“Grandmas are moms with lots of frosting.”
~Author Unknown

Working in acute care for over 20 years I’ve been on the care-giving end of many elderly patients; the majority of them being women who tend to live longest. For many women longevity can be a mixed blessing; while women do live longer than men (on average 5 yrs), they are at greater risk of an old age tempered with disability. 

Aging with Chronic Disease

Many of our disease states, especially in the elderly, have gone from acute, such as pneumonia ( the “old man’s friend”) which killed the patient in 2 weeks—to chronic; not cured but managed over long periods of time. We tend to see acute exacerbations of chronic conditions such as congestive heart failure, diabetes, or COPD, over and over again.

The diseases that drastically shortened life-spans in the past are now the cause of multiple hospitalizations and caregiver-burnout. In the parlance of medical-slang we called them “frequent flyers” and they actually get to be well known by staff as they come in for periodic “tune-ups.”

In rare but extreme cases this can lead to ” Granny Dumping,” the abandonment of an elder to hospitals on Holidays or Weekends by family who can no longer cope with the multiple co-morbidities of grandma.

When do Women’s Chronic Conditions Start?

Researchers at Duke University Medical School found that obesity and arthritis begin for women in the child-bearing and peri-menopausal years caused by weight gain. In addition the study showed the women were more ly than men to experience fractures, vision problems and bronchitis.

“Women have a natural tendency to gain more weight than men over the lifespan, but may be more motivated to maintain a healthy weight if they realize that those extra pounds make it more ly that they will be disabled in later years – potentially becoming a burden to their children or requiring a nursing home. This is important because it suggests that women’s tendency to pack on extra pounds in their child-bearing and peri-menopausal years translates into loss of independence in their old age.”
 - Heather Whitson, M.D. (Assistant Professor of Medicine)

Women’s Chronic Diseases Translates to Loss of Independence

Who ends up in skilled care facilities? According to the U.S. Bureau of the Census , slightly over 5 percent of the 65+ population are in nursing homes, assisted living, and congregate housing; and rates increase with age from 1.4% of the youngest-old to 24.5% of the oldest-old. It’s usually women due to:

1. Longevity: Women invariably represent a high percentage of the oldest old. For example, in the United States in 2000, some 67% of those above age 80 were women; among centenarians, women accounted for 87% of the total

2.  Spend Down : Life-time savings is used up by caring for husbands in old age

3. Lack of Informal Care : Care provided by non-paid family members

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In teaching a new class, Blueprint for Elder Caregiving, I have come up with Five Principles that caregivers can use when caring for elderly or frail parents. I’m hopeful that they’ll be helpful to you, regardless of the type of caregiving in which you’re engaged:

1. Things will change. What was true yesterday about their well-being and abilities may not be true today.

Strategy for caregiving: As you track the changes, day-to-day, try to keep in mind that a failing body does not always mean a failing mind. Base your caregiving in love, honor and respect. 

2. There is no getting better. Amelioration can happen, but not cure. 

Incorporate new ways of living into old routines — holidays, birthdays, find ways to combine old traditions with new lifestyle. Talk about it! 

Strategy for caregiving: When possible, allow your loved one to give to you, not just be a recipient of your care.

 3. Understand the losses. Being the last one of a group of family and friends is hard. Who knows your loved one from childhood, school, work days before your arrival? You also need to understand that the ability to make new friends declines. 

Strategy for caregiving: Work for family connection — turn off the TV, spend time playing games, reading, singing together, go through photos and mementos. Mix the power of touch with memory. 

4. Keep the big picture in focus. This is hard to do when you’re tending to the day-to-day needs. Be attentive to larger, over-arching issues. 

Strategy for caregiving: Be attentive in order to recognize and respond to quality-of-life questions. These may be disguised as seemingly minor medical concerns. Is it a good idea to have your elderly parent undergo surgery for eye problems, or even cancer?

5. Plan to say good-bye. Have you and your loved one talked about advance directives or The Five Questions?

Strategy for caregiving: Visit www.caringinfo.org or www.agingwithdign...

Recently I was contacted by a family whose 84 year old father had passed away unexpectedly leaving his wife of 62 years alone. The family was distraught and grieving. The family was still grappling with the loss of the father, so their daughter brought her mother to stay at her home for a few days.

Everyone in the family knew that the mother had “mild” dementia, which was why they moved their parents in an independent facility and where the couple seemed to do very well. The children had seen some confusion and such, but “she always looked so good”, and “they were active”. Slowly, in between arrangements and all that happens around a funeral, it became very apparent that the mother had more than “mild dementia”.

For the first time the family realized that the father had managed everything for her. At the age of 84, he was a full time Caregiver of a rather advanced dementia patient . Amazing! He would select her food, her clothes, help with her hair and managed all the Activities of Daily Living for her. As she needed more assistance, he assumed more responsibility and whatever she needed became part of their everyday routine. And is often the case, the challenges that they faced daily, went unspoken. It was impressive the way the father really protected the family from seeing the reality of her care.

So, after a devastating loss, the family was now faced with the reality that their mom needed full time care. Fortunately the family acted quickly and we were able to put a full time Live-In Caregiver in the apartment within a few days. As often the case, until the family is fully responsible for the care of a senior family member, they really don’t know what is really going on.

So, the lesson here is to keep a close eye on the seniors in your life, and don’t assume that they are doing okay because that’s what they tell you. I don’t think that the father would have wanted to hire a Caregiver for his wife, because he wa...