When Fraility Arrives

Recently, David Sedaris wrote an article about his family, in particular his elderly father, who fell on the eve of his 95th birthday party. When family arrived he fell again and was disoriented, so he was admitted to a rehab facility and eventually to a long-term care facility. David visited after a few months. A few days later, while spending some time at his beach house, he reflected on the marked change in his father:

“It was strange being at the beach without him, but we didn’t yet have the proper equipment: a walk-in shower, bars beside the toilet, and so on. A year earlier, he hadn’t needed those things, but that’s the difference between ninety-four and ninety-five. The day before his fall, he’d driven to the gym, not knowing that it was his last time behind the wheel of a car, his last night in his own bed. There would be a lot of that in his immediate future: the last time he could dress himself, the last time he could walk. I worried that he had entered a period when it would be one thing after another, death by a thousand cuts….”

This passage resonated with me because of recent events with my 93-year-old mother. She started having difficulty breathing right after the first of the year. Her feeding tube, which had been replaced less than a month earlier, started leaking, soaking her clothes. She was having to do quite a bit of laundry and was feeling overwhelmed. She had an X-ray that discovered fluid around her heart. I was out of town at the time, finally getting back January 9. She had had a bad day and my brother had taken a half-day off work to come over and help her through the afternoon and evening. She had just reached the end of what she could do, she said.

She was only a little better the next morning. I sat in on her appointment with her PA that day. He had prescribed a diuretic and a steroid taper, which helped some with symptoms. Still, he was concerned that she might be developing heart problems. He consulted the following day with a cardiologist, and finally decided she should go into the ER for further evaluation. The X-ray there showed pneumonia. She was admitted, but came home after only one night. They prescribed an antibiotic. The leaky feeding tube was replaced. A few days later she developed diarrhea, apparently from the antibiotic, and came close to her breaking point again as she tried to deal with this additional problem. I went back to the pharmacy to get Imodium. Thankfully, this helped quite a bit. I noticed, though, that she had trouble processing changes such as having to take the antibiotic and Imodium. Since she can’t take anything by mouth, making changes is admittedly more difficult than it would be for most of us. Still, she struggled more than she used to. She became more emotional when things didn’t go well, I think because she lacked confidence and feared that things would get worse.

Mom had a nurse coming to monitor her and for the first time agreed that it would be best to have a caregiver help her when she takes a shower. This extra support seemed to help her rally. She returned to some approximation of what’s been normal for her over the past year or so. She was even able to cope well with her house losing power after an ice storm and having to stay with my brother for four days. Still, episodes like the one in January are reminders that for an “old elderly” person, the dividing line between coping and not coping may be closer than any of us imagine–in mom’s case, just an infection and some extra loads of laundry away. We the family of the octogenarian/nonagenarian/centenarian need to be both attentive to the possibility that the dividing line can easily be crossed and responsive when that happens. It’s also important to have compassion for their struggles. In a couple decades, maybe less, we’re likely to be where they are. The least we can do is treat them as we would like to be treated when we reach that point.

Mom at home, reading.



About Bob Ritzema

I am a fourth-generation American of Dutch ancestry and am trained as a clinical psychologist. In 2012, I retired from Methodist University in North Carolina to return to . Michigan to help family. I maintain a part-time therapy practice in Grand Rapids. I currently worship at Monroe Community Church in Grand Rapids. I can be reached at bobritzema@hotmail.com.
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