I am still learning about caring for the super elderly, and unfortunately have a long ways to go. I fired 33 aides hired to assist in the care of my 103 year old sweety-pie untilI hired two with no experience but intelligence and compassion and trained them myself. One of the big problems is to insure proper nutrition and I have found there is only "one way to skin the racoon". Not two ways. Not three ways. ONE way. I have them keep a permanently bound book with no erasures allowed that contains a daily record of all activities from dawn until dusk with everything noted in national guard time. Hydration is kept track of by using only two and a half ounce cups ONCE. After being used they are stacked on the table. Adding the cups at the end of the day provides a precise measure of daily hydration. Getting to calories. The aides must make note of every single calorie taken in. Just like in the second grade insist they "show their work". One banana rquals 100 calories. One piece of chocolate is 15 calories. One organic egg equals 75 calories. I prepared a long printed table of caloric equivelants. The basal metabilism for my sweety-pie is 980 calories a day. Search on the net tofindout the appropriate number for your loved one. If she takes in less than 980 calories she loses weight. Every single day I get a calorie report. The goal is to insure that she exceeds 980 calories every single day, without exception. That means if 2300 HRS (national Guard Time) arrives and she has not met that goal we feed until she does. Because of a disturbance in the circadian rhythym of the elderly they often feed well between 11P.M and 2 A.M. (2300 HRS-0200 HRS). Heavens to mergetroid! Does that mean the poor aide has to stay up? Well...sometimes. You feed when the patient wants to eat. Not when it is convenient for the aides. As the saying states: "that's how it goes moving west". The one thing to be aware of when you ask: "How is the eating going?", is NOT to be satisfied with vague comments such as"she's eating well". Or: "she had a fair appetite this morning". Unacceptable. You require a PRECISE daily calorie count. Do not pass go. Do not collect two hundred dollars. Of course you have to keep track of nutrition also, which is more than calories. Protein and vitamins are necessary. But that daily calorie count will mean the difference between life and death.
This evening I cuddled my 103 year old sweetie pie until midnight. She was dressed to the nines, as she is every single day. No lolling around in Pajamas. Her nails are done. She picked the color. Her hair is combed. She is well groomed. Clothing is spotless. She is wearing a pink sweater and a dark red dress. White cotton socks. And she likes those little flexible plastic shoes! In precious pink! There is no unpleasant smell or odor in the room. There never ever is. I reviewed everything she ate and drank with the aide and we tallied up 1520 calories of intake for the day! And 28 ounces of liquid. Hooray! For the past thirty days we have exceeded 980 calories by 200-300 calories every single day. Roughly speaking 3800 excess calories reflects itself in weight gain of a pound. Sweet-pie also has swallowing difficulties and a swallow evaluation several times a day is in order. Force feeding is prohibited under any circumstances. Force feeding in the elderly, especially those with post-stroke problems usually results in aspiration of the food into the trachea and "aspiration pneumonia". Unfortunately "force feeding" is apparently taught to many aides in their certification courses and SOP in many nursing homes. When I left at midnight the aide wrote the days caloric tally in the "logbook". I inspect the logbook carefully every single day. As far as beverages go, I fololow the "four flavor rule". At every meal there are four different flavors of beverage, all served in small two and a half ounce cups. Sweety-pie can reach for and hold a small cup herself. Bring the cup to her lips and return it to the table. Something she could not do three yedars ago. And she is very proud of her accomplishment! And I get agita (Italian Heartburn) when I see the aides try to take the cup from her tiny hand and "help her"! The rule is: If the patient can do something by themselves, they should be encouraged to do so. The meals are opportunities for physical therapy and rehabilitaion. Reaching for a cup constitutes physical rehabilitation. And the meals take a very long time. The little one can sometimes only swallow a single spoonful every ten minutes. And when I left her tonight she said: "I'm so happy!" And she put her tiny hand to her mouth and blew me a kiss good-bye.
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