In fulfillment of the CA BBS mandated requirement:

Aging and Long Term Care

3. Aging and Long Term Care New Info Button
Those persons who began graduate study prior to January 1, 2004 must complete a 3-hour continuing education course in aging and long term care. The course could include, but is not limited to, the biological, social, and psychological aspects of aging. The Board may accept evidence of completion of an equivalent course or courses taken prior to January 1, 2005 or may accept prior teaching or practice experience in order to fulfill the continuing education requirement.

http://www.bbs.ca.gov/Licstat3.htm

It was Edith's daughter, Meredith, who realized that there was something wrong with her mother. Meredith kept calling her mother on the phone, and was concerned when there was no answer. She left work in a panic, and drove over to her mother's house. Edith had fallen down her stairs, and gashed her head. She had been bleeding, but the bleeding has stopped. It appeared that she had fallen the night before, slipping on a rug. She was unable to get to the phone to call for help.

It was in the treatment of her fall that Edith entered the network of social services. She was quite disoriented, and told the doctor that Meredith had pushed her down. She said that it had happened many times, and that Meredith had also killed her sister, Gwendolyn. Edith's complaint triggered a report to DSS (Department of Social Services) regarding elder abuse.

It soon became clear that Edith was hungry and dehydrated, as she had not eaten in several days. Once she was treated for her cut, x-rays revealed a broken wrist. She was kept in the hospital while a placement was discussed for her. She could not go to Meredith's until the elder abuse complaint was investigated, and her insurance was quite limited in what would be provided in terms of rehabilitation or in home help while her wrist healed.

Neither of her sons could (or would??) leave their work to come help out their mother. They both lived far away, and had families of their own. Edith said she hated her daughters-in-law, and would live with them "over my dead body!"

When interviewed by DSS, Meredith was in tears. She offered to bring in witnesses that she had been at her son's basketball game the night before, and stated that she would never push her mother. She said that her mother had sometimes before had 'odd' complaints about people (she thought the grocer was short-changing her,and that her mail was being stolen, but that perhaps those were real events); but when "Mom told me that my brother's wives were evil, I did start to get really worried. And she has been slipping with my sons, forgetting their names and ages. I guess I didn't want to see how bad it was getting. It has been getting worse"

After a few days in the hospital, Edith's mental condition began to stabilize. She told the social worker that Meredith had not pushed her, and that she remembered that her sister had died of cancer. She became more oriented to time and place, and seemed to be doing better. As there was no history of abuse by Meredith, and no suspicious bruises, it was agreed to release Edith to her daughter.

After a few weeks of having her mother at her home, Meredith called Dr, A., her Mom's doctor, in tears. "Mom came into the kitchen and took a knife and tried to saw off her cast. I told her to stop, that she needed the cast until her broken bone was healed. She said her bone wasn't broken, but it was a trick to get her money. She said she hated me, and was going home. When I tried to stop her, the knife slipped, and she got cut.

She won't eat, she wouldn't leave her room until she came out for the knife. I don't know what to do! My clean, sweet smelling mother stinks! She refuses to bathe. It is like something happened. She yells at my sons all the time, and calls them 'big oafs'."

"And now I know that social worker is going to talk to her again. How do I explain her cut?"

Dr. A.'s exam of Edith revealed that while her body was slowly healing from her fall, her spirits were low. She hated being dependent on her daughter, and kept wanting to go home. He realized that she was quite depressed, and prescribed antidepressant medication as well was recommended psychotherapy.

He cautioned Edith about giving the medication a chance to work, that people often are tempted to stop medication too soon. Either they feel better and think they no longer need the medication, or they think the
medication isn't helping at all. He told her to keep taking medication until it had a chance to work, and warned her that side effects sometimes appear before the antidepressant activity does. He told her that once she was feeling better, to continue the medication for at least 4 to 9 months to prevent a recurrence of the depression.

Dr. A. also referred Edith to a neurologist to explore her intermittent dementia. He also recommended that she receive a complete eye exam, which revealed that she had significant vision loss due to macular degeneration.

Edith appeared depressed when we met.  At 79, she was isolated and in ill health.  Her recent fall had increased her fears of dependency, and she resented having to stay at her daughter's home. Dr. A. had referred her to me, concerned about her chronic complaints and unhappiness. He told me, "I am in over my head with Edith. Nothing I do seems to help." (A rare physician! He was able to acknowledge the benefits of psychotherapy, and knew that when ALL interventions failed, it could be indicative of a depression, or underlying emotional factors.)

Due to severe osteoporosis, Edith was in pain much of the time; unable to tend her garden. "I can't bend down to weed anymore, and my back hurts to much to plant new things. My garden is dying..." Edith had spent much of her time watching TV or listening to the radio.  It didn't matter what was on. She just wanted to hear human voices. 

She was terrified of falling again. She had learned from the National Osteoporosis Foundation that:

Each year, about one-third of individuals 65 years of age or older will fall, and some will be disabled by the broken bones that can follow.
In many cases, a fall can be precipitated by medications such as sedatives, muscle relaxants, and blood pressure drugs that can cause dizziness, lightheadedness, or loss of balance. When two or more medications are used in combination, these side effects may be aggravated. Falls also result from diminished vision, hearing, muscle strength, coordination, and reflexes and from diseases that affect balance.

Edith's daughter, Meredith, lived nearby, and had taken up the tasks of most of her mother's care. Both of Edith's sons lived on the East Coast and she had few friends.  Edith was isolated, unwilling for her remaining friends to see how stooped she had gotten. She had few outlets and felt alone.

"I miss my sister, Gwendolyn. She wasn't supposed to die first, she was my baby sister. The cancer just raced through her. By the time she went to the doctor, they opened her up, closed her back up again, and sent her home to die. She's been gone a year now. Now every time I turn around, it seems another old friend has died."

Edith hadn't been out at night for years, when her decreasing income had made it impossible to move from her home in a neighborhood which had gotten increasing dangerous. "The house is paid off. I can't pay rent; the property taxes are enough as it is. A mortgage? No, I wouldn't get anything for this house, in this neighborhood. And besides, my whole life has been in this house. I came here as a young bride; my children grew up here. I wouldn't know how to live anywhere else."

After a friend had gotten mugged, Edith stopped leaving her house during the day as well. She would only go to the corner grocery store when she was completely out of food, and would only get what she could carry. As an older, physically impaired woman, she felt very vulnerable. Sadly, there was truth to this; as a society we do not honor and protect our elders.