Evaluating a Patient’s Ability to Live Independently

As a geriatrician in a locale with many elderly retirees, I am frequently asked how long mom or dad (or both) can stay in their home and live safely and successfully.  It is clearly a complicated issue even if the individuals involved are cognitively and mentally intact, physically capable and financially able to pay for support and help.

There is much to consider. Are the patients physically able to maneuver within their household safely?  If sleep is being interrupted constantly by the night time urge to urinate, can the patient safely navigate the trip to the bathroom without suffering a fall? If they get to the bathroom can they easily manipulate a standard toilet?   If they need to clean themselves and bathe can they get in and out of the shower or bath without falling and injuring themselves?

Fortunately there are elderly home experts who will travel to the home and evaluate it for safety.  They make an assessment and provide a written report to the patient and the ordering physician. Many of these safety personnel are specially trained home health company nurses sent into the home by the patient’s physician. In many cases, Medicare or the patients’ insurance will cover the cost of the evaluation. Once the evaluation is complete, they will suggest certified and responsible contractors to do the home safety alterations.

While our goal is always to keep the patient in their home if possible there are many issues other than the safety of the physical plant to consider. One needs to consider how much supervision and assistance the patient needs to perform their normal activities of daily living?  Can they dress and groom themselves independently?  Can they prepare meals for themselves and clean up after them?  Can they get to the store to shop for food and supplies?  Can they get to their doctors’ appointments? What happens if they become injured or ill?  Do they wear a device which allows them to call for help if they are immobile and cannot get to the phone?

The option of paying someone to care for your elderly loved one is quite expensive. It will cost a minimum of $15 per hour to supply inexpensive help. You may need more than one person so that the staff has time off for their personal needs.  Some families choose to hire a companion who in exchange for room and board supplies help and supervision. This is always risky especially if you don’t/cannot check the background of the individual you are inviting into the home.

If you can afford to pay for help and to alter the home for safety there is always the issue of socialization. Many of my patients who have lost their mates have also lost their friends. They no longer have someone or a group to pal around with.

One particularly spry 93 year old patient was still playing golf, going to the gym and aerobics class three days a week and playing cards regularly. Her golf foursome and card game participants all had passed away or moved closer to their children for support.  Although she had the finances to hire a wonderful aide around the clock she was lonely for companionship despite living in a large country club on a golf course.   She became a wonderful candidate for the correct assisted living facility with a broad range of social activities and residents of a similar age looking for companionship as well.

These are complex issues which require the assistance of the individual’s physician in most cases. It is important for the individual to choose and retain a physician who will take the time to talk to family and professionals involved in the enrichment of their lives.

Senior Care – Evaluating a Person’s Ability to “Safely Drive”

Many of my elderly patients seem to take comfort in the fact that they “no longer drive at night,” or “only drive in the community.”  I am not certain that these self-imposed restrictions actually provide any major reduced risk or protective benefits. In Florida, with a lack of public access transportation, giving up your car is giving up your ability to get around.   It’s also perceived by most elderly as giving up their independence.

As part of a routine office visit, I’ll ask my elderly infirm patients “How did you get to the office today”? A common response is that they are still driving independently.  This same patient, who needs assistance getting up the building’s ramp and a 60 minute appointment just to get out of their clothes and into a gown for an examination, is guiding a 5,000 pound vehicle on the roads.

Unfortunately, there’s very little data available that provides guidelines as to when an elderly infirm person should stop driving.  There is even less data supplied by the State of Florida’s Department of Motor Vehicles.

It is clear that after a neurologic event such as a seizure or loss of consciousness there is a state mandated cooling off period before you are permitted back behind the wheel. It is less clear in an individual with diminished hearing, diminished  eyesight  and diminished flexibility whether they should be driving and how much?

Thus, I was pleased to learn that the Florida Department of Motor Vehicles and a local rehabilitation facility run a State supported Senior Adaptive Driving Program. Pine Crest Rehabilitation Hospital in Delray Beach runs a comprehensive driver evaluation and instruction program. It is far more individualized and comprehensive than the programs run for seniors by their auto insurance companies.

In the Program, trained professionals thoroughly evaluate the person’s abilities to safely drive and help adapt the vehicle to assist the senior. If the professionals say you are good to go then you are qualified and capable. If you are not qualified to drive, they begin the process of rescinding your license.

When patients’ children contact me with their concerns about their parents’ driving abilities I refer them for this evaluation all the time. I highly recommend it for those of you questioning your driving abilities or those of your elderly loved ones.