THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Transcripts: 496.1 to 496.4

Week: 496.1 Guest: Karen James M.S.W. Topic: Winter and the Elderly Part One Host: Richard Roeder Producer: Ed Graham

NEMA: This is a four part series on the elderly and the physical and emotional challenges of winter. My guest is Karen James, Director of Social Work at the Broadmead Continuing Care Retirement Community.

NEMA: Ms. James, I think that many adults find winter a tougher time to endure emotionally and physically than the warmer seasons but for the elderly there are special problems that certainly need to be dealt with. Do the elderly that you work with ever talk to you about the emotional stress of the change to winter and the challenges that come along with it?

JAMES: I think there are several different ways that can be a problem. One is just the weather itself and how that can cause problems with mobility and therefore isolation. It can become more difficult to see people and even to get your groceries or your prescriptions so that some activities that may not always be stressful or may be slightly stressful become more stressful.

NEMA: How important is family support and contact to the health and well being of an elderly person particularly in winter when they may feel isolated?

JAMES: I think any type of support is always important. Family support sometimes is the one thing that you can really count on, that's really steady and generally families really do come through for the elderly. It's actually a myth in our country there's been a myth of abandonment where we talk about that people are so far away that they don't even bother and we warehouse our elderly but the research actually shows that families from all different types of socio economic levels and ethnic groups really do honor the elderly and that they do stay in touch and that's always been my experience, that families come back together to help their elderly family member and in terms of the different things that are needed: helping get someone get to a medical appointment, helping someone coordinate different medical appointments, getting food in, getting clothing shopping done, those sorts of things.

NEMA: One of the things that's crucial for all of us but certainly even becomes more so for the elderly is exercise and this could certainly be hard to do when it's cold outside. It can be hard to do anyway. What are some of the alternatives for exercise during the winter?

JAMES: Well, I think you see a lot of mall walkers in the wintertime and also it's good to just try to walk around even in your own apartment. I remember someone telling me about his father who into his '90s would walk back and forth in the house several times a day just to keep his mileage up on his regular walking. I think that it's hard to be outdoors but if someone is able to manage a treadmill, if there balance is good enough and their physician okays it, that's not a real expensive purchase. Many of the people I know use treadmills or exercise bikes. Now if their physical well being doesn't allow that, then they need to just walk as much as they can where they are or follow a very modified exercise program. There are a lot of videotapes that might be available for that too the very low impact aerobic tapes.

NEMA: As a child, I certainly didn't like being sick except for the fact that it got me out of school for a couple of days and as an adult, I find myself actually frequently feeling very depressed when I'm sick. Illness during the winter particularly I imagine must potentially be very depressing and devastating to elderly people.

JAMES: Well, I think it is to anyone. I think that when you're ill is when you very much realize how alone you are and how dependent you are on other people and that's why it's good to have support networks already established so that they can be called into action. Once you need something, it's hard to establish it.

NEMA: Join me for part two on winter and the elderly with Karen James.

Week: 496.2 Guest: Karen James, M.S.W. Topic: Winter and the Elderly Part Two Host: Richard Roeder Producer: Ed Graham

NEMA: This is part two in a four part series on the elderly and the physical and emotional challenges of winter. My guest is Karen James, Director of Social Work at the Broadmead Continuing Care Retirement Community.

JAMES: When you're ill is when you very much realize how alone you are and how dependent you are on other people and that's why it's good to have support networks already established so that they can be called into action. Once you need something, it's hard to establish it. The other thing that often happens too is that even if someone has been well cared for in the hospital or in a rehab center or a short term stay in a nursing home, when they come home they're coming home with a different body than what they left with so that often upon coming home, you really find more depression then, that convalescence is a long process and often people will push themselves harder to be well sooner than they're able to be and I think the way our hospital discharges work now where people are sent home as soon as they've had the procedure or the operation, you don't have that sign that says "Hey, I'm in the hospital. I need to recuperate." You're sent home and expected to be on your own and people then don't make allowances for that.

NEMA: You touch on something very important for a lot of people right now, the issue of the way the insurance and hospitalization situation is changing. That must be a cause of tremendous stress for people who feel precarious about their health already.

JAMES: Oh yes, I really think it is and the fact too that it's so unknown what's going to happen. I'm sure that makes it worse for people. Many people though don't know what their insurance covers or what services are available. There are often misconceptions that insurance is going to cover more than it actually does. Most of the needs that people have in their own homes, unless they're having a very acute medical problem, most of those needs are not covered my Medicare. The coverage for Medicare really is for acute hospitals or some type of acute care. Some home health might be provided after a hospitalization, but people often find themselves expecting that their insurance is going to cover something so they must know what kind of product they have and then look for alternate services.

NEMA: One of the problems of cold weather for adults in their '70s and up is hypothermia. Would you explain what that is.

JAMES: Basically, that means that something has caused ones body to have an extremely low body temperature rather than hitting our usual 98.6 or whatever our normal temperature is, illness, exposure, something has caused the body to lose degrees and it can be related to the environment. If the home someone is living in is not adequately weatherproofed, it can also be affected by activity level. In looking at exercise, often when people are not moving around enough they are more prone to feel too cold and their body experiences the metabolism has slowed down so much that they're experiencing being colder. Medication use and your general health status can also be things that make you more vulnerable to hypothermia or that response to extreme cold and again, it often comes down to economics. If people are on a very fixed income and they're making choices about what they can afford, sometimes their choices end up hurting them.

NEMA: Join me for part three on winter and the elderly with Karen James.

Week: 496.3 Guest: Karen James, M.S.W. Topic: Winter and the Elderly Part Three Host: Richard Roeder Producer: Ed Graham

NEMA: This is part three in a four part series on the elderly and the physical and emotional challenges of winter. My guest is Karen James, Director of Social Work at the Broadmead Continuing Care Retirement Community. I asked Ms. James about the danger of hypothermia in the winter.

JAMES: Sometimes their choices end up hurting them so if they choose not to pay to have the home weatherproofed or if they have not bought adequate clothing that they can wear in layers to keep themselves warm, if they've tried to save or scrimp in that area, then the social problem becomes a medical problem. The other thing that I've seen happen or heard others talk about is the need for the elderly to be in touch with something like a telephone network so that someone is checking on them each day either through a local senior citizens center or by having a buddy in the family or the neighborhood who calls each day just to make sure that everything is all right.

NEMA: What kind of signals do older adults tend to give to their family or friends to let them know that maybe they're getting in some trouble whether it's emotionally or psychologically

JAMES: That really varies. Most problems that people have are related to who they've been their whole lives. The way you've communicated throughout your life is generally the way you communicate when you're elderly. But often people may find that depression and isolation start to create more of a complaining, more of an awareness of different aches and pains and also feelings of being overwhelmed, not being able to make a telephone call, not being able to make arrangements that are needed and there's often a very heavy reliance on children or other friends that sometimes the family needs to talk about, for the adult child to say "I'm noticing this and I'm wondering if there's a problem that we can look at together.

NEMA: Does a professional in your field want input from the family and friends of the people you're caring for?

JAMES: Definitely because usually when anyone is presenting themselves to a physician or health care provider or social worker, they're usually putting on their best face so that it's hard often to get a true picture so that the family, especially as someone ages, the family knows what's going on, the family's part of the solution or part of the problem and they need to be involved and share their insights and it needs to be a true partnership.

NEMA: One of the things that was not really recognized in the past and is being more recognized all the time right now is both intentional and very frequently unintentional abuse frequently unknowing by the elderly of drugs and alcohol and in that many of them are on many prescription medications, they may not recognize interaction. That problem seems to have a lot more to do with depression than was previously understood, doesn't it?

JAMES: Yes, I think it does and it can also affect someone's ability to think clearly and that then people may jump to conclusions thinking that someone has developed dementia or extreme confusion and memory loss. It's good to have people have a physician who is coordinating all their care so that they're not going to different specialists who don't know what one doctor had prescribed. Everyone should keep some type of medication booklet where everything is written down and they show that to each doctor that they're seeing.

NEMA: Join me for part four on winter and the elderly with Karen James.

Week: 496.4 Guest: Karen James, M.S.W. Topic: Winter and the Elderly Part Four Host: Richard Roeder Producer: Ed Graham

NEMA: This is part four in a four part series on the elderly and the physical and emotional challenges of winter. My guest is Karen James, Director of Social Work at the Broadmead Continuing Care Retirement Community. I asked Ms. James what a potential resident should look for in a retirement community.

JAMES: I think that that is such a big move for someone to make. What I see now it's become almost like a rite of passage that many people are traveling around the country or around their area looking at retirement communities the same way that I see my friends taking their high school juniors around looking at colleges. You need to know the field. You need to know what you want and you want to know the track record of each facility. I think it makes sense to be clear that when you're looking at the financial picture of what you're paying for, make sure what services are included. Some places that sound more expensive actually may have more included services. The places that may sound less expensive mean that then when you need those services you start paying more money for them so be very clear about what's included with your initial fees and what will be add on costs later.

NEMA: Nutrition certainly is something that is frequently a problem again with older adults partly because if they live alone they sometimes just don't make the effort to take care of themselves like they would their partner when their partner was with them. What do you do to deal with a problem like that?

JAMES: There are many social programs that are set up to try to deal with that. One would be Meals On Wheels where meals are brought in to someone and they pay based on their ability to pay. The others are eating together programs in senior centers where people will come for a meal and I think many communities you'll see that there are certain areas where older people will congregate for both socialization and a low cost meal. I know in my neighborhood there's a cafeteria that has nice service that's certainly where they all congregate and they know each other, it's familiar and it's comfortable. The other thing is that family members sometimes can help by helping someone learn to use a microwave if they haven't done that before and to deliver portions of food each time they visit them, just make a little extra and freeze it. The convenience foods are good for many elderly, especially the newer ones that will give you the nutritional profile that lets you know how much cholesterol, how much salt.

NEMA: The contrast between the apprehension that an older person may have going into a retirement environment like yours, the apprehension about what that means to their life and themselves and their independence, you must've had discussions with many of the people who live at Broadmead about the idea of how they might have felt coming in and how they feel now that gotten acclimated. Talk about that a little bit.

JAMES: As soon as people make the move and get over the initial exhaustion which everyone experiences, it's hard to take apart a house that you've lived in for a long time, that there are so many different types of activities that people may actually be revitalized. It's easier to be involved in things. There's more a sense of almost a village social life where there are pleasant people and nice exchanges each day. There are definitely benefits but I think that the symbolism of the move is very weighty for people.