Blog – Coleen P. Kenny

A recent patient was a retired nurse; old school; she knew how things should be done. And as she got to feeling better, she would daily crook her index finger at me and motion me over.

“They need to wait for me to move; they shouldn’t rush me.”

“They need to tell me what these pills are for.”
She was right, and as her conditioned improved, she’d add, “I was a nurse, ya know. And that makes me a pain in the ass.” This became a daily exchange, always capped off with a devilish smile that lit her eyes.

One day last week though she wasn’t smiling. She stopped at the nursing station where I was charting. “Am I the only one here who can walk?”

I looked around. Indeed we had several patients in wheelchairs. I wondered if she remembered that was her starting point as well.

“You do get around better than most,” I said.

“That’s a shame. I wish there was something I could do.” Her smile was subdued and didn’t reach her eyes as she said, “See ya later, kid” and ambled on her walker to her room.

She’s still an old nurse, ya know…

“I’m so glad you’re here honey; something is wrong and I need you.”

A pull-me-down-to-bed-level hug followed these words. My 90 year old patient released me but held my arm, stroking it like she might comfort an infant. She fingered the lapel of my blue lab coat and told me how pretty it looked. She pointed to her mouth while saying, “I always loved your beautiful teeth.”

After five minutes of sitting on the edge of her bed, she told me, “I feel better now; I trust you.”

So why do I do it? Why do I take care of the frailest elderly? Isn’t it depressing, or boring?

My heart slips into my throat as I answer that question. In nursing school, the over-seventy set snagged me with a golden lasso of heartstrings that even Wonder Woman would be jealous of. When my brain says it’s time to change careers, God helps me change a life.

Whether it’s prescribing cold medicine, pain medicine, or even end-of-life medicine, I can’t imagine a different career path. I can’t imagine not being hit on the bottom by a grinning 80 year old who knew just where he was aiming that beach ball. Or not having known the silver-haired gentleman who wrote me a love poem, his words still framed on my kitchen table.
I really can’t imagine not having been there this morning when my patient thought I was someone from her past who had given her a sense of security.

I also love coaching the nurses and aides how to provide quality bedside care, and teaching the Nurse Practitioner students how to assess and safely prescribe for this frail population , and guiding families how to cope with the caregiving.

And best of all, who else out there gets told how young you look all day?

So remember, sweet Reader, I do this because I love these folks, and I’m here if you need me!
—Coleen

My soapbox led me to post on Facebook, “If you could ask a geriatric expert a healthcare question about your aging parent or grandparent, what would it be?”

This is the first question and answer in what I hope becomes a blog series useful to all those struggling…

Q: How do you get patients motivated to get up and move around without getting them upset?

My mom is having this problem with my grandma. When my mom tries to get her out of bed, my grandma gets upset with my mom and then it’s hurt feelings all around.

My grandma is 87 and used to doing everything herself so i am certain she has got to be struggling with having to depend on someone to take care of her. Her broken arm is healing well, but I’m sure she is stiff and achey just from being 87!

The staff at the rehab hospital don’t have any ideas, and they are going to discharge her in the next week or two, so this information is going to help my mom when she brings grandma home… and me when my parents need care!

Some ideas to make it less stressful for everyone would be great!

A: My answer is threefold for this complex and not unusual situation.

1. Is her pain managed?

You hit the nail on the head when you mentioned “stiff and achey just from being 87.” Her arm may be healing well, but generalized pain is often overlooked. The frail elder may be comfortable lying still in the bed, but try to move those stiff old muscles and bones, and it hurts. In the hospital, nursing home, or at home, we need to assess pain during movement and not just at rest!! Then one key is timing the pain medication 45-60 minutes before therapy or getting up for the day.
Pain management in the frail elderly is a complex topic, and I will discuss it in a future blog.

2.Depression must be treated!

Anyone in a hospital or rehab loses both function and control; add pain into the mix, and your grandma has every right to, and every likelihood of, a clinical depression.

This depression is not something you or your mom or the staff can pep talk her out of or hug away or tell her to get over, or as one of my patient’s sons did today tell her, “There are people a lot worse off than you.” (I almost kicked him in the shin!)

There are new excellent anti-depressants with fewer side effects than ever before available; I have three medications of choice with my LOLs (little old ladies) depending on other factors such as appetite and pain. Again, in the interest of blogging brevity, depression in the frail elderly is another day’s topic, but please note I do not use fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft) in my frail elder patients.

3 Medical issues must be considered.

Is she uncomfortable due to constipation? Does she have a bladder infection? Is she dizzy when she gets up? Dizziness can be due to several issues but blood pressure should be checked lying, sitting, and standing (if standing is tolerated) and reported to the doc or Nurse Practitioner.

And finally, and yes, fourth-fold, sometimes the family member has to stop pushing. A dignity/control issue may develop with a “Who is the parent?” scenario. I acknowledge this becomes more difficult if your mom will be taking her home.

My thoughts and prayers are with my friend who sent this question, and with each of you reading this blog. Please pass it along if you find it useful, and be sure to comment and send me your questions!

—Coleen