen to their stories and help recall past good times.
- Worrying About Finances: Most retired seniors live on a fixed income, and the added weight of hospital bills, medications and potential long-term care can have a major impact on both their current and future financial standing, causing undue stress during their stay. If possible, offer to lend a hand with any immediate bill-related queries and issues of insurance coverage. Something as small as making a phone call and getting an answer can often make the patient feel as though the situation is not insurmountable. Remind the patient that now is the time to focus on getting better, not paying the bills.
- Getting Used to Being Dependent: Many elderly patients see their hospital stay as the first step toward becoming dependent on family members, friends or third-party caregivers. As their concern about quality-of-life issues grows, so too does the fear that they may soon be unable to fully care for themselves, be it financially, physically or mentally. No one wants to burden his or her children, and this concept can have a marked effect on the patient's state of mind throughout treatment. Listening to their fears, showing support and offering to help with additional care go a long way toward replenishing peace of mind in both the short and long term.
- Confronting Memory Loss: On top of the physical debilitation brought on by their illness and advancing age, some elderly patients must contend with memory-related failings that can dramatically affect their day-to-day life and make it difficult or impossible to care for themselves on a regular basis. In many cases such recognition exacerbates the above mentioned concerns, as the patient begins to notice his or her deterioration, which leads to increased anxiety about the future. Being aware of the psychological changes that may occur in your loved one makes it easier to understand, if not assuage, their fears.
Planning for the Inevitable
As a result of their increased focus on mortality, many elderly patients who find themselves in the hospital become fixated on getting their affairs in order as soon as possible. In addition to topics pertaining to wills, bequeathments and funeral arrangements, many seniors feel the need to discuss what is to be done in the event that their health takes a turn for the worse while in the hospital.
An "advance health care directive," also known as a living will or advance directive, provides a legal mechanism for individuals to specify what actions should be taken to address their health in the event that they are no longer able to make such decisions due to illness or incapacity. These instructions are often of great assistance, as they prevent the need for doctors or family members to "guess" what the patient would like to have done. By appointing a person or persons in this capacity, individuals can let their physician, family and/or friends know their healthcare preferences, including the types of special treatment they may want at the end of life, as well as the extent of their desire for diagnostic testing, surgical intervention, resuscitation and/or organ donation.
Watching an elderly loved one struggle with the effects of aging while in the hospital is no easy task. To truly provide the support these patients need in times of crisis, gaining insight into their perspective is of utmost importance. Listening to their ideas and concerns, offering assistance if possible, and understanding their end-of-care wishes are excellent ways to assure patients that they are not alone and that their needs will ultimately be met.
This Emotional Life is a two-year campaign to foster awareness, connections and solutions around emotional wellness. Join our community at www.pbs.org/thisemotionallife.