For some, a defined crisis marks the point when an elderly person is unable to live independently in their own home. It is often precipitated by a fall, a stroke or other medical problem resulting in an emergency hospital admission. As well as the providing the necessary medical care, being admitted to hospital triggers a series of assessments of the elderly person’s ability to look after themselves thereafter. Consequently, a package of care may be organised in order for the elderly person to return to their own home, or they may need to move into the 24-hour care environment of a residential or nursing home.
Sometimes however, the transition from independence to needing support is gradual and less clearly defined. This can leave family members torn between concerns about whether the elderly person is coping while at the same time, respecting their cherished independence in their own home.
The first step to take is to talk to your relative about arranging for a care needs assessment. You can reassure your loved one that this is not the first step to going into a care home and they are entitled to a free, face-to-face assessment, even if they perceive their needs to be fairly low level. You need to contact the adult social services team at your local authority and request a community based care needs assessment for your relative. There may be a wait of four to six weeks but it should not be longer than that. The assessment will consider what the individual’s care needs are and how these might be met. Even if your loved one is likely to be self-funding because they are above the financial thresholds to qualify for social services funding, your assessor is still responsible for sign-posting local services that may help to meet needs. For a person funding their own care, a care needs assessment provides a good foundation, mapping out needs for you to then consider how services can be brought in to meet those needs.
There are practical things you can consider which can make a significant difference to the well-being of your loved one. Do you find your elderly relative takes much longer to get through food provisions than before? When you ask what they had for dinner, do they say they preferred a sandwich and salad to a full cooked meal? The process of ageing itself creates an inherent risk of malnutrition: elderly people have a much reduced sense of taste and smell compared to the young, particularly if they are taking regular medication and have a long term condition. With food so closely associated with family and company, elderly people living alone can struggle with the motivation to prepare and cook meals.
It is normal for appetite to reduce with age and for weight to stabilise or slightly fall after the age of 75. But any reduction should be very gradual. A loss of more than 5 per cent of body weight in three months or 10 per cent in six months is indicative of a strong risk of malnutrition. Even a mild degree of malnutrition will impair immunity, reducing the body’s ability to fight infection.
To consider this in practical terms, if your relative is relying on cold snacks rather than preparing meals, it may be worth trying a meal delivery service or bringing and sharing hot meals with them. An elderly person who is insufficiently prompted by their own appetite to prepare a meal may nonetheless enjoy a hot meal that is brought and served to them fully prepared.
Falls are another major concern: Government figures show one in three people aged over 65 will fall every year, with the rate increasing to one in two people aged over 80 living in their own homes. Up to a quarter will sustain a serious injury, with falls being the leading cause of mortality in the over 75s.
Consider the home itself: the physical space which your elderly relative managed perfectly during their 60s and often 70s may begin to pose serious risks as they become increasingly frail. Often, home adaptions are made after a fall or other health crisis. What adaptions could be made on a preventative basis? Some adaptions need not be expensive: correcting uneven paving stones in the garden (particularly if close to the washing line where your relative may regularly hang out clothes), adding non-slip rugs to a slippery tiled floor or additional lighting in poorly lit rooms can be a simple way of reducing hazards before falls occur.
Often the greatest cause of anxiety is elderly people negotiating stair cases (particularly in older houses where stairs can be very steep and narrow). Moving a bedroom downstairs can be a very good solution if space is available, although many older people, especially those who are relatively well, may dislike this suggestion. A compromise might be: organising belongings so they only need negotiate the stairs once in the morning and evening and considering having carers visit at these times to be there and support your relative while they negotiate the stairs.