Colonoscopies in the elderly are one of the most dreaded medical procedures due to the high risk of bowel perforation, infection and the fact that you need to undergo sedation or even anaesthetics in some cases.
The question remains, is a colonoscopy really necessary in the elderly and what are the reasons behind having one?
What is a colonoscopy?
This is a procedure which allows a doctor to take an inside look at the function and performance of the entire colon and rectum. Most commonly, a doctor would be looking for ulcers, inflamed tissue or abnormal growths – which can be commonplace amongst the elderly.
Some of the most common reasons a senior would undergo a colonoscopy include:
- Checking for colorectal cancer or other inflammatory conditions such as ulcerative colitis.
- Follow up surveillance of the bowel if a senior has a history of cancer, colon polyps or inflammatory bowel disease.
- To seal off intestinal bleeding or open up colonic blockages.
- Removal of colon polyps or any other internal growths.
Is a colonoscopy really necessary?
Once you reach a certain age, questions begin to arise as to whether a colonoscopy is really worthwhile considering the many risk factors. The truth of the matter is; a colonoscopy may not be necessary if:
- A senior is 75 years old or older
Many experts have ruled out the need to undergo a colonoscopy for preventative or early detection of disease if you are 75-85 years old. Instead, this treatment is only recommended on a case-by-case basis. The simple fact of the matter is that not everyone aged 75 years or older will benefit from a colonoscopy due to the increased risks as you grow older.
- You’ve had a colonoscopy in the last ten years
According to researchers, it takes approximately ten years or more for precancerous polyps to develop inside the colon before cancer is detected. This means that if you have no risk factors, family history or issues with your colon, then a colonoscopy is not necessary more than once every 10 years.
- Less invasive tests could be done instead
Yes, a colonoscopy is the most thorough way to inspect and assess the health of your bowels, but if another test can be carried out instead, this may be the route to go for seniors.
Alternatives to a colonoscopy include a CT scan of the entire colon, known as a colonography, an x-ray of your colon, known as a double contrast barium enema, faecal DNA testing, faecal blood testing or sigmoidoscopy which is a scope inserted into the lower third of the colon.
Ultimately, if you are unhappy with a doctor diagnosis and the necessity to undergo a colonoscopy for an elderly loved one, you have the right to a second opinion!
The honest truth is that it can be hard to tell how your parents are really doing with just a weekly Skype call or phone call. Without being in their living space or physical company, it’s hard to get a gauge on the true state of things in terms of their health, physical and cognitive capabilities.
This is why it’s important to call in and visit elderly parents every so often, and with the Christmas holidays coming up, now is generally the best time for a visit.
Here are 5 things to look out for and observe on your next visit to an elderly parent’s house, because they may be indications that it’s time to step in and offer a little extra help for their safety and your peace-of-mind…
1. A suspicious amount of unopened mail
This is important if your parent(s) have always been organised and on-top of things. If you notice an unusual amount of unopened mail, especially unopened bills, which date back a few weeks, this could be a sign of cognitive impairments, vision troubles or financial troubles your parents don’t know how to tackle. Schedule an appointment with an optometrist for an eye exam, or if financial troubles are to blame, suggest the help of a money manager from within the family.
2. Damage to the garage or vehicles
If you do a quick walk around of the property, including their garage and notice clear signs of damage such as scrapes on the walls, dents or cracked mirrors, this is a sign a parent’s driving skills could be deteriorating. Ask them to go on a drive with you while you’re there to quickly pick up something from the shop and assess how they drive, just to be sure!
3. Their physical appearance
If the physical appearance of your parent(s) has deteriorated since your last visit, this could be a sign of cognitive impairment or physical limitations. Make sure to look for a lack of general grooming, dirty clothes, unwashed hair and noticeable weight loss. These signs are worth a visit to their doctor as things like memory loss can cause an elderly parent to forget to bathe, change and even eat.
4. The care and state of your parent’s pet
While pets are a brilliant source of company for elderly parents, their care can put additional strain on an ageing parent. If a pet looks particularly unkempt, shabby, thin, old or even emaciated, this could be a sign that pet care has become too much of a task for your parent(s). For their sake, and that of your parent(s), it could be time to find them a new home or additional care such as pet walkers, groomers and a mobile vet service.
5. The state of their home
Finally, this is a no-brainer, but if your parent(s) home is not as clean, organised and neat as you remember, this is another obvious sign of deteriorating physical or cognitive capability. Mildew, mould, pantry pests, spoiled food items, dirty bathrooms etc. are all signs that they may need additional help to keep their home clean and safe.
Keep in mind that the Christmas holidays are probably not the best time to hash out these issues. But remember your observations and then call in a family meeting to discuss a way forward at the appropriate time!
According to statistics, over a third of people above the age of 65 die because of an infectious disease that was not caught in time. Now, this may sound macabre, but the reality is that as we age our bodies are no longer able to protect themselves as they used to, no matter how healthy you are.
Infection in the elderly is commonplace because of various reasons, but one of the most common tends to be a suppressed immune system which leaves them vulnerable to any nasties floating about.
So when does infection occur? An infectious disease is caused by microbes in the form of bacteria, fungi, parasites or viruses that invade the body and attack the immune system. This can lead to life-threatening diseases, chronic illness and organ damage.
These microscopic particles can be found in the air we breathe, the food we eat and the soil in which it’s grown, as well as the water we drink. Skin infections in the elderly are also prevalent as the skin begins to thin and wear down as you age. Broken skin sores which are not properly treated are a hot spot for bacterial infection which can spread throughout the rest of the body.
Common symptoms of infection in the elderly
The symptoms of infection will vary depending on the type of infection that has invaded the body, but the most common include:
- Persistent coughing
- Diarrhoea and vomiting
- Constant fatigue
- High fever
Muscle aches and body sensitivity
How to prevent infections in the elderly
To keep infection at bay, it’s important that seniors and caregivers keep their health in-check at all times. Some simple ways to prevent the spread of infection include:
- Always cover a cough to avoid the spread of germs
- Avoid sharing personal items between seniors, i.e. soaps, washcloths, razors etc.
- Ensure a senior is properly vaccinated
- Prepare food in a clean, safe environment
- Always wash hands before meals and after the use of the toilet
- Practice safe sex
- Nourish the body with healthy foods, i.e. plenty of greens, berries, protein, healthy fats and probiotics
- Avoid excessive alcohol intake
- Avoid excessive sugar intake
- Stay active with regular exercise, i.e. walks, yoga, Pilates, swimming, golf, cycling
If your loved one has been struggling with a persistent cough for longer than a week, had a fever for over 48 hours, has a severe headache, trouble breathing, an unusual rash or swelling or vision impairment it’s important to see a doctor as soon as possible!
Post-hospitalisation for seniors, family members and caregivers can be a harrowing experience. A senior can either exit hospital in better shape than before, or more commonly, suffer a number of setbacks in terms of physical and cognitive function. Of course, this is largely determined by age, existing illness and physical capabilities before hospitalisation – and it’s not always permanent!
But if you have a spouse or parent who is particularly frail, ill or suffers from cognitive impairment, returning to a home environment can present a whole new set of challenges.
Here are a few simple ways to ease you through this transition with your loved one;
1. Reassessing mental and physical capabilities
If a senior has taken a turn for the worse post-hospitalisation, it’s important to remember that these changes are not always permanent. This is where adequate assessment of a senior’s cognitive and physical abilities must be done by a professional as well as caregivers and family members alike. From here, you’ll be able to determine the level of care they will need in future months to come.
Caregivers, whether part-time or full-time, should be in contact with doctors, hospital staff, physical therapists and family members during this transition period to assess and report on a senior’s evolving needs. In other words, caregivers should be proactive in determining a senior’s needs after hospitalisation.
2. Adjusting to the senior care spectrum of needs
The care of an ill, frail or mentally impaired senior exists on a spectrum. As they age, their condition tends to progressively worsen, and unfortunately, hospitalisation can only exacerbate this reality. This is where the level of care a senior needs may need to be changed according to their spectrum of needs. For example, a part-time caregiver may need to be replaced by a live-in caregiver or a senior may need to be moved to a 24-hour supervised nursing home. But keep in mind that there are cases where these needs are only temporary, and the change is not necessarily permanent.
3. Consider assistive devices and home modifications
Once the level of care has been adequately determined for a senior post-hospitalisation, you may need to consider an assistive device or simple home modifications to assist in their new level of care. If a senior still lives at home with the help of a part-time caregiver, discuss with their doctor what modifications and devices would help their condition. Physical and occupational therapists can also help in offering advice on devices, walking aids and at-home therapy treatments to help with a senior’s recovery and ongoing care.
4. Understand the reality of hospitalisation delirium
This is a common occurrence for seniors who have been hospitalised for a prolonged period. They may lose their sense of time and space and begin to display symptoms of delirium. A change in environment as drastic as hospitalisation can trigger delirium in seniors due to overstimulation, unfamiliarity and confusion about their health and surroundings. This, in turn, wreaks havoc on their mental actuality.
Combined with a lack of sleep, antibiotics, pain medication and the side-effects of anaesthesia, hospital-induced delirium is a reality to look out for. The disoriented state should stabilise once a senior is back in their familiar environment and regular routine, but for dementia and Alzheimer’s patients, this could only worsen their condition.
5. Keep an eye on mood and behaviour changes
A senior who returns home after hospital with a weakened state of health or state of independence is likely to feel confused and frustrated. These changes can manifest in mood and behavioural changes, such as agitation, defiance, aggression and disorientation. Family members and caregivers must work together to address these challenges and help make a senior’s life as comfortable and uncomplicated as possible.
There comes a time in every family’s life where a formal meeting should be held to discuss the future of an ageing or ill parent. This progression of life is inevitable, and there will come a time where the future of those who once looked after you, needs to be made a priority to ensure they receive the care they deserve in return.
But one thing’s for certain: family dynamics can be complex. With a number of competing personalities, deep-seeded family history and the quality of existing or non-existent relationships, family meetings are not always easy, and sometimes a resolution cannot always be found.
If a family meeting is on the cards for a discussion about the future of an ageing, frail or ill parent, here’s how to approach things for the best possible resolve.
Usually the oldest sibling or primary caregiver of a parent is the one to host this meeting. It’s wise to call each family member beforehand and inform them of the purpose of the meeting, and why it’s important, they be there. Once the meeting takes place, here are a few essential steps to cover:
1. Identify family roles
Family roles are based on the past or present relationship a sibling or child has with a parent. Openly discuss who usually handles each aspect of a parent’s life and make suggestions on who should ‘step up’ in their time of need. Ensure that each family member is happy and 100% able to commit to this role with the time and other responsibilities they may already have.
2. Bring in a third-party if needed
If your family relationship is a particularly sensitive or volatile one, it may be worthwhile bringing in a neutral, third-party to help oversee the family meeting. Someone such as a close family friend, a clergyman, a social worker, a counsellor or even a family doctor can help bring in an objective stance and give some real perspective to the meeting.
3. Plan out the meeting agenda
This may sound a bit formal for a family meeting, but it helps to ensure all important topics are covered in one session, without having to meet back and forth across several months. This is especially helpful if family members have to travel from far for this meeting. The primary caregiver of your parent or the eldest sibling should draw up an agenda of topics to discuss, including:
- Emotional sharing: how does each family member feel about a parent’s illness, diagnosis and thoughts about their inevitable death?
- Up-to-date medical reports from a parent’s doctor and medical procedures recommended by them.
- The needs and wants of your ageing or ill parent and what they need most.
- Living arrangements of the parent and how they will be made, i.e. will they move in with a family member, an assisted living facility or remain in their own home perhaps with a live in carer?
- Financial costs: how much will an assisted living facility or live in carer cost, who will cover what cost, any other financial resources available.
- Who will continue to be the primary caregiver and what kind of support do they need i.e. shopping, cleaning, laundry, transportation, financial, respite.
- Amount of time required from each family member to be spent with an ageing or ill parent.
- Other sources of help and support available, i.e. friends, respite care, nursing home, church etc.
4. Make sure everyone gets a chance to talk
This is extremely important in allowing each family member to voice their emotions and opinions in order to avoid feelings of resentment or anger at a later stage. All feelings are appropriate and have the right to be expressed.
5. Recap on all decisions made
At the end of the meeting, do a quick run over on all the big, important decisions that were made so that everyone has a clear understanding of what their role is going forward. For some families, putting it all down in writing can be a helpful reminder for future reference.
One of the most important factors to keep in mind with family meetings is that a full resolution of all topics is not always possible. A mixture of family dynamics, commitments, responsibilities and personalities makes this difficult, that’s why compromise and flexibility are key. Significant change happens slowly, remember to keep this in mind!
Caregiver stress is real – don’t let anyone fool you into believing that you are over-reacting or shouldn’t be feeling the way you do. Full-time caregiving is demanding - physically, emotionally and mentally. Some days, you may even feel like your life isn’t your own.
Add to this concoction of stress the guilt of feeling like you’re not doing enough for your care receiver, the judgement of those who do not understand your situation and the resentment of a spouse. All of these emotions can add up over time, and all it takes is one snide remark or sarcastic comment to send you over the edge. This is especially potent if you are prone to suppressing your feelings or do not receive the caregiver respite you need.
The unlucky targets of your caregiver blowout are usually those who are closest to you, i.e. your care receiver, a spouse, a sibling or close friend. While caregiver blowouts are understandable from time-to-time, they may leave you feeling riddled with guilt and shame afterwards.
Here’s how to apologise in a genuinely heartfelt, meaningful manner:
In the heat of the moment, you may say something hurtful, spiteful or completely out-of-character. While a simple apology at the time may not seem like much, it will have to do for that moment. This is because a truly heartfelt apology takes introspection and an understanding of why you had a blowout in the first place.
First thing’s first, you could begin with saying: ‘’I am sorry. I didn’t mean what I said; it was in the heat of the moment. I think I need some time alone as I’m feeling overwhelmed.’’
But be aware that an excuse is not an apology, nor will it suffice as reason enough for your behaviour. Deep down, you will need to do some soul searching and think about how your caregiver blowout could have affected those close to you.
One of the main reasons why you direct your anger at those closest to you is because you feel ‘’safe’’ with them and know, deep down, they will forgive you. However, this is no excuse to treat them this way. If you are harbouring anger or resentment in any way, it’s important to talk about it with those concerned, instead of bottling it up. This is how caregiver blowouts happen, often directed at an undeserving target.
Once you have pinpointed the meaning behind your anger, it’s essential to approach your loved one or care receiver and apologise once again, in a sincere manner. Tell them about how you are struggling to manage your stress and need to make more time for respite care for yourself.
Ultimately, learning to talk about your emotions and find a healthy work-life balance with caregiving is utterly essential to your mental and physical health. At the end of the day, it makes you a better caregiver and makes for a better quality-of-life for all of those you care for – family, friends and spouse.
You may have heard of Hendri Terblanche in recent years- the businessman who rightfully and successfully campaigned for increased paternity leave rights for prospective fathers throughout South Africa.
Well, he is on a new mission and has petitioned parliament to extend similar rights to family caregivers looking after elderly loved ones through South Africa.
At present, most employees are offered a minimal amount of ‘family leave’ days which are most commonly reserved for emergencies. Other than that, employees are forced to take unpaid leave to care for family members in need. If the situation is dire enough, they may need to leave their jobs altogether.
To this end, it’s obvious to see why Hendri Terblanche is appealing to parliament for an extension of these leave days and the availability of unpaid leave offered under the labour law. He has since petitioned parliament to introduce an ‘Elder Care Leave’ clause, allowing for three days paid leave, or 6 weeks unpaid leave to care for an ageing or terminally ill loved one.
While it may not be a financial option to place elderly parents in the hands of professional care, is a mere six weeks of unpaid leave enough to ensure frail, ill or cognitively impaired loved ones receive the care they need?
This is where the costs of caregiving need to be carefully weighed
Becoming a primary caregiver for an elderly parent is a huge responsibility, and one that cannot be made lightly – especially if your career is a priority or you are a primary breadwinner.
Some of the most significant questions to ask yourself before taking on the responsibility of caregiving, versus placing an ageing parent in home care include:
- Do I have the space and facilities in my home to support them?
- If not, what amendments will need to be made and what cost?
- Do I have the time, resources, support and finances to take on the responsibility of becoming a primary caregiver?
- Will my company support this decision and what kind of leave allowances are offered to me?
- Is my spouse supportive of this decision and will they be able to help where needed?
- How will my children react to the presence of a frail or seriously ill loved one in their home?
While there is a myriad of things to consider when working a full-time job and considering primary caregiving, one thing must be made a priority- and that is your own peace-of-mind. Will the potential strain of full-time caregiving be worth saving money on professional care? Or will the cost of professional care outweigh the stresses of full-time caregiving, and potentially your career?
The decision is not an easy one; you will need to balance the pros and cons of both options and ultimately, weigh up the costs of personal caregiving versus professional caregiving.
While the day-in and day-out care of those with dementia and Alzheimer’s can be both repetitive and stressful, there are ways to lighten the mood and boost brain stimulation at the same time.
Research has shown that game playing works to engage the brain, memory retention, memory recall and overall health in those that suffer from neurodegenerative diseases.
Games don’t need to be long or overcomplicated, as long as they centre on participation – for both you and your care receiver.
Game playing also works to build on your relationship. By participating in a dual-player game, be it cards, a board game or consol gaming, this is a chance to reconnect with a friend or loved one.
What are the benefits of game playing?
Game playing results in a physical, cognitive and emotional response, stimulating all the senses.
It can boost cognitive recognition in those with memory loss, encouraging memories and building on processing skills – recognising numbers, shapes and colours etc.
- Being physical during game playing is healthy for ageing bodies – especially with games such as Wii bowling, ball games, dart throwing, golfing and more.
- Game playing increases socialisation between family members, friends and you, as the caregiver. This helps to fend off loneliness and depression.
- Connecting with others over game playing can boost a sense of purpose in seniors, especially if game playing becomes a regular activity.
- Game playing is good for the soul through laughing, interacting with others and feeding off positive energies.
- It can improve hand-eye co-ordination with specific card and board games.
- Video games centred on exercise, such as those on Wii Fit, work to improve balance, fitness and co-ordination.
The best games for memory and cognitive stimulation
Depending on the level of memory recall, cognition impairment and frailty, there are numerous games which offer the above benefits:
- Card games: Bridge, Gin Rummy, Cribbage, or Hearts are a little more complicated. For simpler games go for Uno, Old Maid, Solitaire, Go Fish, or Crazy Eights.
- Board games: for games focused on strategy opt for Chess, Clue, Backgammon, Scrabble, Risk, Yahtzee, or Trivial Pursuit. For something a little less difficult, go for Checkers, Candy Land, Trouble, Connect Four, Don’t Wake Daddy, or Kerplunk.
- Memory stimulating games: word games such as Name 5, crosswords, Sudoku, word search, jumble, and I Spy are excellent for this.
- Video or Computer Games: depending on cognitive ability, some of the best games include Smart Brain, Brain Age, Words with Friends, Sea Quest, Candy Crush, Tetris, Wordscapes and WordSearch
- Co-ordination games: focus on building games such as Jenga, Legos, Qwirkle, Jigsaw Puzzles, assembling simple nuts/bolts, folding laundry and working with playdough.
- Movement games – also known as ‘exergames’ using video platforms like dance party or Wii sports, darts, badminton, bowling, ring toss, horseshoes, parachute, volleyball, bean bag toss and more.
Depending on the progression of the disease, be it dementia or Alzheimer’s, a care receiver should be able to participate without frustration and full cognitive attention. Becoming frustrated, aggressive or irritable by following rules or remembering strategy can only result in a negative experience! So remember to choose your game wisely.
The reality is that many caregivers will eventually have to face the palliative care of a loved one as age or illness begins to take over. It’s never an easy conversation to have, but when is a move to hospice care the right decision? Most caregivers and doctors would recommend as early as possible after a loved one has been diagnosed as terminal.
While the term ‘’role reversal’’ may be common terminology used throughout the caregiving world, what does it really mean for the status of your relationship with your parents and how does it affect your mind-set?
The truth is that if caregivers rely on these common catch phrases to describe the type of care they provide, it’s likely to colour their feelings and attitudes towards their role and their parents. The effects are not always positive and can, in turn, work to negatively affect a relationship between parent and child.
Yes, you may need to assert your authority in certain situations, block credit cards, hide the car keys, remind your parent to visit the bathroom and so on. But does this really take away from the fact that your parents were once young and have lived an entire life before they became reliant on you?
A concept that implies switching roles between a child and a parent, such as ‘’role reversal’’ can negatively affect your ability to preserve your parent’s dignity and sense of control as they deserve. It’s difficult enough to set boundaries and care for your parents without them feeling patronised or devalued in any way. The concept of role reversal can only work to compound these difficulties.
How should the idea of role reversal be treated?
The interpretation of this concept is largely left in the hands (and minds) of the caregiver. It’s important to remember that your parents are your parents, and no illness can ever change that
You are their child and they worked to care for and raise you as best they could for most of their adult lives. None of that important history can ever be wiped out just because you have taken over the role of caregiver.
The difference between caring for children and elderly parents
While this may seem obvious, it’s so important to remember as a caregiver that there is a stark difference between caring for elders and children. Children are just starting out in life, they are learning day-by-day and will eventually outgrow their dependency.
As a parent you make decisions based on the best interest of your child, hoping they will grow to be the decent, self-sufficient adults you’ve taught them to be. Once you have taught them what they need to know, children must be set free to make their own way in life - this is a natural part of being a parent.
Be so much more than a popularised phrase
On the other hand, caring for an elder may be similar in some respects, but the overall end-goal is vastly different. The reality is that elders suffer losses, day in and day out, as they age or become increasingly ill. They are aware of these losses and the life they had before. For a senior, there is no way of ‘’growing out of’’ of a situation or illness as their dependence on others only becomes increasingly necessary.
In order to maintain the parent and child dynamic throughout your caregiving journey, try not to hold onto popularised catch phrases which don’t actually do your job as a caregiver any justice.
Remember that your parents have lived – they have experiences and memories and stories to tell. As such, they may struggle with allowing you to take over control when needed. Be patient and respectful of this and both you and your parents can enjoy a loving relationship for as long as possible.
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