CARE OF THE AGED

At the end of life, as at its beginning, every individual especially needs the interest and protection of his own family. In ordinary circ.u.mstances neither a baby nor an aged person can be cared for so fittingly or so successfully in any other place as he can be in his own home.

With advancing years is to be expected a general slowing down of all the powers. In old age both body and mind show characteristic changes, and particularly changes causing lowered resistance and diminished vigor. If the manner of living is adapted to these changes, both happiness and usefulness may be prolonged. But so gradually do the changes often come that they may escape notice for a long time, and the younger generation in looking back sometimes realizes with regret how much earlier measures might have been taken to prolong the usefulness and to mitigate the discomforts of aged parents and friends.

Old people are keenly sensitive to cold, since the circulation gradually becomes less vigorous and they take little exercise. Keeping them warm both in bed and out adds more perhaps to their comfort than any other one measure. They should have warm underclothing and soft shawls and other extra wraps. A real service will be rendered by the person who invents a suitable and dignified wrap for old or feeble men, who dislike the informality of sweaters and feel disgraced by shawls. Old persons should and can be kept warm in bed, by providing them with hot water bags, with warm night clothes including stockings, by using woollen or outing flannel sheets if necessary, and by providing a sufficient number of light but warm bed covers. It is not always understood that many covers do not remedy the deficiencies of a thin mattress. If a thick mattress or two thin mattresses cannot be provided, a thick comforter or even many layers of newspaper should be placed between the mattress and the springs, and another thick comforter should be placed between the mattress and the lower sheet. Rubbing the body with warm olive oil often affords great comfort, by improving the circulation and thus increasing the sensation of warmth, and also by relieving the tendency of the skin to become dry and cracked. Poor circulation at night may cause cramps in the muscles of the legs; the cramps can usually be relieved by warmth and gentle rubbing.

Old people frequently wish their rooms to be very hot, both by day and by night, even as hot as 80 or 85, but if it is possible to keep them warm in any other way the temperature of the room should be kept at 70.

Well ventilated rooms are highly important for old people as for all others of low resistance, and it is entirely possible for their rooms to be warm and yet well ventilated. Aged persons should be carefully guarded from chill, exposure, crowds, and infected persons. Like little children they are peculiarly susceptible to the respiratory diseases, which cause many of the deaths commonly attributed to old age.

Digestion usually becomes weaker than in earlier years, and less food is needed. It should be simple, hot, and divided into four or five meals rather than three. Old people often wake at an early hour, and hot nourishment will prevent them from growing weak and faint while waiting for the family breakfast. Both constipation and looseness of the bowels are common ailments in old age. So far as possible the bowels should be regulated by means of diet; but muscular weakness resulting in inability to control the bowels should not be mistaken for and treated as diarrha.

It is unwise for old people to undertake unaccustomed or sudden muscular exertion, since the muscular system including the heart muscle grows weak and is generally unable to endure great strain. The bones, moreover, grow brittle and heal with difficulty if broken, so that persons of advanced years no matter how active should avoid walking on icy pavements, climbing on chairs to reach high shelves, and placing themselves in other insecure positions. a.s.sistance must be tactfully given, however, as active old people are inclined to resent it. On the other hand, old people should be encouraged to continue moderate and safe activities, and to take regular exercises suited to their strength.

Although increasing muscular weakness tends to make most old people indolent, it is far better for them both in mind and in body to remain as active as they can without danger of too great fatigue. At all events, they should be prevented if possible from becoming bedridden.

Since in old age sight, hearing, and other special senses become less acute, one should remember that an old person may not notice the odor of escaping gas, the light of a smouldering match, or the sound of an approaching motor car, and that he must be specially guarded from such dangers of every day life. On account of their dulled perceptions old people are sometimes unjustly considered to be less intelligent than they really are. Young people moreover should be told, if an aged person is untidy and careless in personal habits, that the apparent negligence is caused by dulled perceptions and diminished muscular control for which old people are no more responsible than they are for failing eyesight or for inability to hear.

Families should also realize that changes in mind and character are beyond an aged person's control and that they should not be made the cause for remonstrance or arguing. Just as the arteries harden with advancing years, as the bones become brittle and as other tissues become less flexible, so changes are likely to occur in the nervous system. It is not surprising when the brain substance like other tissues is becoming less flexible, that the powers of attention should weaken, that memory for recent events should diminish, or that other mental powers should fail. Changes in disposition are not uncommon: previously controlled persons sometimes become querulous and exacting, while excitable and irritable persons become more placid. With most old people emotions become less intense; feeble old people hardly realize great joy or great sorrow, and seldom look forward to death with apprehension.

Among the most important changes that occur in the nervous system is its gradual loss in power to respond to new demands. New habits are difficult or impossible to form, and old habits are hard to break.

Attempts to break the habits of a life time are therefore dangerous, and radical changes in old people's ways of living are attended by risk as well as by unhappiness. Such loss of adaptability in the nervous system makes it increasingly difficult for old people to a.s.similate new ideas and to understand new points of view. The feeling that the world is strange and that the next generation has gone on without them accounts for the tragic loneliness of many old people. Clearly it is for those who are younger and more flexible to bridge the gulf between the generations by their understanding and their sympathy.

Physical care to whatever extent it is needed should be given to all old people as soon as they are unable to care for themselves, and thought should be given to adapting their surroundings and ways of living to their strength and needs, just as they should be adapted to the strength and needs of chronic patients. But a warning should be given against managing old people too much. It is hard for people who have managed their own lives successfully for many years to be managed, even for their own good. Indeed, it is questionable kindness to deprive old people of all freedom of action, even if following their own inclinations occasionally has disastrous results. Few persons would wish to prolong their lives if long life involved being thwarted in every desire, and sometimes real kindness consists in allowing old people to do certain things that are not good for them. Keeping them warm and letting them do as they please will go far to make old people happy.

Many of the changes in old age reverse the developing process of childhood. In youth and age extremes meet, and the care of the aged presents certain marked similarities to the care of little children.

Both require simple food, occupations suited to their strength, and protection from infections, from fatigue, and from nervous strain; both are dependent, more or less helpless, and for their happiness both need the affectionate care of their own families. But in one respect their needs are fundamentally different. In childhood formation of proper habits is all important, and in caring for children the future effect of every word and act must be taken into consideration. Old people, on the other hand, since they live largely in the past and their habits are irrevocably formed, may be indulged without harm in ways that would demoralize a child; with a clear conscience one may make them happy in ways both great and small. This difference makes possible one of the greatest pleasures that come to one who cares for the helpless and the sick, for of all enduring satisfactions few are greater than the power to fill with comfort and happiness the closing days of life.

EXERCISES

1. What is meant by a physical defect? Name some of the most common defects.

2. Name some permanent injuries to the body caused by defective teeth; by diseased or enlarged tonsils and adenoids; by faulty posture.

3. Describe some common symptoms of eye strain in children; of enlarged tonsils and adenoids; of deafness.

4. Name several possible causes of round shoulders, and explain why urging a round-shouldered child to hold himself erect is seldom enough to make him correct his posture.

5. What measures should be taken to overcome nervousness in children?

6. Describe in detail the health work carried on in the public schools of your city or town. Considering the important part played by uncorrected physical defects in causing permanent physical disability among adults, do you think in the long run it is cheaper or more expensive for a community to spend money in protecting the health of school children?

7. Discuss the particular needs of convalescent and of chronic patients.

8. Explain the effect of activity upon recovery, and explain why it is desirable for invalids to have occupation.

9. What special needs should be provided for in caring for old people?

FOR FURTHER READING

Invalid Occupations--Tracy.

Occupation Therapy--Dunton.

Handicrafts for the Handicapped--Hall and Buck.

When Mother Lets Us Make Toys--Rich.

Amus.e.m.e.nts for Convalescent Children--New York State Department of Health, Albany.

Essentials of Medicine--Emerson, Chapter IX.

Civics and Health--Allen.

How to Live--Fisher and Fisk, Chapter III, Section II; and Supplementary Notes, Section III.

Health Work in the Schools--Hoag and Terman.

Medical Inspection of Schools--Gulick and Ayres.

The Hygiene of the Child--Terman.

Posture of School Children--Bancroft.

CHAPTER XV

QUESTIONS FOR REVIEW

I. Show how you would:

1. Make an unoccupied bed. (Notice the number of minutes it takes you to do it well.)

2. Remove all the covers from an unoccupied bed and leave the bed to air.

3. Open a bed to receive a patient.

II. Show how you would:

1. Change all the linen and remake an occupied bed. (How long did it take you?)

2. Turn a patient from his back to his side, and the reverse.

3. Remove, shake, and readjust a patient's pillows.