When Is a Senior at Risk?

Additional Info

• Segment Number: 3
• Audio File: healthy_talk/1516ht4c.mp3
• Featured Speaker: Stephanie Erickson, Clinical Social Worker
• Organization: Erickson Resource Group
• Guest Bio: Stephanie Erickson is a clinical social worker with over 20 years of experience as a geriatric social worker. Her primary area of practice focuses on Dementia and decision-making capacity.
  
  She works with seniors living autonomously, in care facilities, in acute care at the hospital, and who are living with family. Stephanie also provides training and consultation to families, the Alzheimer's Society, community groups, financial and legal institutions and at professional conferences. She hosts her own weekly podcast called Caregivers' Circle on WebTalkRadio.net.
• Transcription: RadioMD Presents: Healthy Talk | Original Air Date: April 16, 2015
  Host: Michael Smith, MD
  
  Living longer and staying healthier. It's Healthy Talk with Dr. Michael Smith, MD. Here's your host, Dr. Mike:
  
  DR MIKE: Alright I'm speaking with Stephanie Erickson. She's a clinical social worker. She's been doing that for over 20 years and she focuses on dementia and decision making capacity. She has her own weekly podcast called Caregivers Circle on WebTalk.net and she has a website EricksonResource.com--all one word.
  
  Stephanie, welcome to Healthy Talk.
  
  STEPHANIE: Thank you so much for having me.
  
  DR MIKE: So, we're going to talk now about seniors and when they're at risk and when should we maybe, as kids, start recognizing that in our parents. So, what are some of the signs that you know an older person, a senior, is at risk at home?
  
  STEPHANIE: I think one of the first things is weight loss. You know, eating is a community and a social event and a lot of times, as people age, they tend to not eat as well. There could also be medication side effects that are interfering or even causing them to have losses that are interfering with the person getting the proper nutrition. So, I think if you notice weight loss it's something big. Also, reduced mobility within the home like going up and down stairs, getting in and out of bed, falls within the home, changes in sleep patterns. That's in terms of the person's physical health. There's also things you can look at just in terms of the environment. So, if you notice...
  
  DR MIKE: Stephanie before we go to that, let's go to the eating part because I have a question for that. So when you talk about weight loss, now there's a lot of reasons for that in a senior, so is it more about maybe losing the desire to eat, loss of appetite? Is that what you're looking at or is it just the weight loss itself?
  
  STEPHANIE: Well, I look at the weight loss because the weight loss is a symptom and a symptom is representative of something else that is going on. Is it because of isolation in the home? Is it because of cognitive losses? Is it just general weight loss over time which seniors experience anyway? Or, is it an underlying, perhaps medical problem, some sort of disease or illness that's impacting somebody's weight? And, obviously, the thinner we are, we're at most risk for dizziness, balance problems, falls, etc.
  
  DR MIKE: Yes. You know, what's funny, Stephanie? Now that I think about it, that was a stupid question because, I mean, if somebody is losing weight, I mean, as a medical doctor, if a senior came into my practice losing weight, I'm going to figure out the cause of it and try and correct it. So, sorry for that and I sort of think, "Well, that I was a dumb question." Let's just go on.
  
  (laughing)
  
  So you looked at some of the physical risks and you were starting to go into some of the cognitive emotional risks, right? So, what are some of those?
  
  STEPHANIE: Well, before I got to the cognitive, I was just going to talk about the home environment in and of itself. So, if you notice that the home is becoming more cluttered, disorganized, mail is piling up, that might be an indication of a person struggling understanding bills that are laying around or having a hard time just physically organizing the information; the cleanliness of the home; the smell of the home, all of these are indications that there might be something else going on. And cognitive, do you want me to go into cognitive now?
  
  DR MIKE: Sure. Yes, please do.
  
  STEPHANIE: Okay, then there are signs of cognitive losses. So, these are things like someone saying, "My microwave is not working," but really it is; or, you're finding burned pots and pans indicating that someone is forgetting the turn the stove off. You're finding expired food in the home, your loved one is becoming ill and vomiting or diarrhea. It might be because they're eating food that is spoiled and they're not recognizing that it's spoiled, or medication errors over or under medicating--these are signs of cognitive losses that can appear within the home.
  
  DR MIKE: Now if you recognize those things, Stephanie, does that automatically mean that that senior needs to be in a home? You know, an assisted living environment something like that? Or, are there steps you can do initially maybe to keep them in their own home?
  
  STEPHANIE: Yes, there are a lot of things you can do to keep somebody in their home and I would encourage people to never jump to relocation because it's a big thing for everybody--the family and the senior him or herself. So, first you have to get the senior to acknowledge that there is a concern; that the family members are wanting some sort of assistance and you can start slowly introducing assistance in the home provided by family members, friends or even paid home care professionals.
  
  DR MIKE: Yes. Do you often find that if steps like that are taken pretty quickly and were proactive about it, that often maybe somebody can still live on their own for two or three more years or something? Do you see that kind of result?
  
  STEPHANIE: Yes. I see it a lot, especially when it comes to nutrition because even if someone is having cognitive losses, once you can improve the nutrition, sometimes it perks people up a bit and if you can get them on the right medication it can help to delay the progression of the symptoms and when they're safe at home, someone can really stay there for a long period of time. Plus, when you have someone in the home, you're providing social stimulation and there's lots of activities you can do and the person begins to have more of a purpose. They feel more connected and that is going to help keep the person at home for a longer period of time as well. Just that impacts the family now and their stress level because now they're having to organize and supervise care in the home. So, is that right for the family versus relocation? That's something that needs to be evaluated.
  
  DR MIKE: So, let's use you, Stephanie, as an example because you told me before in another interview that you are kind of hard headed (laughing) and your kids might have, let's just say, sometime down in the future you start showing some of these signs and stuff...
  
  STEPHANIE: Never!!
  
  DR MIKE: (laughing) See, you're already fighting me! It's just a story. I'm not saying it's going to happen but what are some of the things that you can tell your kids right now about how to address these things with you, if it were to happen? Are there ways to approach seniors with concerns like this?
  
  STEPHANIE: I think so. I think one of the things that is really important is for the children, the adult children, to not act like they have the answer and that it's their life that they are trying to make decisions.
  
  DR MIKE: Good point.
  
  STEPHANIE: To acknowledge that their loved one that it's their life. They're the ones who make the choices. No one is trying to bully anyone or force anyone into a decision. "What I'm doing, mom, is I love you and I'm noticing that it's really hard for you to get your meals together everyday and the last thing I want is for you is to end up at the hospital or to end up in a retirement residence because you don't want it. So, mom what can we do together to come up with a plan that's going to keep you here for as long as possible because I don't want changes just like you don't want changes."
  
  DR MIKE: Yes. So, okay, is there anything though...Okay, so let's say you start recognizing some of this stuff in a mom, dad, grandparents, whatever, are there things that are just absolute red flags that, "Okay, relocation just has to be done right now?" I mean, is there anything that you might walk into a home as a social worker, is there anything that you might come into an environment where you're going to say, "Okay, this person--this senior--needs to get out and get some help?"
  
  STEPHANIE: Yes, , I think wandering is very is a high risk area, so if the person has the personality where they're leaving the home without supervision and they have cognitive losses, that is very scary because the consequences of that can be very severe. So, that's one thing for wandering. But if they're in a home environment, if the person understands, so cognitively they're okay and they understand the risks and the consequences to the choices they're making, even if they're scary and high-risk choices, they really actually have the right to make those scary decisions and that's when the family, then, needs to work on their ability to kind of just let it go. But, wandering is very risky.
  
  DR MIKE: Yes, that's a big one.
  
  STEPHANIE: And over and under medicating is very risky as well.
  
  DR MIKE: So, I watched a show and, gosh, I don't remember what show it was, you know, on cable or whatever, and it was about two seniors--two senior women--and they had been best friends all their lives and they lived separately and they were alone now, but they were still friends, same neighborhood, and they started showing some of these signs that there were some cognitive issues and the families brought both of the seniors together and they were now roommates in one apartment. And, it dramatically changed how they were taking care of themselves they were helping each other. Have you heard of that kind of story is that an option for people?
  
  STEPHANIE: That's a great option. How creative for the family. How respectful for the family to do that sort of an intervention versus forcing a relocation.
  
  DR MIKE: It is cool, yes.
  
  STEPHANIE: I haven't heard of friends coming together. That's really cool.
  
  DR MIKE: Yes. It was really cool. Listen, we've got to end it there.
  
  Her name is Stephanie Erickson her website is EricksonResource.com. Go check it out.
  
  This is Healthy Talk on RadioMD. I'm Dr. Mike. Stay well.
• Length (mins): 10
• Waiver Received: No
• Host: Mike Smith, MD