Reporting Changes 
in Medical Conditions

Your role as a frontline caregiver places you in a critical posi­tion relative to discovering important changes in your elders and reporting them immediately. 

Your alert actions on spotting these changes early-on can be extremely significant in helping them avoid needless pain and suffering.  
 

That is why you need to know about the most common diseases and other con­ditions in your elders and symptoms that you can recognize ear­ly-on before they become much more se­rious. By identify­ing and immediately report­ing such changes to the office, you make it possible for your elders to receive prompt treatment and avoid complications that might can lead to pain and suffering, or even put their life in danger. The fact is, your knowledge and attentiveness can make the difference between life and death. 

In their book, Paraprofessionals in Aging, A Guidebook for Those who Care for Older People, professors Kathryn Braun and Michael Cheang, of the University of Hawaii, write: “Successful caregivers observe and report what they see. They notice changes in the elder, and they share their obser­vations with the health professionals who can help interpret them.”

So, you need to be alert for anything unusual your client has, such as bruises that weren’t there before, or physi­cal changes, such as holding an arm like it’s hurting. Also, listen carefully to what they say. They may complain about not being hungry, for example, or about feeling unwell every time they take a certain medicine. These situa­tions may indicate a health problem. And the sooner you report them to the office, the greater the chances they can be successfully resolved be­fore they become serious prob­lems.

 
Here is a list of the most common changes in body functions, behavior and mood that should alert you for a possibly develop­ing health problem. Be sure to record all observations in the cient’s binder.

 
Excessive thirst and drinking water. This can be a sign of worsening diabetes that needs immediate attention. Other signs of this include ex­cessive hunger and blurred vision. 
 

Urination problems. Exces­sive urination may also be due to worsening diabetes. Very frequent urination in men may be due to an enlarged prostate and an in­crease in this frequency may mean a worsening of his pros­tate problem. 
 

Numb face, arms or legs. If accompanied by vision and speaking difficulties, these can be the signs of stroke, especial­ly if it comes on suddenly. Alert the office immedi­ately if this is the case. Other signs of stroke in­clude sudden severe headache, difficulty walking, dizziness and loss of balance. Numbness of the hands and feet can also be signs of a se­rious circulation problem. 
 

Circulation problems, especially in those with diabetes, are a leading cause of ampu­tation of the hands and feet so be especially vigilant looking for this change in your elders with diabetes. Your alertness may save them from a very serious health situation. including death. 
 

Worsening of shortness of breath. Your clients with certain types of lung and heart conditions may regular­ly have shortness of breath. This is true if they have COPD, heart failure, asthma, emphysema, and other lung conditions. Often, these clients may need an oxygen tank to help with their breathing. 

In cases where you notice that the shortness of breath is worsening – either very suddenly or gradually – you should also notify the office as that can be a sign that the client’s ongoing dis­ease or condition is getting more serious. When shortness of breath worsens suddenly and is accompanied by chest pain that radiates to the neck and shoulders, notify the office immediately as the client may be having a heart attack or other serious situation. 

Increase in bladder/bowel accidents. Accidents may occur occasionally, however, if you notice that they are getting worse or have become a situation involving diarrhea, notify the office right away.
 

Increasingly difficult hand, wrist, or knee movements accompanied by pain. This can indicate that the client’s arthritis may be worsening. Some forms of arthritis can flare up and cause permanent joint damage if not immediately treated. Often, this is accompanied by redness, swelling and warmth around the joints. Another possibility is that the client could have fallen.
 

Dizziness. Dizziness is rela­tively common in many elders and often no cause can be de­termined. If it comes on suddenly and is severe, it could mean a serious health problem such as a stroke. And, even in cases of relatively routine, ongoing dizziness, the client may be at a substantial­ly increased risk of falling, so this, too should be reported. Falls are a leading cause of in­jury and death in elders.

 
Skin injuries. Skin injuries are a deadly situation with elders. Even minor skin injuries can develop into a pressure ulcer, and a huge 90 percent of elders who develop a pressure ulcer within three months of being admitted to a facility die, ac­cording to research. It’s therefore important that you check your client’s skin for bruises and tears. 
 

If your client has diabetes, the situation is even worse, as di­abetes often causes healing to be very difficult and even small sores can eventually get so serious that they lead to amputation. 
 

Skin injuries may also indicate that the client has had a fall. 
 

Shingles. A reddened skin rash that is very sensitive to touch and is itchy or painful may be due to shingles. Shingles can damage the nerves so severely that the client may have a lifetime of se­vere, often debilitating, pain that destroys their quality of life. This condition is called postherpetic neuralgia (PHN) and without early treatment, it may cause very severe pain for years. Over one-third of elders who get shingles also get PHN if treatment is not prompt.
 

Very early treatment – within the first few hours of discovery – with anti-viral medications can prevent this serious shingles condition from developing. Many caregivers and even physicians do not take shingles seriously enough, or the doctors do not diagnosis it early, and the proper medication is not given soon enough. Take any rash seriously and become an advocate for your client in getting proper treatment. 

Poor appetite and tired­ness. These are common in people with depression, COPD and cancer. If you notice an in­crease in these symptoms, noti­fy the office or talk with the family. 
 

Confusion and forgetful­ness. If your client can no longer find their way around their home, asks the same question over and over, or has forgotten their children’s names, these can be signs of a stroke or early signs of demen­tia.

 
Loneliness. Older persons may avoid company because they feel depressed or suffer from something that embar­rasses them when other people are present. This is often the case with elders who cannot hear or see well, those with incontinence, or those with early dementia. Depression and anti-social tendencies can be helped considerably by getting the proper at­tention to the problem as soon as possible. No client should be left alone and unhappy without attempts being made to solve their problems. 
 

Uncontrolled crying. This is common in depressed persons who also tend to have feelings of hopelessness and a lack of interest in things they used to enjoy. If untreated, depression may have life-threatening implications, including suicide. Depression can completely destroy the quality of life of the elder in their later years. In most elders, depression and loneliness can be success­fully treated. 

Eyesight problems. Elders can suffer from a variety of eyesight problems, including glaucoma and macular degener­ation, both of which can cause blindness if not treated early ­on. You need to watch the eye­sight of your elders with diabe­tes very carefully, because dia­betes can cause blindness if early treatment is not initiated. 

Things to watch for include complaints of fuzzy or blurry vi­sion or the inability to see things from the sides. Do not delay in reporting these symptoms as early treat­ment can often prevent a wors­ening of the disease, and blind­ness. 

Problems with hearing. Improper hearing is one of the main causes of a reduced quali­ty of life for elders. It can cause them to retreat from social activities and lead to an isolated and lonely life for the elder, and possibly even depression. Many hearing problems can be corrected, or other special measures can be used to help the elder cope with the disability. Do not assume that poor hearing is just a normal part of aging, and that nothing can be done.

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HELP THEM OPEN UP
It’s not as easy as you might think to spot many of these po­tential problems in your clients. One of the biggest challeng­es is that many do not want to mention their prob­lems and will attempt to keep them a secret.

 
Two major reasons for this are that they do not want to be a bother to you; or that they are simply afraid to talk about their problem. Research shows that even those elders in severe pain are often reluctant to talk about it. 
 

In order to properly keep an effective ongoing assess­ment of your clients and their potential health situations, you need to become a skillful con­versationalist so that you can get them to tell you when they are having problems. 
 

This is an important care­giving skill and may save a client’s life or prevent years of suffering. 
 

Often, it’s just a matter of simply asking, “How are things?” When that doesn’t work, you need to pursue things fur­ther. 
 

Your client is more likely to tell you about their concerns if you show that you really care about them. And there are some things you can do to show this:

• Be friendly and cheerful when you enter their room. Smile and ask how they are. Show them that you care about their welfare.

• For longer conversations, sit down and directly face them when speaking. This shows that you are truly interested in what they have to say.

• Hold their hands, look them in the eye, and smile.

• Call them by their name.

• Ask them directly how they’re feeling, if everything is okay, and if they have any pain or problems that they’d like to talk about.

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If you suspect they have a problem but do not want to admit it, gently ask them for more specific information about their situation. Don’t expect to get all your answers at once. You may need to make several attempts and get to know them quite well before determining that they do have some sort of problem that needs further investigation.
 

BE COMPASSIONATE IN YOUR CAREGIVING
“Compassionate communication” is an important factor in successful caregiving. It means talking with your clients in the same way as you would with a loved family member. Use a caring and gentle tone of voice to help them feel loved and safe.
 

“A look, a touch, a joke, an acknowledgment that maybe you’re not having such a great day either – that momentary connection, whether it’s just visual or just fleeting – makes all the difference,” reports Darshak M. Sanghavi, MD in the Joint Commission Journal on Quality and Patient Safety.
 

Compassionate communication also means showing consideration for the person’s feelings. For example, the client may feel embarrassed to talk about a certain problem. Let them know that you understand what they are going through and that you want to help them. Perhaps they will find the confidence to talk about it.

Lastly, consider that your clients have needs that younger people don’t have. 
 

It may take longer for them to understand and think, so you need to talk slowly, maybe repeat yourself a few times, and allow them time to respond.
 

Good advice: Always try to start a conversation with your clients – even if they don’t seem to want to talk. This may be the only way to get im­portant information from them. 

They may need a little bit of persuasion now and then and may have difficulties hearing or seeing well. Being sensitive to such needs is an all-important part of compassionate communication. 

RECOGNIZING CHANGES IN DEMENTIA ELDERS
Elders with dementia have ad­ditional problems which further challenges their ability to communicate. 
 

For example, they may be in pain but cannot tell you be­cause they cannot talk, or do not even know that they are in pain. 
In these elders, be alert for things like frowning, grimacing, fidgeting, and pulling away, as well as not wanting to be touched ... or such things as sweating and shaking. These can indicate the presence of pain. 

PAIN: A SERIOUS PROBLEM
Pain is a serious problem in elders with dementia. Research studies continually show that a high percentage of dementia patients are in unresolved pain and often their caregivers don’t even know it. It’s also important to look for sudden physical and behavioral changes that can be a sign of delirium, which can be serious and need immediate treatment.
 

Nearly 90 percent of people with dementia develop delirium, but because the symp­toms of this condition are so similar to dementia, it often goes undetected. In one study, certified assistants didn’t recognize delirium in 88 percent of their elders with dementia. 
 

If the person in your care suddenly appears more confused than usual, has more fre­quent hallucinations and delu­sions, is particularly sensitive to light and noise, and starts slipping in and out of conscious­ness, you should call the office immediately.
 

FOLLOW THROUGH
Whatever your client’s prob­lems, once you have reported your observations you should follow through to make sure that the necessary steps are taken. 

Your compassionate caregiving and attentiveness to chang­es in your client’s functioning and behavior are paramount because they allow them to have a much better quality of life as they age. By observing and report­ing what you see, you may gift them with a longer and happier life.

The best advice:

• Be alert and caring.

• Get to know your elders and their health condi­tions.

• Report any suspicious changes in their medical condition regardless of how minor they may seem.