Mrs. Pratt was an independent woman who had never had children of her own.
Her aging siblings, nieces and nephews were her support system as she grew old. A diagnosis of Parkinson’s Disease didn’t stop her from doing the things she loved, but after she was taking medication to stop her tremors, she developed another unwanted symptom: hallucinations. The hallucinations made her act like she’d lost her mind and were very upsetting to her family. That’s when I got involved to find her a geriatrician to improve her situation.
Tuning the Elderly Care Residential and Treatment Setting
Mrs. Pratt’s challenge became how to provide a living situation that met her complex medical, social and safety needs. She needed to be in a an environment that catered to people with memory loss as she had bouts of “appearing to have lost her mind.” Her facility restricted access to leaving the premesis for safety reasons. Unfortunately, her level of understanding and reasoning were superior to that of the other residents who mostly had forms of dementia which required memory care. A complex medical and psychological situation like this is where understanding the resources in your community becomes critical.
Bringing in a Geriatrician to Manage Complicated Medication Needs
As her medical team grew more complex and specialized, the chances of her having a medication side effect grew exponentially. There was no one doctor in charge of her care. I decided the best course for Ms. Pratt was to connect her with a physician who specialized in geriatrics. Geriatrics is a specialty that focuses on the safety and well-being of seniors. One of the tenets of geriatrics is to limit the medication regimen to the bare essentials so that side effects can be avoided. This is a challenge for Parkinson’s patients! It was necessary to ensure that Mrs. Pratt’s many varied medications (which been prescribed by several different specialists including a neurologist, psychiatrist, gastroenterologist and opthalmologist) were assessed to avoid potential disaster when taken together. Ms. Pratt’s geriatrician expertly adjusted doses of her medications and closely monitored her for problems.
In addition to finding her a geriatrician, it was also important to prevent isolation and loneliness since she moved from her social setting of 10 years. We worked to solve this through video conferencing, regular engagements outside the facility (these required special transportation) and employing a service to provide companionship. Companionship can come in many forms, group day care, pet therapy and specially matched volunteers who share the person’s interests.
Taking care of a senior is hard enough, taking care of a senior with a degenerative condition like Parkinson’s requires thought, a multi-disciplinary team and outside resources such as transportation, and mental/social engagement. Mrs. Pratt was lucky to have family nearby and the resources to pay for her complex care. Not everyone is so lucky. However, there are a lot of innovative programs that provide these services at low or no cost, such as the PACE program for Medicaid recipients. C2it Health is building a directory and a team that will help families see what’s needed and connect them with resources to do the best they can for those in need. Because, caring for seniors takes more than a village, it takes a small city of experts, services and a lot of love.
For more information about multiple medications, read The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills by Paula Span in The New York Times health section.