ASNA INDEPENDENT STUDY

Alabama Nurse, Sep-Nov 2005 by Varner, Joyce

Primary care providers and nurses may also see elders with mental retardation or other disabling conditions who have always lived with a parent and then that parent dies. Down's syndrome individuals live longer now than in the past, and may still be alive at age 60 or 70 and are not accustomed to living independently in the community. They are suddenly isolated at a late stage of their lives and will require institutionalization unless they can somehow obtain services at home. This also is a segment of the population whose numbers are growing daily. Leaving aging children who are unable to fend for themselves is an extreme stressor for elders who may be widowed and in bad health. As they plan for their last years they must also shoulder the burden of planning for their disabled child. Many of these elders are well into their 80s and 90s and are still parenting. Also, these elderly parents may lose needed income with the death of a child for whom they have provided care.

Many elders who find themselves widowed are faced with the loss of one income and may no longer be able to afford to maintain the home they have lived in for many years with their spouse. Decreasing their income from two to one may lead to a loss of ability to pay rent, make house payments, purchase necessary medication, maintain an automobile, or purchase food for an adequate diet.

What Can We Do

First we must identify our elders who are patients, friends, or community members who fall into the elder orphan category. We must take the initiative and discuss this problem with the elder and/or any remaining family or caregivers, seek available resources, and assist with arrangements.

Living arrangements of the single elder must be determined by cognitive abilities, financial support, and state of health. We must be ready and able to perform a geriatric and social assessment to determine need for services by performing an assessment of activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

In an assessment of activities of daily living we assess the elders ability to perform activities such as bathing, dressing, toileting, transferring, continence, and feeding self.

To assess instrumental activities of daily living we assess abilities to use the telephone, travel, shop, prepare meals, perform housework, prepare and take medications, and handle money. We may also need to perform a cognitive assessment such as a Mini-Mental State Exam (MMSE) to screen for cognitive deficiencies. This exam tests short-term memory, attention, calculation, ability, language, and construction ability. The results of these exams will assist in helping the elder and/or caregiver make the best choice for continued living arrangements. Some elders have prepared their homes for their last years and have the financial resources to remain at home while the majority may not be able to remain at home due to financial burdens.

For the elder who is able to remain at home or outside an institution there are many options available such as: