Providing care to a severely debilitated older person

DR KHOR HUI MIN


Looking after a sick or severely disabled family member at home can put a lot of stress on the caregiver, who has generally had little or no training in home-care. The elderly care-receiver who is bedbound or totally dependent has a range of needs - physical, emotional, social and spiritual care. Knowledge of basic home-caring procedures can help relieve a lot of strain and improve the caregiver’s confidence in their respected role.

Assisting with eating

All efforts should be made to assist and encourage the older person to eat themselves as it promotes independence and self-worth of the individual. In certain older person where they lose the ability to eat themselves, safe feeding techniques have to be applied to avoid choking or aspiration.

Debilitated1

Figure 1:
Feeding with older person sitting upright in bed and facing the caregiver


 Debilitated2

Figure 2:
Correct positioning when feeding older person sitting on chair.

 

Exercises for bedridden person

Range of motion exercise is used to preserve joint and muscle function. In the bedridden person, prolonged immobilization can cause muscle atrophy, shortening and contracture. These complications can cause pain and abnormal posture which interfere with care and hygiene.
Range of motion exercise promotes flexibility, comfort and blood circulation in the joints, such as the ankles, knees, hips, elbows and shoulders. The caregiver moves the person’s joints in passive exercise. For example, to exercise the ankle, the caregiver holds the ankle and heel of one foot. The caregiver alternatively bends the foot forward into plantarflexion and then pushes the foot upwards into dorsiflexion. Hold each position for 5 to 10seconds.
Do not continue if the older person complains of any pain during these exercises. Consult a doctor or physical therapist first because range of motion exercises can cause pain or injury if they are not done properly.

Regular turning and preventing pressure ulcers

Pressure ulcers can develop in bedridden person who are unable to change their position without help. The pressure exerted between the bony prominence against the mattress, chair or other surface can impede adequate blood flow and oxygen supply to the tissues between that specified region. This will eventually lead to tissue damage or tissue death which then peels off leaving an open ulcer.
Prevention of pressure ulcer

Advance care planning

Advance care planning (ACP) is about making decisions regarding a person’s future health care choices and letting others know about what they would agree to, or refuse, if they become incapable of expressing their decisions. ACP is applicable in adults of all ages and stages of life. In the debilitated older person who could still communicate their wishes, ACP is important and leads to better end of life care. Knowing their personal values and beliefs towards end of life helps take off some burden and anxiety from family and friends.
Facilitating the ACP discussion with a competent older person:

Bear in mind that circumstances can change and anyone can change their mind about the decisions on their ACP during the course of their lifetime.


DR. KHOR is a geriatrician and lecturer based in University of Malaya, Kuala Lumpur.

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