Early intervention is key to successful diagnosis and treatment. Family caregivers will be empowered to have confidence in their ability to use their powers of observation and tools and information that are readily available to them to detect six common medical complications, frequently fatal to the elderly, and to act as an early warning system. Caregivers will be encouraged to form a healthy alliance with doctors and nurses, to communicate symptoms to them and to advocate for an accurate diagnosis and effective treatment. Further, caregivers will learn to work with doctors and nurses to devise prevention strategies. Caregivers will learn how to ameliorate the dangers that understaffing in nursing homes poses to their loved ones. They will also learn about legal, ethical, and medical issues in end-of-life care. The goal is to help family
caregivers to prolong their love ones' lives, to promote a higher quality of life, and a dignified end-of-life experience.
Taking Charge: Good Medical Care for the Elderly and How to Get It
Chapter One. Family caregivers are encouraged to realize that they do not need medical degrees in order to form an effective first line of defense for their elderly loved ones. Since few doctors and nurses have any training at all in geriatrics (1.5% and 1% respectively), and since they spend far less time with the elderly than do family caregivers, it is the caregiver who is in the best position to detect subtle changes in status that signal a medical crisis. They are encouraged to have confidence in their observations and to recognize that a change in status is a “red flag” that caregivers should communicate as “an early warning system” to doctors and nurses.
Family caregivers will learn to detect, to communicate symptoms to the doctors and nurses, to advocate for early intervention and to help prevent the following six common medical complications:
Chapter Two. Delirium—Delirium is misdiagnosed 95% of the time, with 15% to 26% of these patients dying as a result, usually of the medical condition that is causing the delirium.
Family caregivers will learn that they are in the best position to recognize
delirium and its danger to their loved one. Caregivers learn to advocate for
accurate diagnosis and treatment of the underlying cause of delirium in order to
avoid serious harm.
Chapter Three. Medication error—There are eight categories of medication errors. The family caregiver will learn in broad brush-strokes about these.
Chapter Four. Adverse medication reactions—In more depth, the family caregiver will learn how to detect common ADRS such as urinary or bowel incontinence, sedation or dizziness, difficulty in swallowing or talking, bleeding, tremor or rigidity. They will also learn many effective prevention techniques.
Chapter Five. Falls—Family caregivers will learn that most falls are not accidents, and a significant number of the elderly who fall die within one year. About 50% of falls by the elderly are due to intrinsic factors (patient characteristics such as polypharmacy) and about 50% are due to extrinsic factors (e.g. environmental factors such as loose rugs, poor lighting). Caregivers will learn to help detect causes for falls that require medical intervention and also to work with doctors and nurses to prevent falls in the future.
Chapter Six. Dehydration—There are significant tools and information available to family caregivers that can help them to detect dehydration or the potential for dehydration so that they can act as an early warning system for doctors and nurses. Caregivers will learn to get medical caregivers involved early to diagnose problems, to treat dehydration or medical problems that could cause dehydration if untreated. They will also learn prevention techniques.
Chapter Seven. Protein-energy malnutrition—Caregivers will learn that significant numbers of the elderly are malnourished and that this is not always related to poverty. They will learn that 40% of nursing home residents, 44% of home-dwelling elderly, and 50% of hospitalized elderly patients are malnourished. They will learn what places the elderly at risk for malnutrition and how to detect malnutrition so that they can get medical caregivers to intervene early enough to make a difference. They will learn to analyze the benefits and detriments of artificial nutrition and they will also learn prevention strategies.
Chapter Eight. Understaffing in nursing homes—Family caregivers will learn about some effective ways in which they may ameliorate the dangers that understaffing in nursing homes poses to their loved ones.
Chapter Nine. End-of-life care—Family caregivers will learn about the legal, ethical, and medical approaches to end-of-life care and how they might increase their loved one’s quality of end-of-life experience.
Family caregivers will learn
A. Which elderly persons are most at risk for these complications;
B. What makes the elderly at risk for these complications (e.g., urinary tract infections or other infections producing fever, overload of anticholinergic drugs, side effects of medications, mediation interactions, metabolic disorder, electrolyte imbalance, imbalances of acids and bases in the body, dehydration, hypothermia, retention of urine, fecal impaction, etc.)
C. How the complications manifest themselves (the symptoms);
D. Tools available to family caregivers to help them monitor their loved one’s condition;
E. How family caregivers may and should advocate with doctors and nurses for early intervention and a proper diagnosis and treatment;
F. How family caregivers can work with doctors and nurses to devise a prevention protocol.
Family caregivers will be encouraged to maintain their own mini-medical record in which they can record medications (when prescribed, the purpose of the medication, any ADRs observed, any changes in medications, e.g.), and maintain a record of changes in status (weight changes, changes in alertness, e.g.). They will be directed to information and tools readily available to them to help them detect these 6 common complications.