IS IT safe for senior citizens to live independently? Up to which point? When should they consider moving to a nursing home?
These are not easy questions to bring up with your loved ones, or to contemplate yourself.
However, it is something that the elderly and those caring for them should think about and discuss.
Consultant physician, geriatrician and healthy ageing specialist Dr Rajbans Singh says that independent living should be encouraged as much as possible.
According to him, in the United States, it was found that a lot of people going into nursing homes felt they had lost their independence.
“They were taken out of their home environment and put in a place that’s very regimented. So, they lost their independence and they were told what time to get up, what time to eat, and what to do. A lot of people were very unhappy,” says Dr Rajbans.
He explains that this can lead to depression. That’s why many are looking at the independent living concept instead, says Dr Rajbans.
Independent living simply means ageing in place with the support of the community.
One way to do this is for you to live independently within a senior living community. You would have your own apartment with a kitchen, TV, and everything else you would find in your own home, and if you need medical help or any assistance, you would be able to press a button or make a call and somebody would come by to check on you and offer help.
The other way is to live in your own home and have support services come to you.
According to Dr Rajbans, some countries offer many services for the elderly so that they can remain at home.
“That is actually very ideal. It means a person can stay in their own home for as long as possible, unless he really needs medical help. Then he might have to go to the hospital, get treated and come back. This type of scenario needs a lot of community support and elderly care, which Malaysia still lacks. The services that are available tend to be by private companies and done ad hoc and these can be pricey.
“We have to look at that sort of concept though. We have to start looking at community support services. A lot of times the elderly don’t really need to go to a nursing home. They are sometimes quite independent, but because there is no support for them, we end up putting them in nursing homes. Sometimes you might see people who are mobile and can still do a lot of things, but they are in nursing homes because they might have a bit of vision problems or memory issue and the family feels that they are not safe alone at home,” says Dr Rajbans.
Some of the elderly may just need a little bit of support to be able to continue living at home. If they can continue there, they would be happier and less prone to depression.
Placing an elderly person, who is still mobile and fairly independent, in the same home as those with dementia or a terminal illness would affect them emotionally and mentally.
According to Dr Rajbans, a nursing home should be the last resort for those who need care 24-7 such as those who are bedridden or have dementia or if they are in the later stages of Alzheimer’s.
How to do it
He advises families to consider making some adjustments at home so that senior citizens can remain there longer:
- Grab bars in the bathroom;
- Anti-slip flooring;
- Lunch and dinner delivery services;
- Medication preparation (if needed); and
- Opportunity to socialise and exercise.
While taking in a foreign worker as a carer may be an option, Dr Rajbans feels they should go for some form of training first so that they know how to take care of the elderly and what symptoms and signs to watch out for.
“Some of my patients get along very well with their carer and they are very happy. Otherwise, if you can get a family member or a relative who can stay with them at home, that is another concept that seems to work a lot. But we see less and less of that these days as all family members go to work and the nuclear families get smaller and smaller,” says Dr Rajbans.
What to look out for
Falls, incontinence and nutrition are some of the key areas to watch out for when the elderly live at home with minimal supervision.
“Falls is a big thing that we worry about; second is nutrition. A lof of people forget that one of the biggest problems we have with the elderly is nutrition. In fact, a lot of studies show that malnutrition is a big issue with older people. They don’t eat enough. It could be because they don’t like the food, or because their sense of taste or smell is affected, or if they are on drugs that cause them to lose their appetite. If no one watches out for that, their nutrition will drop and they actually become malnourished. Because of that, their immune system would get weaker, making them prone to infections,” he says.
Sometimes all it takes is someone to buy them food or cook for them. The food should be tasty and palatable. If the food is cooked in the morning and left in the fridge, the elderly may not want to warm it up and they may feel it is not palatable.
“In addition, if no one is looking after them, they might sit down the whole day. That will weaken their muscles and have a spiral effect, making them not so mobile and prone to falls,” says Dr Rajbans.
He feels that many of these issues can be resolved easily if the family make the necessary adjustments.
He mentions that carers should even note if the elderly are drinking enough water so that they don’t damage their kidneys.
“All of these small things need to be looked at. Sometimes, the carer doesn’t know what to watch out for and doesn’t realise all these things.
“Some of these are simple, preventable things that carers can be taught,” says Dr Rajbans.
Family members and carers need to be very patient as the elderly may sometimes be fussy or they may take a longer time to respond or to complete tasks.
Dr Rajbans warns that carers also need to be aware of mental health issues and watch out for signs of depression.
He explains that in Britain, for someone to be taken out of the community and placed in a nursing home, a needs assessment must be done by a geriatrician, nurse and social worker. They would then decide if the elderly needs to be transferred to a state-run nursing home.
“You don’t just move because somebody says you need to move there. This is because the government doesn’t want to pay for people who don’t need to move to a state-run nursing home.
“Here, we don’t have those kinds of services, so people can just send their parents to a nursing home without first having an assessment done.
“If you visit the nursing homes in Malaysia, you will see people who are bedridden as well as those who are still independent and mobile. It’s very depressing for the independent one to see the bedridden in the same home as them; some of the elderly become depressed and lonely and just give up as a result.
“Instead of a nursing home, they should be in a place where there is assisted daily living services and they can be among others who are healthy like them,” says Dr Rajbans.
For those who are recently retired or going to retire and want to live independently at home for as long as possible, Dr Rajbans recommends they take care of themselves mentally, physically and emotionally.
“In fact, I think you should start from young. Keep yourself fit. Make sure you are mentally and physically well, keep yourself active …. Most people when they are young don’t bother, so when they get old they run into many problems.
“Retirement is another issue. When people retire, they don’t do anything and it becomes worse. If they keep themselves mentally and physically fit and remain active, they can age very well.
“I have patients in their 80s and 90s who are still very healthy. A lot of times people don’t take care of themselves. They have a self-defeating attitude – oh, I’m old. That itself is not good,” says Dr Rajbans.
He advises adult children to let their elderly parents remain active, rather than tell them not to do tasks around the house for fear that they may break something or take a long time to complete it.
“I think we have to educate people that ageing is not a disease. You just have to maintain yourself. If you see people who have aged very well, you will notice they are very active, mentally and physically. It’s your mindset and what you think about ageing. In Japan, there are many in their 90s and 100s who are still very active. But you need the support services to make things easier for them to be independent,” says Dr Rajbans.