Senior Self-Neglect

"Mr. Joe" lived alone in his old house at the end of the street. Nobody saw much of him anymore since his wife died four years ago. His house hadn't seen a paint brush in years, and the yard was, as they say, reverting to its natural state. If you did not know that Joe lived there, you might think the house was abandoned.

Joe didn't even go to church any more, where he had once been one of the most active members. One Sunday, some of the members decided to pay him a visit. What they found was appalling. The inside of the house was filthy, with spoiled food scattered all around for dozens of rats to devour. The winter wind blew through broken windows and holes in the floor. Joe himself was dressed in tattered clothes, unshaven, and had dried blood on his forehead from a nasty fall.

The church members immediately contacted the county social services agency to get Joe moved to a safer, cleaner personal care home. When they arrived to help Joe move, however, they were stunned when he refused to budge. He didn't care about their plans. Just leave him alone!

Seniors who neglect their own minimal needs for food, clothing, and shelter do so for many reasons. Some have always neglected their needs; others lose their ability to care for themselves through memory loss, illness, or poverty. It is against the law to neglect children, but mentally competent adults have the right to refuse all assistance. This puts friends and caregivers in a terrible dilemma: basically, it forces them to stand by and let a senior waste away.

Why would seniors allow themselves to get into such a state, and why would they resist genuine offers of help? The reasons include:

• some seniors resist asking for help because they think they will become a burden to someone else, or lose some of their privacy;
  
• some seniors are fiercely independent and have negative images of assisted care settings;
  
• some are disoriented because of alcohol/drug abuse or misuse of medications;
  
• some suffer from memory loss, depression, or other mental illness;
  
• some have been taken advantage of, physically or financially, and are very suspicious;
  
• some are totally focused on not spending whatever resources they may have saved;
  
• some have become "stuck" in a grief cycle and simply lost the will to live.

A characteristic common among nearly all self-neglecting seniors is a sense of aloneness. Sometimes they have driven other people away with their eccentricities; sometimes they don't understand why they are so alone. In any case, a good first step is to gradually establish a friendship with the senior. Their world likely consists totally of their four walls, almost like a prisoner. Any contact with the "outside world" may spark interests long forgotten. A personal relationship, even with a pet, can become a reason to live and serve as motivation for better self-care. You can help ensure that the senior has an accurate understanding of support options in your community such as visiting home health care and homemaking aides. By reaching out to self-neglecting seniors, you may literally become the difference between their life and death.

Your Health

Getting to the Heart of Heartburn

Many of us suffer from heartburn after eating a big meal. The official name for heartburn is esophageal reflux. Heartburn may mean we have eaten too much, but it can also signal that the sphincter that keeps food in our stomach is weak.

How can heartburn be treated? Depending on how severe it is, we can treat it with diet and/or medi- cation. The first step is to eat three or four small meals throughout the day so that the stomach is never too full.

Also avoid food and drink that increases stomach acid or slows stomach emptying. Greasy, high fat foods, spicy meals, tomato products, citrus foods, regular and decaffeinated coffee, cola drinks, alcohol, onions and chocolate can all cause problems. Unfortunately peppermint and spearmint candy, often eaten after meals to settle the stomach, can also relax the sphincter and increase risk for heartburn.

Lose weight if you have too much fat around your middle. Excess fat presses on your stomach pushing its contents up into the esophagus. Even if you are not overweight, wearing too tight a waistband or belt will make heartburn worse.

Many people suffer more heartburn if they lie down or bend over after eating. To prevent this, don't eat within two hours of going to bed.

If you smoke, stop. Nicotine increases release of stomach acid and allows the sphincter to open more easily.

If heartburn is frequent or severe and changing your eating habits does not help, see your doctor. Unfortunately some people think they have heartburn when in fact they are having a heart attack. If your problem really is heartburn, you may need some tests to see if stomach acid has damaged your esophagus. The doctor may also help if you need to quit smoking or lose some weight.

Certain medications increase risk for heartburn. Pain relievers like aspirin, ibuprofen and naproxen can irritate the stomach. Asthma medication and calcium-channel blockers taken for heart problems can also increase heartburn symptoms. Even hormone replacement therapy taken after menopause and some antidepressants can make heartburn worse. However, don't stop any medication without discussing it first with your doctor.

New drugs and therapies for heartburn are available if changes in diet and lifestyle don't work. You don't have to suffer that miserable burning feeling every time you eat. Heartburn can be controlled with the right diet, medication and lifestyle.

Tarts for Two

Most dessert recipes serve six to eight people. If you live alone or as a couple, you either end up eating more than you want or throwing part of it away. Here is a tart recipe that makes only two servings. You can add one and a half cups of milk to the instant pudding mix you don't use to make three small servings of pudding on another day.

Ingredients

3 tablespoons plus one teaspoon of fat-free, sugar-free instant pudding mix, vanilla or chocolate flavor
ounces skim milk
½ cup frozen, unsweetened cherries
½ teaspoon cornstarch
½ teaspoon cold water
2 graham cracker tart shells

1. Measure out the pudding mix from the instant pudding box. Store the remaining mix in an air tight container for later use.
2. Blend measured pudding mix with the skim milk in a small bowl until smooth and thickened.
3. In a small microwave-safe bowl, microwave the cherries for one minute on HIGH until the cherries thaw and cherry juice is released.
4. Mix cornstarch with water until smooth. Add to cherries. Microwave on HIGH for 30 seconds or until thickened.
5. Spoon pudding evenly into the two tart shells. Top with cherries. Chill until ready to serve.

Makes 2 servings.

Your Resources

Guard Against Hypothermia

During cold weather, everyone's health may be endangered by extremely cold temperatures, but members of the elderly population are particularly vulnerable to hypothermia.

Hypothermia is caused by unusually low body temperature of 95°F. and under. If not detected and treated in time, this condition can be fatal. Older people are the most likely victims and account for approximately one half of all victims. Among older people, those who are poor and unable to afford adequate heating and those whose bodies do not respond to the cold normally are more susceptible to hypothermia.

To guard against hypothermia, avoid prolonged exposure to cold without taking care to keep warm, keep the room temperature around 70 F., wear adequate clothing, which includes extras like hats, sweaters and long underwear, and sleep with extra blankets. A person with hypothermia may not realize it because the body does not respond to the cold, and the person may insist he/she feels comfortable. The person whose temperature regulation is defective does not shiver and thus cannot conserve body heat.

Hypothermia may be suspected if any of these signs are evident:

• Bloated face, pale waxy skin
  
• Trembling on one side of the body, or in one arm or leg
  
• Slurred speech
  
• Slow breathing, slowed irregular heartbeat
  
• Low blood pressure
  
• Momentary blackouts
  
• Dizziness and drowsiness
  
• Fleeting memory

• Put the person into a warm bed. Rewarm gradually; rapidly rewarming could be fatal.
  
• Elevate the feet to force blood to the head.
  
• Keep the victim still and quiet.
  
• Give the victim a warm drink such as milk or water. Do not give the victim alcohol or medicine, as the condition could worsen.
  
• If hot water bottles and/or heating pads are available, they may be used on the chest, feet, and ankles.
  
• Contact a physician. It is important that victims of hypothermia be treated by a physician, especially if their body temperature is drastically low (90 F. and below).

The University of Georgia and Ft. Valley State College, the U.S. Department of Agriculture and counties of the state cooperating. The Cooperative Extension Service offers educational programs, assistance and materials to all people without regard to race, color, national origin, age, sex, or disability. For large print, taped or braille editions of this publication, contact the author.

An Equal Opportunity/Affirmative Action Organization Committed to a Diverse Work Force

DP-RM&HD-105 January, 1997

Issued in furtherance of Cooperative Extension work, Acts of May 8 and June 30, 1914, The University of Georgia College of Agricultural and Environmental Sciences and the U.S. Department of Agriculture cooperating.

Gale A. Buchanan, Dean and Director