Having a hard time w/ the elderly lately


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.


661 Posts

Specializes in acute rehab, med surg, LTC, peds, home c. Has 16 years experience.

I think it may be many different things for different people and any combonation of things. As far as the lack of hygiene, that could be depression, inability to get in the shower or both. Maybe in there culture or time, washing everyday was considered a luxury or unnecessary. Maybe it was not something they did ever in their lives.

As far as being demanding, I guess bossing us around makes them feel like they have control over something when everything else in their lives seems to be out of their control more and more.

I think you might have something there when you talk about ageism and discrimination. They are probably lowest on the ladder of importance in our society. We joke about them, treat them like children, call them honey or sweetie. I know I get annoyed when people call me sweetie or honey, it is very condescending. Maybe it annoys them because they dont see themselves as feeble old codgers like we do, they see themselves as adults who worked and raised kids and did important things, and now they are relegated to the nsg home like some useless old rag. They may no longer be productive members of society and I think this causes them to get depressed. They have watched many of their friends and family die and might be really lonely.

They might see the younger generation as a bunch of ireverant wippersnappers who dont have any respect. Every generation does this. I know I do and I am not even that old. I just try to keep things in perspective but I still get angry when I see some stupid kid with his underwear showing because his pants are below his a$$ cheeks :angryfire:madface::hlk:. God that infuriates me.

And lastly, they have alot of time on their hands to dwell on things, especially their numerous somatic complaints. Please be patient and kind to them. They are not long for this earth and they have been through alot.

I sort of think of them as living history books. I like to ask them about their personal experiences of some historic event ie, WW2, the 60s or whatever, depending on how old they are. I think it helps them to know you see a person with a history and not some old fart. Remember, they were someones baby once and then they came of age, fell in love, got married, had kids, etc. It is actually quite interesting if you have time to talk to them.

morte, LPN, LVN

7,015 Posts

remember, we see a skewed segment of society.....you dont see the healthy 82 yr old still working as an accountant....or the healthy 76 yr old that summers in maine and winters in florida.....or the thousands-millions more just like them......you dont see them......they are too busy living......

RNperdiem, RN

4,591 Posts

Has 14 years experience.


You said what I was planning to say. Look around at the plenty of non-frail elderly out there.

I recommend a book called "Another Country", a book about the emotional terrain of old age. I found it at the library and found it enlightening.


1,174 Posts

Specializes in Cardiology, Oncology, Medsurge.
I guess bossing us around makes them feel like they have control over something when everything else in their lives seems to be out of their control more and more.

I see this behavior could be a reaction to being ignored too often when assistance is required. When understaffing and underfunding take place, the elderly suffer the consequences.

I believe that our health care system has let some elderly down by not answering the call light on time, by allowing them to sit in their own feces, by giving them too many pills to swallow, by not assisting with their feedings and taking the tray too early before they're finished, by eagerly restraining them rather than taking steps to nullify the need for restraint (placing the patient in a WC at the nurses station or having them ambulate with assist, for example), by making fun of them rather than respecting their dignity, by mocking them with inappropriate behaviors, by being to aggressive with them (grabbing the arm to administer an IV push med) rather than introduction and teaching first, by allowing the system take care of a family member and not insisting family take the time to call or visit.

Virgo_RN, BSN, RN

3,543 Posts

Specializes in Cardiac Telemetry, ED.

I think there is a tremendous knowledge deficit related to caring for elderly loved ones that exists in this culture. Couple that with the economic reality that most people have to work for a living, and cannot stay home to care for an elderly relative. Another dimension is the family structure that is predominant in our culture, which typically consists of the nuclear family, and not the extended family. When you take all of those things into consideration, it's easy to see how so many fragile elderly fall through the cracks.

Another thing to consider is how exhausting it is to care for someone with so many needs. I see so many elders brought to the hospital for the simple reason that the family feels they can no longer care for the person. It is simply too much, and they are in over their head. I consider admitting these elders to the hospital to be an act of compassion, because then social work can get involved and help connect the family with resources to better care for the person.

The problem with long term care facilities is that they are primarily for-profit. This means that in order to do business, the facility has to keep overhead low. Caregivers cost money, so getting by with as few caregivers as possible and paying them as little as possible, cutting corners on costs such as food, laundry, toilet paper, whatever...this is how more profit is made.

And last but not least, is the avoidance of death at all costs. If Grandma gets aspiration pneumonia, well, let's just give her some antibiotics and put in a feeding tube. But what if Grandma has advanced Alzheimer's disease and no quality of life whatsoever? Perhaps it would be kinder to let the pneumonia take its course....or the 95yo LOL with an EF of 20%. Do we really need to put in a pacemaker?

While I understand that this comes from the value we place on life, and that family members want to do everything they can for their loved ones, I think it's important to look at quality of life as being just as important, if not more so, than quantity of life. If Grandma's last years are filled with nothing but pain and misery, at what point do we stop treating every little thing in order to eke out as much time as possible? When do we say enough is enough?

leslie :-D

11,191 Posts

i think many of our a&o elderly, are also asking themselves, "how the hell did this happen to me???"...

and this self-loathing shows in their affect.

you can always distinguish those who have lived miserably from those who have been more privileged.

it truly bears repeating, you die as you've lived.

op, the moment they sense that you respect them, they will meet you halfway.

and it's perfectly ok to implement limit-setting with outlandish behaviors.

i sooo pity these folks.

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


Are you being rather discriminatory? I don't like your pessimist tone.

nurse grace RN, BSN

4 Articles; 118 Posts

Specializes in med/surg, TELE,CM, clinica[ documentation. Has 15 years experience.

I hope that the nurse that cares for you when you are old has more patience than you do. I cherish the old patients I care for and I give them the respect that they deserve.


116 Posts

I have a relative in assisted living who has a movement disorder. It never fails every time I visit her she tells me what some of the LNA"s have said to her. They state I just saw you walking an hour ago, why can't you walk now? They do not understand despite being told with a movement disorder sometimes one can walk and other times they cannot. My relative tells me sometimes she has no choice but to hobble along and it is only then will she get assistance.

And please do not answer an elderly persons call light with What's up?

I also feel for her getting awakened at 5am to get washed and dressed with constant reminders " I have so many other people to take off", and do not have the time to do the little things that matter to the patient. When I worked in assisted living, I tried to do those little things, adjust a blind, look for a sweater, or water a plant.

It is not easy for these folks, they need compassion, patience and respect.


1,016 Posts

I hope that the nurse that cares for you when you are old has more patience than you do. I cherish the old patients I care for and I give them the respect that they deserve.

It's really discouraging to get disparing comments like these. I may come off as pessimistic or impatient, but I'm truly trying to seek understanding, to gain other perspectives, and seek guidance from experienced nurses. I find taking care of older folks day in and day out quite exhausting. I'm trying to do a better job and truly am just seeking input. I feel badly for these people that they are in such bad shape. I'm just asking why.

Several of the comments here have been quite helpful, and I appreciate those who took the time to comment positively, give reading recommendations, etc.

Also, I will admit -- I find it quite difficult to "cherish" someone who has just called me a foul name, or who has just gotten done beating me over the head or yanking my hair, or telling me they are going to murder me, or perhaps has spat on me or bitten me, or has demanded something, never EVER asking for anything in a polite manner for the 100th time that day. I mean -- I have taken some royal abuse from some -- not all, but some of these folks and it is TRYING. I'm just trying to understand their behavior so I can cope with it and be effective.

I'm sorry, but they're not all little sweet angels. There are some who do not even try to show an ounce of respect to me, their nurse. Am I to constantly be some sort of doormat for abusive individuals? I had a man yesterday who was calling all of us the "N" word (regardless of our color, which was weird), and it was not in a nice way. He was not demented -- he was just mean, and his behavior was unacceptable. I think he was in his 80's.

And don't get me wrong. Some of these folks -- the WWII vets, the former teachers, professors, businesspeople, parents, mothers, fathers, etc -- you can listen to them and learn so much -- and some I'd honestly I wish I could approach and ask if they'd perform as substitute grandparents for my kids -- they are just that wonderful. I'm definitely not generalizing.