There are many points to consider when someone has to take care of an individual who is disabled or a frail elderly person. If the person in question is confined to a bed or wheelchair, then the considerations for the care provider increase exponentially. These patients are in need of more assistance and time in their care. It also takes extra planning and an insight into the potential problems that the patient may experience, and to look for the best possible way to either remedy it quickly or avoid these problems altogether. It increases vulnerability of the patients and creates new challenges for nurses and other health care providers, as they have to keep in mind the dignity and autonomy of the frail elderly, which requires a great deal of clinical competence, compassion and patience. The four most common geriatric syndromes that adversely affect the quality of life of elderly people and mandates the need for nursing home care include frequent falls, dementia, depression, and incontinence. A multidisciplinary approach must be evolved, to keep the frail elderly safe and independent, to the greatest extent possible, in their own home environment.
Meal Time for the Frail
Malnutrition, including both underweight and overweight nutrition is a common problem amongst frail elderly. A myriad of risk factors are associated to inadequate nutrition to such individuals, as malnutrition is both the cause as well as consequence of ill-health amongst them. The consequences of undernutrition include decreased quality of life and survival rates due to higher prevalence of ill effects manifesting from other health complications. It’s impacts may be physiological, biochemical and psychological, which includes reduced immunity, delayed wound healing, decreased muscle strength, which have a severe adverse effect on the recovery and rehabilitation. The various significant psychosocial impact of malnutrition includes reduced socialization and self confidence, changes in mood and attitude, eventually leading to depression.
A “food-first” approach is advocated for the nursing home care of such individuals which advocates eating frequent, small, and high energy yielding meals and snacks. Oral nutrition supplements, which includes ready made sip-feeds or powders, which are fed by mixing with lukewarm water or milk, can be used as a top-up to the food intake and can be clubbed in between the meal time.
Even meal time can be a bit of a challenge with a bedridden individual because the care provider will need to make sure that they can safely get the patient into a sitting position or they will often time need to feed that person by hand to assure that they get the food properly. These individuals also need to eat on specific time tables so scheduling meals is a must to assure things flow smoothly. In addition, the person’s ability to chew and/or swallow needs to be factored in. If the patient is on a semi-solid or liquid diet, then the caregiver has to be aware of the nutritional quality of the foods to ensure that the patient is adequately nourished.
Traveling with a Frail Person
If the elderly person of the family has issues with Activities of Daily Living (ADL issues) which includes inability to perform one or more of the daily living tasks such as mobility, feeding oneself, toileting, bathing and cleaning, and cognitive abilities or even if a person is bedridden, eventualities may arise where they will need to venture out of the house. Remember that the person would still enjoy being out of their bed even if they have limited mobility. A trip to the doctor or an important family event like a wedding needs to be carefully planned and the pitfalls and dangers of travelling with an older adult must be taken into consideration.
The obvious measures would be using the handicapped parking or parking as close to the building as possible. But with the frail, you also have to take into consideration other factors like sunlight and heat within the car. There is nothing worse having to sit on scalding hot upholstery on a car. Now imagine if you are disabled and cannot moved to find a comfortable spot. As insignificant a point as it may seem to the abled body, to a frail person it could make the difference between burns or even ulcers if the area gets infected. Proper and adequate packing of food and necessary medications must be ensured to last the trip.
Patient Care for the Bedridden
The bedridden patients face a lot of practical challenges including the lack of care providers, depression, lack of cleanliness and hygiene, and increased propensity towards bedsores along with a range of skin diseases if they are not cared for appropriately. This means regular bathing and changing of adequately cleaned bed linen, turning the person onto different positions and avoiding food spills or messing (urine, feces) on the clothing or linen.
A bedridden patient still enjoys entertainment and a system for them to control the TV, radio or lights will greatly improve the quality of life and give the patient some sense of independence. Another important consideration is a buzzer or bell to attract the caregiver’s attention. The inability to communicate can in certain situations mean life or death. As a care provider, one cannot always be by the patient’s bedside but a proper means to monitor the patient and be reached remotely is important.
One of the serious threat faced by the bedridden patient is the development of deep vein thrombosis which includes the development of blood clots which could travel to the lungs, heart or brain and can lead to strokes. Such patients are advised to be kept on blood thinners and platelet inhibitors like aspirin along with the physiotherapy, which includes muscle strengthening exercises and deep massages to prevent blood circulation related complications.
Taking on the job to care for the frail or elderly is no easy task. If it is not your occupation and you do not have the training for it, there is a lot to learn and even more to think about at every turn. The best place to get started is to speak to the patient’s doctor, visit a nursing home or institution caring for a people with similar impairments and possibly even paying a nursing sister to come over and teach you on ways to take care of the person for a few days.