Aging, loss, and lessons learned — UPDATED

The morning of June 7 as we were preparing to go to a wedding, we got a panicked phone call from my elderly and frail mother-in-law’s neighbor.  She had fallen while reaching down for a hose to fill a bird bath, gotten a nasty gash on the head and spent the previous night outside, unable to get herself into the house.  The “panic button” she always wore to summon help in an emergency?  She forgot she had it on!  Don’t even ask what the heck she was doing outside trying to fill a bird bath…  She simply didn’t believe that she should no longer be doing that sort of thing.

So, we packed quickly — knowing that bad falls by frail, elderly people often end badly — and hit the road for a seven hour drive.  We knew that our trip might well end with planning  a memorial service.  The cell phone was in use most of the trip as we notified family members and got updates from the neighbor as the emergency docs tried to work their magic.  A possible broken pelvis, 11 stitches and 11 staples to close the head gash, great confusion — but almost miraculously no apparent additional head injury.  We knew she had suffered a compression fracture several weeks earlier and that there had been indications of an additional fracture.  Her bones are little more than shells due to advanced osteoporosis.  The spinal fractures don’t show up even on CT scans because there is so little bone mass.

Fast forward two weeks… a procedure to shore up the (now) two vertebral fractures has relieved pain.   The head wound is healing.  The pelvic crack is stable, and also seems to have occurred prior to the fall.  No stroke, no brain bleed, no skull fracture.   Clear medical proof that she is, indeed, very hard-headed, even if the rest of her bones are extremely fragile.  She’s currently in a rehab hospital for some “sub-acute” physical therapy.  And she will be moving into an assisted living group home when her rehab phase is completed.

While we marvel that she survived and that there is hope that she will graduate from a wheelchair to a walker once her pelvis heals, she is mourning loss on almost every front.  She is clearly no longer able to live alone.  We’d suspected so for some time, but she wouldn’t hear of it — until now.  And when the crisis occurs, options quickly become limited by the need for a rapid solution. Probably the source of greatest worry for her has been her little dog.  She cannot take him to the group home, but we’ve been able to find a new home for him as well.

So, the lessons learned?  While it’s important for aging parents to retain as much autonomy as possible, they may be unaware that their physical decline has progressed to the point where safety is the paramount concern.  The older they become, the more likely that the physical decline is accompanied by cognitive impairment, whether due to Alzheimer’s Disease or something as simple as chronic dehydration.  Cognitive impairment often occurs slowly, and the signs can be subtle and easily missed.  In our case, we became aware in retrospect that the long recitation of the week’s activities and meals had stopped, but because we’d not been interested in that level of detail, we didn’t recognize that the change indicated that she simply didn’t remember.  Additionally, her cheery “Hanging in there” response to the question of how she was had masked the reality — that she didn’t want to worry us.  Many of us live at some distance from our parents, and our own busy lives combine with the distance to limit contact to regular phone calls and infrequent visits.  It’s imperative to establish relationships with people who live close to the loved one — people who can be our eyes and ears and who will honestly report changes without feeling disloyal to the senior.  We need to know these things.  And our loved ones need for us to know.  It’s not disloyal.  It’s not “ratting” on the senior.  It’s an act of loving concern to let children know that there are concerns of which they may be unaware.  If, once the children are notified, there is no increased vigilance from them, then there may be additional issues within the family that put the senior at increased risk.

We are glad that our loved one had interested neighbors and extended family and that we became aware that there were concerns before Mom fell.  In fact, we were trying to get some help for her.  But getting help takes time unless social workers who know the ropes are involved.  Hospitals can be a great source of information on local resources.  And speaking of hospitals, we cannot thank the professionals enough.  Not only did they provide excellent and compassionate care — well, with the exception of one 1:30 a.m. bath… — but they were able to put us in touch with outside resources who explained options to us, worked with us to identify an appropriate solution, answered a myriad of questions, and supported all of us as we dealt with the changes we were all facing.

UPDATE:  After a visit from the psychiatrist, who assured us that she is not clinically depressed but rather mourning the losses — freedom, driving, her dog, her home — we instituted Plan B.  Instead of the group home, she will be moving into an assisted living facility on Tuesday.  There she will get the care and assistance she needs with daily activities and will have the advantage of numerous activities to keep her mentally and socially involved — far more activities than she would have had access to in the group home.  She has made a remarkable recovery.  She’s now using a walker at least some of the time.  The emotional adjustment will be up to her.  She has been consistently kind and considerate of the care-givers, both in the hospital and in the rehab hospital, thanking them for each interaction.  We hope that portends well for the next phase.  We understand that this is not the way she hoped to complete her life.  It’s not what we had hoped for her, either.  But it is what it is, and we’re all having to adjust to the new reality.