July 7, 2022

European Geriatric Medicine: Protecting the fun

Involve the family

The Case

We have all been there, engaging in a conversation with an elderly person and their families, inquiring about how we can assist, patient goals, and so forth.

The elderly person insists that nothing is wrong and that they are fine, while the family member (looking slightly perplexed and vigorously shaking their head) insists that they are not fine at all and provides a list of extremely serious problems.

The happiest times of our lives

When we all take a moment to reflect, what are the happiest times of our lives? They are occasions to spend time with family. Seeing our children take their first steps, their first successful wee on a potty, their first time swimming, their first day of school, their weddings, and witnessing the arrival of the next generation. For those without children, quality time with their partners or close friends is equally important.

Elderly people are no different, and life in a care home can (and frequently does) provide ample opportunity for mirth and merriment. As with previous memories, it is best to share these new life experiences with family.

What struck me the most was how inviting her room appeared. The room was strewn with photographs from four generations of the family. As I looked at the photograph of her great grandchildren, she smiled warmly and began telling me all about them.

I recently saw an older lady with severe frailty and rheumatoid arthritis who was living in a care home. Her hands exhibited the classic deformities associated with the era prior to the advent of disease-modifying antirheumatic drugs (DMAD). Her son and daughter-in-law had been summoned for this consultation; as a close family, they were more than happy to attend.

A referral to an OT was unnecessary, as the care home staff devised some ingenious solutions, and she was soon drinking from a modified long-handled mug.

The conversation shifted to her goals and what was important to her. She cast a glance at the beaker encased in straw on her table and then smiled, “I’m missing a cup of tea.” I truly wish that my hands were capable of holding a cup and sipping from it in the manner of a normal person.”

Our lives are replete with fond recollections of the past, joy in the present, and optimism for the future. To adore and to be adored. That is a genuine happiness, and it is the essence of fun protection.

Another significant source of sadness for her was the fact that she had four brothers and sisters who were all in care homes across the country. Her eyes welled up with tears and she shook her head, “I’m sure I’ll never see them again.” She raised her head, her tears replaced by the characteristic stoicism seen in the eyes of older people. “I’ve said my farewells in my heart,” she stated. I’m guessing they have as well…”

I locked my gaze on her son. “Do you have access to a laptop?”

“Yes,” he replied, perplexed.

“Are you adept at using the internet and mobile applications? Such things?”

“Yeah,” his perplexed expression abruptly gave way to a ‘eureka’ moment. He explained to his mother how he could set up Skype for her to video call her brothers and sisters.

“It’s not ideal, Mom, but it could be a lot of fun, and you’d all be able to see one another…”

She sobbed with joy and thanked him (and her other children, who were not present) for being so thoughtful and kind.

“You’ve always looked after us, Mom.” He wiped away his tears.

“At this point, it is our turn.”

Alter the perspective

Thus, when I consider fun-guarding, I consider my family. We need to alter our perspective. Elderly residents of care homes are first and foremost human beings. They are still alive and in need of the joy and happiness that come from loving and being loved.

Family is critical to preserving the memories of yesterday and successfully creating the memories of tomorrow today.