Age Related Macular Degeneration: Night Driving
Emergency Visit Continued
Georgia falls asleep and Rosemary continues to sit on a hard, cold folding chair. Her back is starting to hurt so she goes for a walk to the waiting room. She finds that the waiting room door locks behind her and she cannot get back to Georgia’s room. She asks the triage person if she can go back to see her friend, and it is lucky that she recognizes Rosemary and takes her back right away. Georgia is awake now and the surgeon is in the room. Rosemary enters the room but feels like an intruder, Georgia tells her to stay. Hospital staff arrive to take Georgia to the operating room and Rosemary follows. Rosemary is hungry and tired. She waits in the operating room waiting area in a comfortable chair after buying coffee and peanuts from the vending machine. It is now 11 pm and the surgeon has told Rosemary that the surgery will last several hours and she should go home. Rosemary does not want to abandon her friend, but decides she is not feeling well herself. Rosemary reluctantly calls a cab to take her home because she does not drive in the dark. She will go home for a few hours and then come back to be with Georgia. Rosemary makes a mental note to get new glasses; she is having more and more trouble with seeing while driving.
Age-Related Macular Degeneration (AMD)
Rosemary is experiencing macular degeneration. It is an age related disorder that damages the macula, which is the part of the retina that distinguishes fine details. There are two types of macular degeneration wet AMD and dry AMD.
Wet AMD occurs when blood vessels grow under the retina causing blood and fluid leakage. The person with wet AMD might notice that straight lines appear to look wavy.
Dry AMD is the more common form of macular degeneration. Vision gradually blurs over time as the retina becomes thinner. Macular degeneration is the leading cause of vision impairment in those aged 65 years or older.
Treatment options are available for both wet and dry AMD. Treatment includes injectable drug therapy, laser treatment surgery, and vitamin supplementation. Regular eye exams are recommended to detect any changes in the retina.
http://www.cdc.gov/visionhealth/
http://www.healthguidance.org/entry/16207/1/Age-Related-Macular-Degeneration-AMD.html
Georgia Suffers a Hip fracture
After what seems like many hours, the doctor and nurse come back into Georgia’s room to break the news that Georgia’s right hip is broken and she will need surgery. She will have surgery as soon as the surgeon finishes with the patient he is operating on right now. Georgia will wait in the emergency room; they are told it could be hours. Georgia tells Rosemary to go home and she will be fine, but Rosemary does not believe her and stays because Georgia has no family in town. She cannot just leave her there. Rosemary feels that Georgia needs an advocate here with her, someone to watch out for her. Rosemary feels that she should ask some questions of the doctor about hip fractures, but is not sure what to ask.
Hip Fractures
Hip fractures are very common. In 2006 there were over 300,000 hospital admissions due to hip fractures. Most hip fractures are caused by falling sideways on to the hip. Women sustain 75 percent of hip fractures, with the risk greatly increasing for both men and women over the age of 85.
Treatment
Treatment most often includes surgery, hospitalization for at least one week, and then rehabilitation. A hip fracture is considered a serious injury and sadly, one in five patients who have sustained a hip fracture will die within one year. The best scenario is prevention.
Prevention of Hip Fractures
- Weight bearing exercises that build strength and improve balance.
- Evaluate medications for side effects that cause dizziness.
- Schedule medications to promote a good night’s sleep without the need to get up to urinate.
- Regular eye exams
- Avoid fall risks in the home; remove throw rugs and clutter, use assistive devices such as canes and walkers when needed and use them appropriately.
- Make sure there is adequate lighting in the home and outside.
- Eat a healthy diet with adequate calcium and vitamin D which assists with absorption of the calcium for strong.
- Osteoporosis screening
For more information
http://www.cdc.gov/HomeandRecreationalSafety/Falls/adulthipfx.html
http://www.healthguidance.org/entry/9891/1/Osteoporosis-Calcium-and-Estrogen.html
Senior Health: Emergency Room Challenges
Georgia tells Rosemary that she has been given some pain medication that made her more dizzy and tired. The nurse tells Rosemary and Georgia that they are now waiting for the results of the x-ray, and to let her know if they need anything while they wait. Georgia refuses more pain medication because it made her feel funny. Now they wait.
Georgia needs to go to the bathroom. Rosemary steps out of the room to look for Georgia’s nurse, everyone is walking so quickly and not making eye contact. Rosemary goes back into the room. She does not know what to do but Georgia is desperate so Rosemary goes back out of the room to find someone. Rosemary stops a woman wearing a white coat who ends up being a doctor, the doctor states she will send someone in to help. Rosemary goes back into the room, Georgia still has to go to the bathroom; Rosemary holds her hand to try to comfort her. After what seems like a lifetime, a nurse comes into the room to place a catheter for Georgia so that she can go to the bathroom. Georgia is not allowed to get out of bed. Rosemary is sent out of the room for this procedure. She feels uncomfortable standing in the hall and tries not to be in the way of the stretchers and the multitude of people rushing by.
Rosemary is let back into the room and the nurse rushes off. Rosemary notices a bag hanging on the bed nearly full of urine. Georgia makes a face about having to have a “tube put in her bladder” but she admits that she feels better. Now they wait and Georgia dozes.
Emergency Room – What is taking so long?
Most people have visited the emergency room at least once in their lives, if not to seek care personally, then to visit someone else. You may have wondered what is going on in there and why it seems to take so long. Accessing emergency care can be confusing, stressful, and scary. Here are a few things to debunk some of the mystery.
Six common misconceptions about the emergency room
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Seniors at Home: The Value of Support from Family and Friends
Rosemary arrives at the emergency department. She is looking for her friend, but how on earth is she going to find her? As a senior living at home, she often must navigate unfamiliar territory on her own. There are a lot of people wearing hospital uniforms, but they are walking fast and looking busy. Rosemary sits in the waiting room for a while to see what happens. A very nice looking young man in a police uniform or maybe a security uniform, walks by and she asks him how to find her friend in the emergency room. He directs her to the triage booth, but they are busy so they ask her to sit down. Rosemary gets her turn and insists to the staff she is not sick but wants to see her friend. They call Georgia’s nurse and Rosemary is walked back to see her. Rosemary enters Georgia’s room to find it empty, the nurse states that Georgia is in x-ray right now and will be back in about 20 minutes. The nurse invites Rosemary to have a seat in the room to wait for her.
Rosemary sits on a very hard, cold folding chair, watching television in the room. Rosemary cannot figure out how to change the channel and is too short to reach the television on the wall, so she watches a sport fishing program. Georgia is wheeled back into the room and starts to cry when she sees Rosemary. Rosemary is concerned, but Georgia states that she is so happy to see her and she is not in too much pain as long as she does not try to move her leg. Rosemary suspects that Georgia is trying to be strong for her.
Support from Friends and Neighbors
Family members and adult children of seniors do not always live close by. Seniors living at home often rely on friends and neighbors for support in the event of a crisis until family members can arrive.
Rosemary is a close friend to Georgia and although Rosemary does not make medical decisions for Georgia, she is there to provide company and support for Georgia. If a patient arrives in the emergency room unconscious the presence of friends, family, and neighbors can assist the staff in innumerable ways. Friends and family provide medical personnel with information such as medical history, medications, and background information about the patient. Being present with a friend or family member in the hospital also provides a second set of ears for the multitude of information that is passed to the patient. It is a lot to take in when the patient is under stress, in pain, or if they have received pain medications that may alter their ability to think clearly.
Rosemary Visits Georgia in the Emergency Room
While getting her groceries out of her car, Riley the neighbor boy who mows Rosemary’s lawn, offers to help her carry her groceries into the house. This is a little unlike him, he does not usually talk much; he always has his headphones in his ears. Rosemary looks toward Riley’s house and sure enough, there is his father smiling and waving at her. Rosemary accepts Riley’s offer for help and gives him a two-dollar tip. She knows that he was sent over, but she may as well reward good behavior regardless of the reason. Rosemary arrives in the house to find that there is a message on her answering machine – the one her son bought her.
Her friend Georgia is in the emergency room. Rosemary leaves the house once more to go to her friend. Rosemary became friends with Georgia 10 years ago. They met accidently while shopping for shoes at the mall. Georgia is a 75 year-old volunteer ballroom dancing teacher who is light on her feet and dresses like a southern bell. Georgia’s father taught her how to dance; she has always loved the freedom it provides. Rosemary has watched Georgia dance many times; she looks so beautiful out there. Of late, Georgia has been feeling dizzy. Her doctor diagnosed her with vertigo resulting from inflammation in her inner ear. Not much to do for it except take anti-nausea pills according to Georgia. These pills make her sleepy and she still feels dizzy.
What is Vertigo?
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Rosemary Goes for a Drive
In the afternoon, Rosemary feels like she should get out of the house and go grocery shopping to replenish the juice and soda that was used at the party. No one is scheduled to visit, but Rosemary wants to be ready just in case. Century Five Market is only two miles away from her home, but Rosemary feels like it is getting farther away. She drives a 1983 Ford LTC station wagon; it was top of the line when her husband purchased it. The car still runs well and it has very few miles on it for its age. Rosemary’s son pesters her to get a new car or let him drive her to the market. She likes to drive and does not want to bother her son with a silly thing like grocery shopping. Rosemary is concerned that she may need to take him up on his offer to drive her to the store; it seems like she is playing the lottery every time she takes her car for a smog check. Her car reminds her of her husband and the time that they spent together. Buying a new car would end that chapter of her life. She does not want to tell anyone this, because she will get the “it is time to move on” lecture. She still misses her husband.
Rosemary feels that she may need her son to drive her to the store in the future, but she wants to be independent as long as possible because her son is so busy. Secretly, Rosemary would like to know when her son is coming over next so she can plan for it.
Rosemary finishes her grocery shopping after a conversation with an acquaintance. She gets in her car and begins to back out of the parking space. Someone is honking at her. There is a car waiting for her spot and they seem very anxious to have it. Rosemary feels a little rushed, but backs out her long station wagon safely despite her short stature and inability to see over the back seat. Rosemary heads home driving slowly.
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Rosemary’s First Journal Entry
Dear diary,
Yesterday was my 78th birthday. Alex organized the whole day including the cake. I bought a lot of extra food in case Alex did not bring enough for everyone, but they all brought food. There was too much food. No one would let me do anything. I used to be the one who threw these parties, but now all the parties are thrown for me. I wish Bob were here. He always did nice things for my birthday; usually he would take me to a restaurant. I miss him so much and I can’t talk about him to anyone, because it makes people uncomfortable when you talk about the deceased.
The key to an active mind is to keep it busy
One way to keep the mind active is to journal life events even if they seem mundane. Journaling documents daily activities and can be rewarding for people of all ages. It encourages reflection on the day’s events, and it can provide a method of stress relief by acting as a nonjudgmental counselor. Journaling can be therapeutic and is a great way to keep the mind active while capturing a life story. In the event that a senior has memory loss, a journal can act as a reminder of what happened and provide a cherished connection to friends and family.
From my personal experience, my mother has kept a daily journal for her whole adult life. It is so valuable to the family especially to my siblings and me. I cannot tell you how many times we have called to ask her to consult her diary for details of a specific date or event. A few years ago, my mother had a brilliant idea that she should photocopy her journal and give a copy to the whole family. It does have some embarrassing moments in it, so it makes for an interesting read.
“Tell me the tales that to me were so dear, long, long ago.” Thomas Haynes Bayly
Independent Senior Living: Rosemary’s Birthday Party is Over
Rosemary’s birthday party was yesterday. She is feeling tired today and decides to take it easy. This is fine with her as she enjoys puttering around the house and reminiscing about the party she had yesterday. The whole family was at her home for the party and yes, there was cake. Mr. Garrison dropped by the party to have some punch, but Jackson was off running a marathon in another city, so was not able to make it to Rosemary’s party. Her son would no let her do anything for the party and would not hear of her serving food for the guests, even though it is her house. She sat like a queen on the couch while everyone milled around her. It was nice to see the grand children; it is difficult to understand what they are talking about these days. It is all cell phones and gadgets; they hardly seem to pay attention to what is going on in the real world. They are always bent over those cell phones clicking, tapping, and typing.
Nicole, Rosemary’s daughter, was able to fly in from Denver for the party. That is a long way to travel for one day. Too bad she does not live closer. Rosemary imagines the possibility of taking the bus to visit her daughter in Denver. She does not want to burden her, and shelves the idea for now. It would be quite an adventure though.
Rosemary received a journal as a gift for her birthday from her granddaughters, it is pink with a cat on the front it is apparently a Hello Kitty journal. Rosemary used to journal a little when the children were young.
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