'Shoot me before I get there' is the often heard plea from those in their robust, active-retired 60's, 70's or 80's. The trouble is we become aged incrementally and once there, decisions about what happens to us will fall to our relatives.
I have had close contact with a few ill, confused, very elderly women while in hospital and wanted to blog about this seperately as I have a lot to say (as ever!).
Firstly, I saw none of the neglect of elderly patients in hospital that has preoccupied the media. Particularly during the five days I spent on an acute ward, I watched and heard the nurses take painstaking care with elderly women who needed to be cleaned up, who had bed sores, who were incontinent and who were unable to feed themselves. My opinion from this limited sample of five days is that the women who were being cared for at home by a series of carers were in a worse state than those from care homes. In both hospitals, the LRI and Leicester General, no woman was ever left unfed or left soiled for any length of time.
I found it difficult to be the sole cognitively aware patient on the ward. I would have liked to have been more helpful but I'd had a stroke and it was hard for me to stop a determined patient from trying to get out of bed and escape, or to retrieve her dropped call button, to answer her repetitive questions or to call the nurse when she needed to go to the toilet. The confused elderly need more human contact than they currently get. I'm not saying it's the job of highly qualified nurses to spend their time watching old people but I'm told there are many people 'out there' who are looking for voluntary work and perhaps this may be a role for volunteers.
The confused, aged patient is rarely able to sleep, is not able to read or watch television because they are agitated. Their agitation stems from anxiety, which leads to repetitive questioning and stereotypical behaviour such as folding, sifting, sorting or hand-rubbing.
I was struck by the similarity with the behaviour of young children with autism and I feel there is much to be shared in terms of strategies. The elderly people I met would have benefitted from visual systems, for example photographs, symbols or objects e.g 'night/day','toilet','bed' to support their understanding. A visual timetable would also help, so that the sequence of the day can be made clear e.g 'first lunch (symbol), then visiting time (symbol'). Choice boards would be a good idea. 'Do you want tea (object/symbol) or coffee (object/symbol)?'
Elderly people need someone to listen to what they mean. Amidst the repetitive questions and comments without any obvious context, something is being communicated. But it needs an adult with time to sit, listen and make a guess. To help with the agitation, these patients need someone to show them pictures, to play simple games or puzzles with them, to help bring them out of their inner preoccupation. Everyone needs to avoid the relentless, forced jocularity which is often the way they are spoken to. There isn't much humour in being 95. The elderly patients didn't get the joke and nor did I.
Incontinent patients, like children who aren't yet toilet trained, need a regular toileting schedule. This wouldn't prevent all accidents but might cut down on the frequent need for cleaning-up that I observed. This would be time consuming but it could easily become just another regular procedure such as taking patients' blood pressure.
I shared some great moments with my aged companions. I enjoyed hearing their feisty answers to the competency tests ('you can stick your tongue out all you like, when's your birthday?') and struggled myself to remember the date of the end of WWII. I enjoyed sharing, at second hand, the devotion of long-term partners and their children, in particular a tiny, aged couple who couldn't bear to be separated by her illness. When he left with their children, she made repeated attempts to get off the ward using her mobile tray for support, so that she could follow him.
Every one had a complex personal story. I heard one old lady tell the staff that she had heard her baby cry after its birth and then she was told he had died. She never saw or held the baby. Being in hospital triggered this memory. Perhaps she had never spoken of it before.
I enjoyed their refusal to comply, to be meek and accepting. I watched one old lady refuse food from a spoon, then finish the meal herself as soon as the nurse was called away.
But I was relieved to get away. I found the constant worry of monitoring my companions too much. They needed more help. I was advised to draw my curtains around me, so that I couldn't see what was happening and I'm sorry to say that in the end, I did.
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