Friday, September 2, 2011

Family Medicine: Serving Patients with Declining Health and Supporting Their Families

Note on front of patient chart I read just before knocking to enter the exam room:  "Please read before seeing my father, John Smith, and don't say anything to him about the note.  He is falling again and forgets to eat sometimes.  He is more depressed and frustrated more often.  He would be very upset if he knew I wrote this."  Sally Smith (daughter)

How do family members deal with an aging loved one who is losing more and more memory?

It looks very difficult, up to and including the moment when driving privileges are removed and frustration, guilt and anger intensify.  Then the decision about home safety, nutrition and hygiene followed by assisted living and/or an extended care facility and/or hospice.  It looks like a downhill course toward the patient's ultimate demise.  How do families know what to do?

Family Physicians often become facilitators for families, while evaluating the patient for their ability to perform their Activities of Daily Living (ADL's) and their Instrumental Activities of Daily Living (IADL's). 

From "Activities of Daily Living: What are ADLs and IADLs" by Gilbert Guide on
Activities of Daily Living:  Hygiene (bathing, grooming, shaving and oral care), Continence (urine and/or stool), Dressing, Eating ( feeding oneself), Toileting (using a restroom), Transferring (e.g., going from a seated to standing position and getting in and out of bed).

"In an assisted living facility, the amount of help one needs with ADLs determines the resident's needed level of care. Typically, the cost of care for each individual is based on the level of care he or she requires.

IADLs are more nuanced and complex social activities than ADLs. IADLs can include, but are not limited to:
  • Finding and utilizing resources (looking up phone numbers, using a telephone, making and keeping doctors appointments)
  • Driving or arranging travel (either by public transportation,... or private car)
  • Preparing meals (opening containers, using kitchen equipment)
  • Shopping (getting to stores and purchasing necessities like food or clothing)
  • Doing housework (doing laundry, cleaning up spills and maintaining a clean living space)
  • Managing medication (taking prescribed dosages at correct times and keeping track of medications)
  • Managing finances (basic budgeting, paying bills and writing checks)"
As the Family Physician hears of or sees limitations developing in the ADL's and IADL's of the patient, they can advise the patient and family about some of the options and resources available as the body is less supportive of the patient's life needs.  One of our responsibilities is to support people and families through difficult times, especially when health is declining.

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