Winter often becomes a time when individuals and families take a closer look at care and living arrangements for aging relatives, experts say.
Holidays reunite far-flung relatives, who may be more likely to notice changes in an older person's condition or surroundings. At the same time, harsher weather can raise concerns about increased risks from exposure and falls, which increase in people over 65.
Dementia is a general term for a decline in mental stability severe enough to interfere with daily life.
There are several types, with Alzheimer's disease being the most common.
However, many other conditions can cause symptoms of dementia, including some such as thyroid problems and vitamin deficiencies that are reversible.
Dementia symptoms can vary greatly, but two of the following typically must be significantly impaired:
» Communication and language
» Ability to focus and pay attention
» Reasoning and judgment
» Visual perception
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Levels of care outside the home
» Independent living. Not licensed by the State of Nebraska. A general name for any housing designed exclusively for older adults who function largely independently. They usually have a manager on-site but do not provide nursing or personal care services, such as administering medications or assistance with bathing and dressing. If needed, the resident must purchase these services from outside agencies.
» Assisted living. Licensed by the state. Typically provide housing and group meals at minimum. Other services vary widely and may (but are not required to) include medication management, transportation, help with daily living, emergency assistance and 24-hour staffing. However, neither 24-hour staffing nor licensed nurses are required. Some assisted living facilities primarily serve people with mental illness, Alzheimer's disease, dementia or physical disabilities.
» Nursing homes. Also licensed by the state, nursing homes provide a higher level of care than that provided by assisted living facilities either for an extended period of time or for a shorter length of rehabilitation. Services include medical, nursing and rehabilitative, personal and residential care. Nursing homes provide 24-hour licensed nursing care to serve individuals with higher medical needs.
Sources: Nebraska Health and Human Services System; Nebraska Nursing Facility Association; Eastern Nebraska Office on Aging; University of Nebraska Medical Center Home Instead Center for Successful Aging
On Jan. 1, 82-year-old Carl J. Kern of Omaha died in a parking lot outside his apartment building at Woodbridge Senior Village, an independent senior apartment complex near 72nd Street and Sorensen Parkway.
A Douglas County sheriff's investigator said it appeared Kern may have stumbled or fallen. He was wearing a T-shirt and jogging pants, socks and slippers. Next to him were a walker and a cane, split in two. An autopsy indicated he died of hypothermia and heart failure.
In Lincoln last week, retired judge William Blue, 86, was found dead in a shallow creek near Legacy Estates near 72nd and Van Dorn Streets.
Police said it appeared that Blue, who lived in the independent living side of the retirement community and was free to come and go, may have had a medical incident or fallen. An autopsy was pending.
Little is known about either man's condition or the level of care either might have been receiving. Family members of both men declined to comment.
In general, however, changes in an aging person's condition — and the need for more care — can sometimes be hard to recognize, particularly for family members who have frequent contact, said Diane Hendricks, a social worker with the University of Nebraska Medical Center's Home Instead Center for Successful Aging.
Dementia, unless triggered by an event such as stroke or injury, usually comes on gradually. Occasionally forgetting names or appointments or the day of the week and remembering later are typical changes that come with age.
But memory loss that disrupts daily life, solving problems or completing familiar tasks can be signs of something more. So, too, can changes in mood or personality.
Other things to look for: Is there food in the person's house? How does the person do with day-to-day functions such as driving, cooking and taking medication? Is the person starting to return later than usual from walks or coffee with friends? Can she explain the delay? Does the person consistently forget where she's put things?
If such signs come on suddenly, Hendricks said, it can indicate reversible conditions, such as dehydration or fatigue. A more permanent condition probably means the person needs more care.
Even then, however, a host of factors can come into play in determining what level of care an individual may need and when it may be time to step it up, she and others said. The key is to start planning early.
“We always ask: What are your goals here? What are your hopes? Do you see yourself in a place with assistance? That talk should happen very early on,” Hendricks said.
Family members should try to maintain the person's dignity by giving choices. If the person wants to stay at home, for example, make sure the person gets help in setting up medications.
Janelle Cox, division director for the Eastern Nebraska Office on Aging's CHOICES Programs, said the aging agency tries to keep people in their homes.
“It's the trend, and it's what they want to do,” she said.
When is it time to leave the home? When an elderly person faces mobility issues, such as too many steps to climb, and it isn't feasible to modify the home, Cox said. Or when a person wants more companionship or fewer chores, such as lawn-mowing or snow-clearing.
In such cases, a person may choose an independent living community. Typically, independent living apartments are just like those younger people might rent, Hendricks said. They may have varying levels of added service. Meals, transportation, an emergency call system and help with daily activities may be offered, sometimes on an ala carte basis.
As conditions worsen, the patient may need the next level of care: assisted living, where limited nursing services are available. Those services may include transportation to medical appointments or distributing medications.
The next shift, from assisted living to nursing facilities, typically comes when patients have complex nursing issues that assisted living can't help on an ongoing basis.
Assisted living centers typically have resident services agreements, indicating what services they can and cannot provide, Cox said. They inform residents when they can no longer meet their needs.
A search for a nursing facility, too, should start well before it's needed, when a person is feeling well and isn't under pressure to make a quick decision, Cox said. The individual and his family should consider not only the quality of care but also whether the facility's location will make it easy for relatives to visit.
“If you want to be in control,” Cox said, “you need to let your wishes be known.”
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Other resources:The Nebraska Resource Referral System provides a statewide database of local and state services. It includes a self-assessment tool that allows families or individuals to gauge their needs and connect with services, and a tool to help with assisted living choices
The Eastern Nebraska Office on Aging Know the Facts Book provides a consumer's guide to choosing assisted living facilities. .
The University of Nebraska Medical Center Home Instead Center for Successful Aging lists housing options for older adults in the Omaha area.