Caring for the Frail Elderly: As Life Draws to a Close

Harriet Hodgson

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As I left the nursing home a sad-looking woman suddenly burst into tears. The nurse rushed over, took her hands gently, and asked, “What's wrong?"

"It's so hard, " the woman answered. “It's just so hard. " What did she mean? I did not understand her comment then but, after 14 years of caregiving experience, I understand it now. Coming to the end of your life is hard.

The definition of “frail elderly" has become clearer in recent years. Amy J. Markowitz, JD and Steven Z. Pantilat, MD, define the term in their JAMA article, “Palliative Care for Frail Older Adults: “There are Things I Can't Do Any More That I Wish I Could. " According to the authors, the clinical features of the frail elderly include loss of strength, weight loss, limited physical activity, lack of endurance, and fatigue.

My mother had all of these symptoms. Though she was unsteady on her feet I could not convince her to use a walker. Mom would take a few steps and then lurch to the left or right. Once she hit a wall so hard she was knocked to the floor. My husband and I took her to the emergency room and had her checked for head trauma.

Nursing homes and memory care facilities take many steps to protect the frail elderly. Bedrails help to keep people from falling out of bed. But bedrails sometimes do more harm than good. Joseph Shapiro writes about the dangers of bedrails in “Bedrails Can Cause Deaths in Frail, Elderly. " The frail elderly use bedrails to pull themselves up, Shapiro notes, and then things go wrong.

"Sometimes patients - particularly frail, older ones with dementia or Alzheimer's - can get trapped between a bedrail and the bed mattress, which can lead to serious injury or even death. "

This happens when bedrails are improperly assembled, made from spare parts, or beds have the wrong mattresses. (The bed and frame should be made by the same manufacturer. ) In June of 2006 the Food and Drug Administration (FDA) issued bedrail guidelines for nursing homes and hospitals. These guidelines contain calculations to make sure hospital beds are assembled correctly.

According to an HUD/FHA article, “Elderly Most in Danger as Hurricane Strikes, " posted on, in times of disaster the frail elderly suffer most. As the article says, “Many are shut-ins and have no way to get help. " So the U. S. Government has developed a disaster plan for the frail elderly.

How can you help your frail loved one? Ask about the nursing home's disaster plan. Make sure your loved one's bed is safe. Put emergency cords/buttons within easy reach. Get special equipment: a raised toilet seat, special eating utensils, mugs with two handles, sound sensitive light switches, grab bars, hip protectors, transfer bench for the tub, shower seat, and reading machine for the blind.

Life is indeed hard for the frail elderly. Your attention and love will make it easier.

Copyright 2007 by Harriet Hodgson

Harriet Hodgson has been a freelance nonfiction writer for 28 years. She is a member of the Association of Health Care Journalists and the Association for Death Education and Counseling. Her 24th book, “Smiling Through Your Tears: Anticipating Grief, " written with Lois Krahn, MD, is available from A five-star review of the book is posted on Amazon. You will find another review on the American Hospice Foundation Web site under the “School Corner" heading.

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