Advice wanted: Aging grandparents

In My Humble Opinion
1

My grandparents are getting older (my grandpa is 80 and my grandma 78), and as they age, they’re begining to forget things, it comes and goes a bit. One day, my grandpa may not be able to recognise one of his grandkids (but he knows that he knows them), the next day he’ll recognise them straight off. My grandpa also has episodes (that last ~5-6 hours) where he has no idea who he is, where he is or how to do the most simple tasks (like getting a glass of water), and he’s becoming more and more likely to do socially inappropriate things (inappropriate comments, crawling around on the floor to pick up crumbs while there are guests around etc). We had accepted this as part of getting older, and since they’re generally OK, have been as supportive as we can, and although obviously concerned, not too worried about them getting into too much trouble. They both still drive (although in my opinion it would be safer if they didn’t).

Until yesterday.

Yesterday was father’s day in Australia, and we went to visit them. When we got there, we found that one of them (they both blame the other) had left the gas stove with a burner on full bore, with no flame. This resulted in the house filling up with gas, and obviously a dangerous situation. Had we not been there, who knows what could have happened? The last time they were sure it was off was over a day before - not a comforting thought.

This is coupled with my grandmother (who has the sounder mind of the two) being very frail - she has serious scarring on her lungs, and can’t talk for more than a few minutes without becoming breathless and having to rest. She has taken a recent turn for the worse where she has joint and muscle pain, such that she cannot get out of bed easily of a morning, can’t bend to the floor and can’t lift her arms above her shoulders. Her doctor wants her to use oxygen all the time now, but she refuses at all, afraid that it will be a sign of weakness.

My question is what can we do? They’re fiercely independent, and still live on their own. We’re their nearest (physical location) family, and we live 45 minutes drive away. To give you an idea of how they may respond to suggestions of a nursing home, my grandmother’s best friend moved into a nursing home a few weeks ago, and she has started speaking about her as if she were already dead. They will not voluntarily move out of where they now live, and will not accept any form of help.

I figure it can’t be all that rare a problem of having relatives getting older and not realising their limitations, but we’re really worried. Especially after the gas incident. So have any dopers been here before? Any advice?

2

Got any younger family members, just starting out, who could move in with the grands? You could pose it to the grandparents as they’re helping out the “kid”–which they are–and the younger member could pay a nominal rent and keep an eye on them.

3

Are they seeing a geriatric doctor? That’s a very important step. A geriatric doctor will have the best understanding of what your grandparents are going through and what needs to be done.

Your Grandfather sounds like he has the beginnings of Altzeimers. This is not something you can mess around with. About 6 months ago an old man here disappeared, just wandered out, got lost and he hasn’t been found yet. A couple times an elderly man upstairs who also had altzeimers for some reason left his home in the middle of the night and happened to knock on my door at 2am. Luckily he had a medical alert bracelet that allowed me to find his wife. My grandfather also had altzeimers and eventually I had to purchase a special lock that locked us and him into the house. It was illegal but it was the only way to keep him from leaving home when he couldn’t find his way home. He went from the place your grandfather sounds like to being completely helpless in 2 years. It got very bad. He couldn’t control his bowel or go to the bathroom by himself. Nor could he pick himself up off the floor and it was almost impossible for my grandma to pick him up.

Having someone move in with them is the easiest for them. There are also assisted living places which are not 24 hour care facilities but let the residents have more control over their lives. Nursing homes can certainly be an eventuallity. My grandma detests the idea but I can’t care for her forever. A home is an eventuality. Hopefully not for years, she’s 88 now. One of the good things we’ve found lately is Nursing Homes without walls. Their benefits run from weekly visits to litteraly having someone there 24/7. Right now we have a nurse come twice a week for an hour to help my grandmother take a bath, give her some exercise and company. You should look into that.

My grandmother was also fiercely independent but after bankrupting herself and flooding the house and melting some pots on the stove I just took over most things in her life. She doesn’t have altzeimers but is forgetful.

One of the most difficult things to deal with will be the revelation that they no longer have the ability to properly control their lives. They are, in effect, children. And how you get them to realize that it difficult. Certainly a plain speaking geriatric doctor could help. But there may be a need to assert a control over their lives. Thankfully most of the things I had to take control of in my grandmother’s life she mostly forgets that I am so. Like her finances and her food.

Sorry my post sounds so disconjointed. I think you have time to explore your options but time is at a premium. It’s a very tough time in anyones life and they may certainly not appreciate some of the steps a responsible and caring relative must take. Good luck.

4

Make sure they don’t drive anymore. Your grandmother sounds too frail, and your grandfather is obviously not up to the task anymore. It’ll probably mean a bigger strain on the family, of course, but this is about the safety of your grandparents - and potentially others as well.

5

I agree, but how do we make them stop? They won’t have a bar of it if we try and encourage them to stop voluntarily and hand in their licences, and although we could dob them into the police, somehow that seems wrong - I just can’t do it to family - they would be so hurt.

6

You steal their car, of course.

Kidding. :slight_smile:

My maternal grandfather was wise enough to hand my mother the keys to his car the day he turned 70. My paternal grandfather was a little harder to convince, but one ride as a passenger when he had purchased another car at age 83, after having done without one for 5 years, was enough. Effectively, we sat him down and told him that we thought driving was no longer a thing he should do. He felt horrible about it, but he did give in.

It’s not gonna be easy. Especially for men, it’s like giving away your penis. :slight_smile:

(Gotta hand it to my maternal grandfather for having the wisdom to see his own shortcomings, he was an absolute car and motorbike enthusiast - it must have been rough on him. The only times he would still drive was when my father would buy a new car, and he’d take the wheel on a deserted industrial area on Sunday morning. You should have seen his face when he got to drive those small stretches. :))

7

I, too, am going through this difficult process. My parents are slowly coming to realize that they cannot do all the things that they would like to do. My biggest problem is that they do not want to “have a serious talk” about what the future has in store. Every time I suggest that we sit down and talk about important details of their day-to-day life, I end up being the bad guy for even mentioning such a depressing subject. My mother, especially, wants nothing to do such a discussion - she actually becomes angry with me when I say that we should look into assisted living arrangements or having a professional care-giver visit on a regular basis. On top of all this, they are both in poor health. I am very worried about tests that my dad will undergo soon - I’m not sure how I can cope with the inevitable… Because of their fierce independent attitudes, it will be difficult to find a way to help them come to terms with reality.

8

I wish I had some advice to give you, but all I can do, really, is empathize. My grandfather died last December 2 weeks short of his 97th birthday. He had had a horrible car accident some 60-odd years ago, which left one leg and hip barely functional at all, and with age, they obviously got worse. (Orthopedics and rehab certainly weren’t the sciences in the 40’s that they are now, and after that, he decided that doctors had ruined his life and would go several decades at a time without seeing one.) When I was a small child, he walked with just a cane, progressing to a quad cane, then two quad canes, then a walker, then a wheelchair; after a fall in the bathroom a few years ago, he just decided he wasn’t going to get out of bed anymore.

His mind, however, was sharp as a tack until the last few weeks of his life, and he would not allow anyone to help him around the house except my grandmother and occasionally my dad or my cousins. (I live 900 miles away, so I was pretty helpless.) My grandmother is 10 years younger and in better health than my grandfather, but she was certainly no spring chicken, and after he decided he was bedridden, she had a hard time keeping up with simple tasks like bathing him because she didn’t have the strength to help him turn over. (She also has a bad leg from an old injury and isn’t too steady on her feet anymore.) His legs were turning brownish-purple from midcalf down from the lack of circulation because he never moved; the last few times I visited, he smelled awful and had bedsores. He was certainly my model for how not to handle physical infirmity.

My father and aunt tried countless times to hire a visiting nurse to help with his care, but he refused to let anyone in the house. (Did I mention my aunt is a Ph.D. psychologist, but was still unable to convince him?) After his bathroom fall, they thought he’d broken his good hip, but it took several days to convince him to allow a doctor to come examine him; he was afraid that they’d take him away to the hospital and he’d never come home. He didn’t break the hip, but he did spend several weeks in a rehab facility; at that point, he probably hadn’t seen a doctor in 40 years.

The situation got to the point that my dad didn’t want to take my 13-year-old brother to visit them for fear of him getting the idea that this was a normal way to live. Then, late last fall, he started to head downhill in earnest; had difficulty breathing, became disoriented, etc., but still refused treatment of any kind. Finally a doctor came to see him again, and said that he thought there might be a kidney failure issue, and that the symptoms might be alleviated with oxygen, which could be administered easily at home, but that my grandfather would have to go to the hospital for some tests in order to be sure. He refused, and slowly slipped away, ironically dying at the very hour when a hospice nurse had arrived to evaluate him so my grandmother could get some respite care around the house. I guess in the end he lived as long as he did out of sheer stubbornness, and died of sheer stubbornness.

What’s the point of all this? I’m not entirely sure, except maybe to let you know that a) you’re certainly not alone in your frustration, and b) I needed to get it off my chest (sorry for the partial hijack). But here are some things that were helpful, at least to my grandmother:

a) knowing that her children and grandchildren loved and supported her;
b) having neighbors and old friends who lived nearby stop by, even just to keep her company (the building super was also very helpful);
c) having people provide some small things that they would accept, like an occasional home-cooked meal, or an amplified telephone so they could hear phone calls better;
d) toward the end, the support of a local rabbi, even though he wasn’t the one whose congregation they had attended while they were able.

Perhaps there is some sort of local social worker or gerontological counselor who could provide more concrete suggestions, as I don’t know what other resources are available in your area. My heart goes out to you, and good luck.

9

You know, again don’t be too afriad about bullying them, especially if the memory’s not all there. Or perhaps a better way of thinking is don’t be afraid to be the adult in the relationship.

My grandmother hates doctors and hospitals. She had breast cancer in the early 80s. Had a sample of the treatment for it and then decided no thank you I’m ready to die with dignity and stopped going and subsequently refused to go to the doctor. Little did she know she’s do ahead and beat it and live so much longer. And around 1997 she began to get into poor shape. Had trouble bathing, wouln’t bath, would wear the same clothes over and over, and was very depressed all the time. So we deided it was time for her to go to the doctor and my mom made all these appointments but she wouldn’t go. But I used my pseudo-parental attitudes, basically standing around a lot and saying “Come on! We got to go.” giving her changes of clothes, and occaisional out right lies. I didn’t take no for an answer and boy did I get cussed out but she went. And I learned that haveing little short term memory means that the next day she didn’t remember all the goings on.

Now I do the same thing with medicine. I speak firmly, I do not take no for an answer and she does it. She goes to the doctor now, endures the medecine (which she used to refuse to take, and spit it ot and stuff since medecine is for sick people) and she sometimes even enjoys the baths and she is happier, partially due to the medication, but she does feel better. And every time I have to be harsh and she gets angry, like I’m sure she will when she has to have 2 appointments next month, I rest a little easier knowing it wont be remembered tomorrow.

Being the adult is hard to do, and of course they can fight you and different people will be able to oppose your efforts better. Thankfully my grandma only cussed at us then gave in. Now altzeimers patients can be violent and take swings at you, my grandpa did a few times.

So I like Coldfire’s advice for an elderly intervention chuckle. It sounds like their books are probably in order due to your grandmother. And don’t worry too much about upsetting them since it is for their own good (remember, just like a child hates bedtimes) and it sounds like your grandpa won’t remember it anyway.

10

No advice, just hugs {{{robinc}}}

My mum is currently nursing her mother, and I know it’s going to fall to me, when it comes to my parents, and Mr Goo’s parents and I’m not looking forward to it at all. I can see the things my mother has had to go through and it isn’t easy.

Good luck, and make sure you have a support network behind you too.

11

I certainly empathize with your situation. My parents are 77 and 78 respectively, and so far are independent and going strong. Their finances are good and they are looking forward to a cruise they are taking in November. Are there any community based geriatric services you could take advantage of? Could you search the net in your area to get information on any elder care services such as a visiting nurse organization or Meals on Wheels service so that your grandparents get nutritious meals? I live in Alexandria VA, about 2 miles from my parents. I suppose when the time comes, I can talk to their doctor and get options to help out. You might also want to get in touch with any religious organizations that have elder care programs available. I hope some of my suggestions help. Good Luck.

12

(Standard medical advice disclaimers apply.)

What you describe is dementia, which IS NOT a normal feature of aging.

Your grandparents seriously need to see their doctor, and describe those symptoms to him or her. While they could be the result of any number of things, these symtoms are consistent with Alzheimer’s or other similar conditions. Your doctor can rule out other, reversible causes of dementia, and if it is Alzheimer’s, there are drugs that can help slow the progression and resources available to help both the patient and the family.

In the meantime, the family should converge on the house and do everything they can to make it safer for them. Make sure any rugs in the house have non-skid pads on the back, especially in the kitchen. Make sure they’re keeping up with all the basic maintenance on the house–smoke alarms, heating system, etc. Check the handrails on any stairs to make sure they’re solid. Make sure the tub has those non-slip things in it, and that they can get in and out of it safely. Maybe the family could chip in this Christmas and get them a new electric stove.

It would be good if someone–if not a family member, someone in the area–could check on them every day just to make sure everything is OK. Ideally they’d have someone around the clock, but they aren’t going to want that. It may not be long before it isn’t optional. What I always tell patients and families when I have this conversation (which I do pretty much every day) is that you have to consider what you’re going to do when you aren’t able to provide adequate care for yourself/your loved one, and then you have to consider whether or not you’ve already passed that point.

I wish I had more good answers for you.

Dr. J

13

Definitely get in touch with your local council and find out about community-based services in the area. Quite often, help with bathing, medications etc is provided by community nurses free of charge. One benefit of using these services now is that the nurses will notice any change which might indicate the need for further medical intervention.

Also, the Red Cross operates a volunteer service which is aimed at touching base with elderly people on a daily basis. The volunteer will telephone daily, have a chat, and generally just check that everything is OK.

Be aware that nursing homes have waiting lists which can be very long, so your grandparents may need a fair amount of community-based assistance (again, most councils operate a community transport service for elderly people).

Even if your grandparents aren’t ready to accept any assistance at the moment, now is the time to do research about the resources which are available in their community.

I would seriously suggest talking to their doctor about the driver’s license issue as well.

14

Thanks everyone.

It’s all happening pretty fast - this time last year they were traipsing off on a round the world trip.

I have concerns about their doctor - sometimes they can’t get appointments with him for weeks or months when it’s clear (to me) that something’s very wrong. I don’t know how much of it is them refusing to push the issue, however. Also, I know my grandma won’t take the doctor’s advice, and I suspect my grandpa forgets it the second he walks out the door. I think also, they don’t tell their doctor the full story - their in denial about it - grandma dismisses grandpa’s forgetfulness and strange behaviour as “funny” and in turn, he thinks that she just needs to sleep in a little later.

The problem is that they are so fiercely independent and won’t accept help of any kind, and won’t talk about it. Fortunately, their house is great for old people - wide hallways and door ways, all on one level and a low maintainence garden. I’m having dinner with them tonight, so I guess I’ll try and bring it up and see what we can get them to agree to. Otherwise, we’ll just have to try and be subtle about it.

15

My grandfather, like yours, is a fiercely independent driver. A couple of years ago, he went out and purchased a Honda Hybrid car, because “it’s the wave of the future” (his words, not mine). A year and a half ago he suffered a heart attack (during which he lost consciousness and fell face forward into the bathtub), and one of the complications of his heart attack is low level dementia. He would drive around for hours trying to get somewhere, but not knowing where he was. At times he’d show up at my door not knowing how he got to my house. :eek:

My mother and I tried to convince him to give up his car, but he wasn’t very cooperative. Finally, my insurance agent suggested that we contact his insurance agency, because they can cancel his insurance, contingent on the results of a driving test. We did this, and he received a nice little notice in the mail from his insurance agency stating that it was their standard practice to request driving test results from “at risk” people that hey insured. He took the test but did not pass. He then realized that he could no longer keep his car, because he was uninsurable.

I hope that this information helps you. You could also contact your local Motor Vehicles Department and see if they can send out an anonymous test request to your grandparents.