Tuesday, 26 June 2018

How Often You Visit Your Aged Parent ? SOUMYA NAIR

How Often You Visit Your Aged Parent ? 
                                                                                                 Soumya Nair                                 
Recently I and my colleague visited a Trust run old age home where they house underprivileged or may be not so privileged elderly women. In a large dormitory with beds adjacent to each other with an ample space to move around and highly ventilated well-kept with utmost cleanliness it is far fancier to be called as a charitable place. The first look may entice you with the fancy structure and facilities, however, the second look can be really heart wrenching. Each one curled up in their bed, there was a cold shivering silence in the dormitory. Sad faces facing one another but no interactions. My colleague Swetha hurried to a bed where a lady welcomed her with a sad, saggy face. The manager of the facility referred her as Lakshmamma (name changed) and surprisingly she is 90 years old. Without talking anything much Lakshmamma held Swetha by hand and seated close to her on the bed, the first thing she did was stretching her hands out to pick up a framed photo which must be ages old, in black and white, almost faded and hardly faces were recognizable, that was her husband and herself when they got married 73 years back. Handing out that photo she was curiously looking at Swetha for her reactions, somewhere she saw Lakshmamma was trying to hide her tears, she swallowed her heaviness and started talking about herself and her husband. Swetha told me, how desperate Lakshmamma was for interactions and to speak out  her stories which may means nothing to us but for her certainly it is. May be her great grand-children and grand-children has a lot to hear from their great grand mom who made it to a century. Unfortunately there was nothing of a thing called visitor to Lakshmamma and it was very evident in her desperation to speak and communicate.    

According to many social gerontology studies across the world, social isolation of the seniors has been associated with cognitive decline, decline in health, depression, increased rates of infection and ultimately even mortality. Communicating and visiting with the elders in our lives, be it a close relative or a neighbour can help ward off these detrimental effects. Periodic visits with your senior loved ones is not only rewarding, but it leads to a myriad of benefits.Spending quality time with the infirm elderly has huge benefits for their health, primarily keeping elders physically young and emotionally happy.

I can share my personal experience as a social gerontologist that many of people in residential senior care have no visitors 365 days of the year. It saddens me immensely …. particularly dementia patients, receive no visitors. I remember asking the son of a dementia patient, ‘Why you are not visiting your mother?’ The straight answer was shocking to me. “What is the point in visiting her, she cannot recognise me.” I retorted, ‘But you don’t have dementia”. 

For me, one of the most disturbing and growing trend I see in Indian ageing is the loneliness. When it comes to spend quality time with our elders, we have thousands excuses of time constraints. When you answer to your conscious: ‘Do I want to be abandoned in my later years? Is this what my elders deserve? Is this how I want to live out my old age? We must promote inclusion, and reach out to senior Indians. When I talk to my inmates in our care facility, I many who crave for a simple touch, a hug, or a soothing hand on their shoulder. We must extend our hearts and our hands in love and respect.

Despite the prevailing myth that caregiving ends with placement in a care facility, family members ideally continue their caregiving obligations after institutionalization through active involvement. But the reality is just the opposite. I recollect my friend Ms. Flipse an RD from the United States telling me how she visited her dad when he was admitted in a care facility. It sounds strange, she visited her dad in the early morning hours when daily routine chores are performed. She said, the first thing she checked was if his tooth brush was wet, which indicated her that her father was brushed for the day. Yes, it sounds immensely crazy but when you leave your loved in a professionally run care setting and not at your home it is important to get into the details of care in order to ensure your beloved parent is not hoodwinked of the right care. It is not only to make sure your parents are cheerful but also to ensure that they are extended the qualitative care. 
Some people just don’t visit because they want to avoid awkward moments. Others make brief, stiff visits. It’s important to find ways to overcome the reluctance because visits from family and friends give older adults the connection and support they need. Learn more about how to keep our senior loved ones feeling young and happy through these six benefits:

1. An opportunity to evaluate their health, safety and well-being.
The most important reason to visit loved ones is the chance to check up on their happiness and health, and make sure that nothing untoward is happening since the last time you saw them. If they suffer from chronic illness, how are they coping? Do they need extra help with care, chores, finances or medications? Do they just need a little encouragement to ensure healthy eating and physical activities? 

2. Visits can help you prevent elder abuse.
If your loved one lives alone and if they are having trouble caring for themselves a visit can clue you in to any signs of self-neglect—whether the issue is declining cognition, health or mobility. Find out the people who visit them as well as the finances. If they have home care assistance or live in a care facility, a visit is the perfect time to make sure their living situation is keeping them happy and healthy. Learn the signs of common health problems before hand as well as markers of abuse, so that you can detect any problems early.
3. Visits with family can help bring back positive memories.
Make sure each visits also serve as a time to reminisce about past happy get-togethers with family. Albums, conversation, home videos, music and photos can prompt nostalgia. These ‘memory prompts’ can be beneficial to those with dementia and memory loss. Try to avoid bringing up painful memories. But if they want to talk about something in their past, let them reminisce. Talking through it may help them put things in perspective or come to terms with what happened.

4. Be Mindful of the Length of the Visit and Number of Visitors

There is no standard “right” length of time for a visit with your older adult. It will depend on many factors like your relationship, their health condition and their energy level that day. During the visit, pay attention to signs that they’re getting tired or agitated. For some people, especially those with dementia, shorter visits may work better. Others may enjoy longer visits where you have more time to enjoy activities together. In general, it’s more meaningful and easier to handle visits from one or two people at a time. A dozen people visiting at once can be overwhelming for anyone.

5.Communicate Effectively and Respectfully

Effective and respectful communication is essential for any visit. Address and treat your older adult and other residents as adults, not children. Even if they’ve lost physical or mental abilities, they still deserve respect.
Hearing loss is very common among the seniors, so make sure they can hear you. Also, keep your faces at about the same level. Besides from being polite, many people rely on facial expressions or lip reading to understand the conversation. Overall, do your best to keep the conversation positive, and avoid arguing or upsetting them. This is especially important when visiting seniors with dementia. It’s also a good practice to make it clear that you’re glad to be there.

6. Show Affection Appropriately

As mentioned in the beginning, many elders no longer get the benefit of human touch. Show affection with hugs, holding hands or stroking their arm or back. Again it depends on person to person and your closeness which determines the physical intimacy. Pay close attention to their face and body language as you respectfully touch them to make sure they continue to be comfortable. Older adults can be sensitive and fragile, so err on the side of being extra gentle until you know what suits them.
7. Be grateful to those who care your loved ones 

You need to admire those care workers, nurses and doctors there, because they selflessly gave their time and put in the extra mile to ensure that the elderly are living comfortably there. They had to change their diapers and endure many unpleasant situations. Being in elderly healthcare sector is most challenging and difficult and we must thank them for their selfless service. 

A Few More Tips for Staying Connected to Loved Ones
When you live in a different city or country, it’s impossible to swing an in-person visit, no matter how much we might want to check on our loved ones and spend some time with them. There are other ways that we can, and should, remind our senior loved ones that we’re thinking of them, like through:
·       Cards
·       Emails
·       Letters
·       Photos
·       Phone
·       Skype

No matter where we live, we can simply pick up the phone, too — a simple phone call can do so much to bring in happiness. Long distance caregiving is a regular affair as many children live far away cities or even abroad. Also, thanks to modern technology, video chat programs like FaceTime and Skype can bridge the miles and enable us to see our loved ones face to face. So, there’s no excuse to not visit a senior loved one, in person or virtually, and the benefits are enormous. Visiting loved ones makes them happy, makes you happy, and is key to hold them in happy mood. Let them know you are there, even though they may not remember or know who you are. Everyone needs to feel loved; it the universal language.

Sunday, 25 February 2018

Parenting Your Parent – Stories of Five Loving Daughters

                                                                                                                             Roshan Jacob

My previous article was about “Compassion Fatigue”, and the case study I started off is about a woman named Krishnaprabha, who finally decided to quit her caregiving assignment’.  Imagining  our parents as feeble or infirm is a difficult thought to bear, but the reality is that millions of people, like Krishnaprabha are currently caring for a chronically ill, disabled or aged family member or friend. Majority of those caregivers are women. When caregiving is thrusted on you, many of us feel unprepared and overwhelmed, with no precedent to guide us through this challenging time. To help ease the isolation and juggling often felt by caregivers, I portray five brave loving daughters who share their stories, each highlighting the complex emotional, physical and financial tolls. This is a compilation of the experiences of few primary caregivers.

"I became a parent to my parents." Vidhya Mahadevan
Mrs. Mahaden relocated from Singapore to Bangalore where her parents live after retiring from Hosur. It was a bit strange for many of her relatives when they came to know that she was relocating  just to be with her parents in their old age. At times she feels it was too much for her but she continued with grit and determination. Let’s listen to her own words.

“When I realised that shuttling between countries is not sufficient, I decided to take a plunge. Caregiving to a parent starts gradually: initially a doctor’s appointment here, a lab appointment there, and before I knew it, I was managing all of healthcare needs and eventually, all of their life needs. No, not managing—let’s be specific, micromanaging. I became a parent to my parents. I made them ‘baby food’ and fed them by the spoonful; I tucked them in at night and often get up to change diapers. The caregiver can become sicker than the patient because she neglects taking care of herself. This is a silent epidemic.”

"I was always with my mother fearing something would happen if I weren't around”, Leila Thomas.
Leila explained how she cared for her terminally ill mother and continued her studies side by side. It was a harrowing time for her as they couldn’t hire a professional care giver due to their financial difficulty. Just before her mother diagnosed with cancer, her sister married and a whole lot of money was spent for her marriage. Then came the costlier cancer treatment, which literally eroded all their savings. One good thing happened is when her brother got a good opening in an MNC. Here is her story how she survived this harrowing time.

“My mother was diagnosed with stage 3 breast cancer in 2013. They told her she only had six months to live, she was sort of a fighter and she fought back aggressively. It's hard to get all in your feelings when you see someone so determined to live…. She turned those six months into five years. No doubt she was my superhero. After graduating college, I told her I was putting off design school, but she insisted it. She breathed life into my dreams and encouraged me to go into the world and live my life. During my first year of design school, I was her primary caretaker, and naturally I did terrible in school. I had professors and family tell me to quit, but I knew that’s not what mother wanted. Still, I lived in constant fear that something would happen if I weren't around. My second year of design school, my dad got laid off, which was a surprise blessing: He became her primary caretaker, so we’d rotate night time shifts and weekends with my aunts who stopped by during the day. My mother was never alone.”

"I had to attend therapy sessions to build the strength to deal with it all." Nirupama Koppikar
Nirupama came to me for counselling few years back as she was completely distraught as she thinks things are going out of hand. A bipolar disorder father, not so smart mother, insensitive siblings made her life miserable. Father and mother, both were central government employees and thus drawing pensions. Though money issues are nil, managing the parents was an emotional roller coaster.  She was vocal about her siblings attitude. In the bargain she lost her job and got into depression.

“My dad had severe bipolar disorder. Back then, it was not as well known as it is today and no one told us it was a disease until I came to you for a counseling. He was also diabetic and had heart disease, leading to by-pass surgery. He was verbally intimidating and abusive, and my mother was too ignorant to understand his illness, too weak to leave him, and never supportive. They had a very difficult marriage, and I was always caught in the middle because I was the only sibling living in the city. My brothers stayed away from the scene as if it was my duty. There were times where we had to have him institutionalized and treated, and I’d go from the hospital to work the next morning, or from the hospital, home to change, and then to work. He was so cunning, though, and he’d manage to convince his doctors that he was fine and could go home. I got so depressed I lost my job for almost one year. I did therapy during this time so I could build the strength to deal with it all. I finally decided to prepare a bunch of paperwork on his condition and calmly sat with him to explain everything one Saturday afternoon. ‘These are things that you do, dad; it's not that you want to. I just want you to understand,’ I explained. First time I saw him very receptive. That was the last time I saw him alive. The following Monday he had a massive heart attack and passed away, but I have a comfort in my heart from that conversation. I was 34 when he died and dealt with his illness for almost a decade.”

"I was forced to care my father but in the end It was satisfying”, Revathy Sukumaran
Revathy was pulled into the vortex of caregiving knowingly or unknowingly. Her father left her small family of three consisting of her mother and younger brother. Her mother, a nurse in the government services all alone did the parenting. It was bitter days and lot of resentment about her father’s waywardness. When Revathy heard that her father was diagnosed with cancer, initial thought was different but for all resentments aside, she decided to visit him after 13 long years. Here is her experience in her own words.

“I never thought I am going to be helping my father in his sick (death) bed. My dad was diagnosed with terminal lung cancer in 2016, and I flew to his home in Chennai to say ‘goodbye’ but ended up staying and taking care of him. The cancer spread faster than any of us anticipated, and while I was there for the long weekend, the doctor gave him two weeks to live. My dad didn't have anyone to take care of him, largely because of his wayward life style and had burned a lot of bridges. Story has many twists and turns and I need not say much. I was only 24 years old at the time, and I had no idea what I was doing. I need not have to show any mercy just because he never cared for us. He had so many different medications, difficulty breathing, and continuous pain. I slept only two hours or so at a time while I cared for him; it was insanely difficult. I resented having to take on a parenting role at such a young age for a parent who hadn't been an active part of my life since my childhood. We both wanted to be close but my mother wasn’t for it, and I wouldn't say that taking care of him fixed all that, but he did say he was proud of me and appreciated me. I wouldn't trade those last few days, even though they were the hardest of my life. After two weeks, I reluctantly put him in a nursing home so I could return to work (I lived in another state) and he died about a week later.”

" We tried to be strong for each other, even when we were crumbling inside." Rosalind D’Silva
I call her Rosie, and she met me in regard of an admission of her grandfather to our care home. Though her problems are too many one would admire her grit and determination. Rosalind is just 21 and doing her management studies and her father Thomas had a long battle with prostate cancer. Being the eldest daughter she has two young sisters and two aged grandparents and her mother to complete the family. Her problem was not her ailing father but it was her abusive grandfather, whom she hate. Her grandfather made a fortune by selling imported cars and those days it was sort of a monopoly business as he was a pioneer. Father joined him in his business and was doing well all these years. Grand father treats everybody as his slave and nobody can put up with him. Handling the health issues of her terminally ill father and an abusive grandfather was too much to handle. As a young girl, she juggled between hospitals, dialysis centres, and business. She came to me to address the ‘issue of grand father’. These are her words.

“My dad succumbed to death last year when he was 55. My father lived with us for 26 years, and much of that time he was healthy. The worst period was the six months preceding his death. I had lived with him and my grandparents since I was three years old, but my grandfather was no easy person with his bloated ego created hell for everyone. My dad developed prostate complications and had diabetic complications when he died. He had a doctor’s appointment the next week to discuss options for improving his condition. We all knew that we were fighting a losing battle. My mother was my rock. We, sisters clung to each other for support. As bad as it was, we tried to be strong for each other, even when we were crumbling inside. We felt both helpless and guilty when our dad passed away.  Finally, my 87 year old grand father outlived my father. Now I have to manage my infirm grand parents.”