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Caitlin Whyte: As our loved ones age, we are often called upon to provide additional caregiver support in many forms. Helping to navigate increasing health care needs can be overwhelming, but there are people and resources available to help. Dr. Mary Rudyk with New Hanover Regional Medical Center specializes in the care of geriatric patients. And she is here today to talk through some options and resources that you may find helpful if you're caring for an aging loved one.

This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Caitlin Whyte. So Dr. Rudyk, how can we help our older loved ones maintain their independence?

Dr. Mary Rudyk: So that's a great question. First of all, a lot of elderly patients are independent. And if we start to look at some of the statistics, which I think are pretty interesting, one of the myths that we have to stop perpetuating is that the majority of older patients are in nursing homes. When we actually look at some of those statistics, currently right now about 3.5% of those over the age of 65 are in nursing homes. And in about 10 more years, probably about 15% of them will be in nursing homes.

But in the majority of patients, a lot of people live by themselves. In their 80s and 90s, they're living alone and they're living in the community. By 2038, about 17.5 million people will be in their 80s. And a majority of them will be single persons living by themselves. So how do we support them? We support them in a variety of ways. When we start to look at people living by themselves, the areas that we have to be concerned about are transportation because of issues with driving, trying to get into some of the grocery stores, getting their food. Mobility is a big area and also some social connections. Those are the big things on how we can support the older person living within the community and how we can support their independence. So those are some of the interesting statistics that I think are some of the myth-breaking ones that we should think about.

Also, when we get older, we can still learn a lot of things. A lot of older people volunteer or they're still working and they have a lot to contribute. So when we look at that older person, we shouldn't look at statistics and we shouldn't stereotype. Because there's a lot of individual characteristics that we should be seeing, so we can't classify people by age by themselves. So we need to really look at that individual person.

One of the things that I start talking about with my patients is that I want them to have the conversation with their family members. So I want their family members to kind of have a checklist for them. I want to make sure that they have a healthcare power of attorney. So that when they can't make their own decisions, they have someone in their family that's going to help make those decisions for them and know what they want and don't want.

I also talk to them about the fact that they have to sign a HIPAA form. So that if they wanted me to talk to their daughter or their son or whoever, they have to let me have that information. And then we also talk about living wills and what they should be putting in them and what they want and what matters most to them.

But the biggest thing I tell them is that they really need to talk to their family about this. And the best time to have that conversation is when they're healthy and when they're well. Because when we get sick and when our family members don't know what our wants and desires are, that's when mistakes are usually made. So I always tell them that it's really important to start that discussion early with their family members and with their sons, daughters, nieces, nephews, so that doesn't happen at a bad time.

Caitlin Whyte: Now, what about exercise? How can we keep our older loved ones moving and incorporating that routine?

Dr. Mary Rudyk: Let's talk about that because one of the other big myths is that, you know, people when they get older, they develop dementia. So let's talk about that because it doesn't have to happen. I always say there's things that don't have to happen. And one of the big ones there is dementia and memory impairment.

So let's talk about exercise. Let's talk about the benefit of exercise. I tell my patients, it's like putting money in the bank. So you exercise, you will accrue the benefits later on. So let's say Monday, you have to have a hip replacement. All of that exercise that you've done has given that muscle memory. So let's say you need to have a hip replacement. Your muscles will remember so much from all the exercise that you had done. So exercise is wonderful for the body, but it's also really important for the mind because it releases those endorphins to make you feel better.

So exercise is actually so vital. It's vital to the body. It's vital to the mind. It gives that muscle the strength and endurance for me. Because as we get older, we developed something called sarcopenia, which is loss of muscle mass. So we want to build that up as much as we can. And I tell people, take the form of exercise that you detest the least. So if it's walking that you like, go out and walk, but by all means you have to do something. You cannot just sit and vegetate at home. Because the more you sit, the more muscle mass you're going to lose.

So just even in the hospital, that's another one of my big issues. If you sit in the hospital and you don't get up and move within three to five days, you will lose about 5% of your muscle mass. So I really push people to exercise, but not just the body, we also have to exercise the mind.

And there are in life the issues that we're starting to have, particularly with the pandemic, because a lot of people socialize and that's the brain exercises, but I really encourage people to get onto the computer. If they can't get on the computer, do something called mind searches, do some mind games, talk with people on the phone, do some FaceTime with other people. So we have to exercise both the body and mind.

Those are two really, really important things for our patients so that they can look after themselves better and live, you know, mentally and physically much better when they get older.

Caitlin Whyte: If we get to a point where we're bringing a loved one into our homes to live, what are some good resources for that transition?

Dr. Mary Rudyk: So I think there has to be some ground rules, which is really important. We have to have, you know, some rules because what could eventually happen is it can invade our whole lives and quality of life goes down for both parties. So just because, you know, I moved into your home doesn't mean that you can take total control of me. So we have to have respect on both sides. And that's what I tell people. We have to, you know, kind of respect our boundaries and know what, you know, is allowed and what isn't allowed. So I think that's one of the really, really important things, is boundary respect when we move someone into our home.

And, you know, if they have a room, it doesn't mean that we can walk into that room without knocking and the same thing, vice versa. So we have to respect those boundaries. And that's a really big decision, to move into someone's home because it's a loss of independence and that person is really struggling with that. So it also always doesn't work out or sometimes it doesn't work out. And then that may mean a move for someone. So it has to be well-vetted before it happens.

Caitlin Whyte: We've seen so much in the news surrounding COVID and nursing homes. Tell us about those remote visits you mentioned.

Dr. Mary Rudyk: So let's talk about that because I think that's one of the saddest thing that's happened. I have read a terrific article in the New York Times a few weeks ago, and it's a great analogy because the analogy is you have someone who has a wheelchair and they need that wheelchair, so they rely on that wheelchair to get around. In a nursing home, a lot of patients rely on family, friends to kind of help with their minds, okay? To give them connections, to help with loneliness.

And all of a sudden, we've created this solitary confinement for them. And basically, it's like solitary confinement because no one's allowed to come in. You're stuck in your room. You can't open the doors. Staff can't come in. You can't talk to them. It's all of a sudden in a solitary environment and everything that's kind of kept you together, your family, your friends, your social contact is being taken away from you. So it's kind of like taking the wheelchair for the mind away from you.

And then you're left desolate. So you're living, but you're not really living because you're in total lockdown. You're in solitary confinement and it's one of the worst thing that's happened. I can tell you, people feel abandoned. They don't remember that their families can't come visit. Their spirits die. They think they've been less completely alone and they just don't understand it.

And staff are busy. There's that abandonment from staff because staff sometimes leave because they can't deal with COVID. So they may have looked after you for years. And then all of a sudden, COVID hits and they're gone. They can't come into the rooms and chat with you. It's simply, "Let's just deal with your basic needs." And the whole issue of even touching goes out the window and what touch does for you. So there's so many things that have happened because of COVID. The pandemic has hit every facet of someone's life.

So even those living at home, all of a sudden families don't come in. They don't see their grandchildren anymore, you know, their friends. I mean, just when the pandemic hit, I can give you an example of what some of my patients did, and I thought this was terrific. Kind of each day, one would have a reason to go out. Someone would pick a toilet paper hunt and they would go out and enter the grocery stores and find out what grocery stores have toilet paper and call everybody out. Or one would be a paper towel hunt or a food hunt for chicken or whatever. So they kind of formed this buddy system, but that kept them going and that gave them purpose, during that pandemic, because we always have to have a purpose and we have to have a structure to our life.

And what the condemning did to most people is it took their structure away. And when you have, you know, a mild cognitive impairment or some of the memory issue that may be very mild, remember that that wheelchair for your mind is your friends and your family and you take that away, we see such transitions of care occurring because all of a sudden that person can't live independently. And then they're all of a sudden in assisted living home and it just goes on and on with the things that have happened with the pandemic to people. It's been horrific.

And the alcohol too. So let's talk about that too, because it's all of a sudden, like the pandemic allows permissive drinking. So alcoholism has gone skyrocketing in my population too.

Caitlin Whyte: And if you are caring for someone remote these days, I mean, how does that work? What are some signs that maybe your loved one needs more care, they're suffering from some of those things you just mentioned?

Dr. Mary Rudyk: So I think that some of the signs are what I call changes in routine. So it's really, really important that you ensure that whoever, you know, if it's your mom or your dad, you really encourage them to have a purpose. So you want to make sure they're getting up at the same time, they're going to bed at the same time. When you do remotely, looking on them, are they still in their pajamas at two o'clock in the afternoon? Are they showering? Do they look disheveled? Do they have food in their house? So you'd want to kind of look at some of those signs. Does the house look tidy and neat as it always did before? So those maybe some of the signs that things are not going well.

Caitlin Whyte: For some of us bringing a loved one into our homes or remote care, you know, both aren't options, so when it comes to institutionalization, what does that include? Where should someone begin with that search?

Dr. Mary Rudyk: So, again, it really depends on an evaluation of that person. So typically, when I have a patient that family are concerned about, you know, changing status and do they need a higher level of care? So they can no longer live independently. So we look at what we call activities of daily living. Can they dress by themselves? Are they able to use the telephone? Are they able to do their finances? What kind of care needs do they actually require?

And based on those care needs, we then kind of determine do they need, you know, just some help with their medications? Do they need more help? Do they need help getting dressed? Do they need help bathing? Do they need help if they're a diabetic but insulin? So it all depends on what their care needs are. And then that determines what level of care they would go into.

Caitlin Whyte: And wrapping up here, you know, talking about things like assets and wills, always a difficult conversation to dive into. Can you give us some tips on, you know, starting those conversations and a little bit more about what are advanced directives and what is a power of attorney?

Dr. Mary Rudyk: Absolutely. So power of attorney really is making the decision if you couldn't make your own decisions about what you would want happen to you if you had a stroke and you couldn't speak. Who in your family would you want to help make those decision? Who seems to know you the best? Who would carry out your wishes?

You know, for someone to do that, they have to know what your wishes are. So that conversation has to start. You have to talk to them about what matters most. You have to talk to them about, you know, what happens when you are no longer capable of doing those things? What matters most to you in life? If you can no longer look after yourself, where would you want to be? Those are very hard conversations to have.

Sometimes you can start the conversation with asking them to read a book. Being Mortal by Atul Gawande is an excellent start to it. But it is a hard conversation. People are reluctant to talk about what their care needs will be when they get older. But again, it becomes just so important, because we don't want to do something to someone that they would never have wanted.

And, you know, would they ever want a feeding tube if they couldn't eat by themselves? And I can tell you right now when I talk to my patients about that, they're horrified of the thought of that, about never being able to have food in their mouth, about never having, you know, anyone kind of touch them to help feed them. They would not want to have that.

So when you talk to them and really explain some of what's involved. When we talk about resuscitation, the majority of people would not want that. So you have to sit down and have a really good, honest conversation about what matters to them. And is it life or is it quality of life? Is it time or is it quality? Tough conversations.

Caitlin Whyte: Absolutely. Well, Dr. Rudyk, just jam packed with information here. Is there anything we didn't touch on that you want to make sure it gets in?

Dr. Mary Rudyk: I think that's a lot of it. There's is so much more to talk about, but if we can at least have an honest conversation about the people that we care about and what they would want when they can no longer look after themselves, that's such a huge start because most people never start the conversation. So if we get anything from today, it's just to start the conversation with your family, your aunts or uncles, whoever you care about, so that you know what they would want.

Caitlin Whyte: Well, thank you for your care and your compassion and taking the time to walk us through these important steps.

That was Dr. Mary Rudyk, the Medical Director of the Senior Unit at the NHRMC Orthopedic Hospital and Post-Acute Care. Learn more about our geriatric services at nhrmc.org. This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Caitlyn White. Stay well.