Having a hard time w/ the elderly lately

[SoundofMusic]

What is it about elderly people sometimes?? I sort of mentioned this on another thread.

Some of them are ok -- sweet, kind, and good patients. Many of them, however, I must say, are truly a MESS.

They will usually be admitted in such poor shape, and have so many co-morbidities: DM, CHF, PAD, PVD, GERD, depression, anxiety, you name it -- they've got it. Then they've got alzheimers, or some other dementia problem. So many seem neglected -- neglected by their families, their spouses, their facilities that they reside in.

They come in bruised, battered, many just filthy. Nails that haven't been trimmed in months, and odors that just almost singe your nostrils.

And many are just so absolutely demanding. Get me this, get me that. I NEED this, I need that. I need you in here every 5 minutes to do something FOR me. They behave as if they are helpless. Whatever happened to the old stoic and wise self reliant man/woman?

What is going on in this country? Have these people just neglected themselves all their lives? Does it stem from their familial relationships? Their state of health? Does it stem from our society as a whole and how we discriminate? Does it come from ageism? Does it come from the gradual breakdown of society?

I'm just trying to understand it as I work on a unit that cares mostly for them. I lately have dealt with some of the nastiest and filthiest people lately -- and I just have to wonder how they ended up like this?? And they seem to come from ok families most of the time.

It makes me truly, truly fearful of getting older.

[meluhn]

WONDERFUL post.......thank you!!!!!:yeah:

It also helps to remember that even the surliest, filthiest, nastiest-dispositioned person on Earth is, or at least was, loved by someone. (I could also add that he/she is loved by God, which alone makes him/her worthy of respect IMHO.) I know it's hard sometimes to be patient and kind when somebody's yanking on the call light for the tenth time in the past five minutes and screaming like a shrew if you don't fly down there at the speed of sound, but it's better than regretting a sharp word spoken in frustration or feeling guilty because the one time you ignore them, they really ARE dying.

Thanks. I personally find older folks easier to work with than pediatric patients. Sometime the family dynamics are really messed up and I tend to be a little too judgemental about that. Also, some kids/families can really suck the life out of you. At least with adults you really only have to deal with one person. JMO. Luckily, there is a population out there that all nurses enjoy working with, that is the great thing about nursing.

[leslie :-D]

ok, call me warped...

but i just LOVE those who act-out, spit, kick and cuss til the cows come home.

there isn't one time that i haven't smiled while trying to contain or redirect them.

esp the lol's...

just.LOVE.them.

and while they're being literally carried away, a doctor walks about and the lol starts unabashedly flirting with him, coy smiles and all.

i'm thinking of one who started massaging her 32aaaaa breasts while trying to press herself against the doc.

(the feces under her nails i think, were the clincher).

i don't know why i love them so, but i just do.

probably because i know that one day, i will be one of those incorrigible residents, that will be overdosed on haldol in 4 pt restraints.

my best memories of the elderly, are those who were impossible to handle.:redpinkhe

empathy really does go a long way...

towards trying to understand what the folks are feeling AND towards trying to understand what the op is experiencing.

leslie

[SuesquatchRN, BSN, RN]

I don't have that much trouble with my old ones. There are a few who are combative with everyone but usually (usually) I can re-approach after they have calmed down.

When we brought my dad to the hospital I was angry at the little intern who was disgusted that he needed to be cleaned. Hello, we brought him in because he would not permit us to care for him and was, you know, dying.

This week I had a guy rip his Foley out. Rip it right out. I simply asked him, "Mr. X, you removed your catheter. Do you know why?"

"Nope. Don't remember. Can you take the water out of it and put it back in?"

"No, we'll use a new one. Now, this may hurt a bit because you did a little damage when you took it out. Are you ready?"

"Well, that wasn't too bad at all!"

"I'm glad. Please don't do that again, okay? Let us know if you're uncomfortable."

Respect, calling them by their honorific, and maintaining a relaxed affect all help.

Screen them often for pain. They can not always express what they are feeling and it is often pain. Remember, too, that they often have no short-term memory left and are confused and frightened. "Mrs. Y, do you know where you are? You are in the hospital. You fell down and hurt yourself. We're trying to fix you."

[ellakate]

i sooo pity these folks.

and honor every bit of their being, til the day they die.:redbeathe

That is right, Leslie. I think that sometimes the failing memory and dementia make them angrier. And then there are people who were born unhappy and can't get past it.

[leslie :-D]

That is right, Leslie. I think that sometimes the failing memory and dementia make them angrier. And then there are people who were born unhappy and can't get past it.

spot on, centex.

so they live out their lives, fighting for any remaining autonomy.

sue, your handling of your pt (pulling foley out) was perfect.

no matter how demented one is, they always know when they're being respected...

or not.

leslie

[SuesquatchRN, BSN, RN]

The other thing to remember is that they want to go home. Period. And they're trying to get there, poor things. I have one guy who is breaking my heart because he just wants his wife, and he reminds me of my dad.

[PostOpPrincess, BSN, RN]

I often find these types of patients don't have the family support that they are probably craving.

When my grandmother died, she had all of her children there are the bedside...holding her hand and they all watched her go peacefully....there was so much love for this little tiny lady...everything she wanted, we gave her..a massage, a treat...she was such a wonderful mom, and grandmom....

She was so loved throughout her life because she LOVED so much and she was so loved at the end of her life because she loved SO MUCH.

Imagine, these others who've probably never had that.

It's disheartening.

[nurse grace RN, BSN]

I now have more insight into the posters' situation and the elderly can be scary if you have not had experience with them. They also can be extremely stubborn, set in their ways and even defiant. I do believe that they are often afraid of losing control of their lives, losing their loved ones and sometimes they are afraid of dying.

Unfortunately, some of them are abused, beaten, ignored and just looked upon by their family and caregivers as a monthly check. I have seen patients that have not had the care from family that they should have had and how it makes them lash out at everyone. It did not scare me but that is because my father has dementia and often acts out and even in public places.

I would just take each patient as they come to you and try to understand that it could be many things that caused them to present in their condition and it is not anything to do with you. Don't take it personally when they call you names or are verbally abusive; they may not even realize they are doing it.

I think each of us has a patient population that proves to be extra difficult to deal with: for me it is alcoholics , but over time I have learned to be tolerant and more understanding.

I think that through time and experience it will become easier to handle the elderly and to understand them.

I apologize for being judgmental in my previous post and wish the poster only the best.:redpinkhe

[SoundofMusic]

I suppose what I really wish is that some of these things could be avoided through better education and awareness. Seriously. We are ALL going to be in this boat someday, and it personally scares me.

Is there a way to ensure that the elderly are taken care of better? Perhaps better visitation rules in nursing facilities, an end to polypharmacy, better counseling as we age, so we can all better understand what is happening to our bodies and how to cope. I mean -- situations could improve.

I've just got to wonder why so many are so confused and why so many are suffering from dementia as well. It seems epidemic. Are there any studies out on dementia and possible causes?

I feel this is a very important topic. I'm middle aged myself, and I see "old age" as lasting potentially 20 or 30 YEARS! How great it could be if those years were quality ones, healthy ones, productive ones. How sad that many of those years for so many are just so difficult.

[SuesquatchRN, BSN, RN]

I've just got to wonder why so many are so confused and why so many are suffering from dementia as well. It seems epidemic. Are there any studies out on dementia and possible causes?

When my grandparents got sick they died within several months of the precipitating incapacitating event. My grandfather had a stroke, became very childlike, and died shortly thereafter, after having been care for by his daughters at home. Now think about today, with the Coumadin, pressors, blah blah blah - we could probably keep him going for a long time. Why? He was gone.

I had a resident who had had a brain stem stroke 25 years ago. His wife was STILL waiting for this quasi-vegetable to recognze her.