The Katz Index of Independence in Activities of Daily Living (referred to as the Katz index or the Katz ADL) is a tool for assessing an older adult’s baseline ability to bathe, dress, use the toilet, transfer, and remain continent, and feed her- or himself. It’s also used for evaluating changes in response to illness.
A second part of ADL’s is dressing. This is assessed to understand if the older person gets clothes from closets and drawers and puts on clothes and outer garments complete with fasteners and can tie shoes.
Detailed questioning can assist the geriatric care manager in making the best recommendations. If the family reports that the client is wearing soiled clothes, it may be that the person has a visual impairment that is preventing him or her from seeing that the soiled clothes should be changed. However, it may also be that, if the person has dementia, he or she is forgetting to change clothes and might just need reminders or need to have a caregiver lay out the appropriate clothes to wear.
If a person can get dressed unassisted except for shoes and socks, recommending that the person use adaptive devices such as a long shoehorn will enable the person to continue to be independent. Older people who need hands-on assistance because they are unable to dress themselves because of physical problems, such as Parkinson’s disease or cognitive loss, will need a referral to a home health aide if family members are not available.
Physical Elder abuse can happen during the holiday season , a joyous season also fraught with family tension.
Family caregivers are of the most vulnerable. . They teeter on a thin ledge where they can slip on the knife’s edge of elder abuse. Neglected, untrained, unpaid yet representing 78% of the long-term care system, family caregivers are stress on steroids. You may personally know what I mean. Most kin, in spite of the constant worry and tension, do a heroic job. Yet certain groups of caregivers are vulnerable to cracking up and some are predisposed to a cycle of violence. How do we know who might be a perpetrator?
Let’s take a step back and see who is a caregiver. The aging 21st century family is no longer the nuclear family made up of 50’s TV Ozzie and Harriet, and their famous kids Ricky and David. Divorce and long distance have shattered what we knew of that family. Now the aging family and its’ care providers are not just blood relatives. It’s not just David who cares for Harriet and Ozzie. Ricky, if he were still alive, might be divorced or both he and David might have new wives .So we have multiple caregivers and grandchildren who are steps, halves and fictive kin.
Or you may have partners caring for older family members, friends, neighbors, and significant others the aging family .The family itself has washed over its banks just like the Mississippi flooding New Orleans.
Because growing old means suffering chronic conditions like Alzheimer’s and cancer, the care receiver demands more and more care. The caregiver may be unwilling or unable to keep filling up this bigger and bigger plate. Their backs get more and more weighed down like the proverbial camel. Some last straw, some new demand may just shatter that spine and cascade the family member over the ledge, falling down Niagara without a barrel. In their terrifying freefall some family caregivers commit elder abuse
What are some triggers to elder abuse in families? The number one detonator of elder physical or financial abuse is bad past relationships. That miserable family past might harbor child abuse, child neglect, child abandonment, or alcohol or drug use involving the now aging parents. When the some inner barrier that holds back pain cracks, it can result in violence and deceit. If the family of 50 years ago suffered some searing hurt which carries through to the present, that old wound can turn into a fist or a slap in the here and now. So some adult children and family caregivers are horribly vulnerable to violence in the present aging family.
In a susceptible family caregiver, what are some care receiver triggers that can make them snap.
• Verbal aggression
• Refusal to eat
• Refusal to take meds
• Calling police
• Embarrassing displays- taking of clothes
• Physical aggression
• Vulgar habits – example spitting
• Disruptive behavior
If you have concerns about caregivers and elder abuse., call you local Adult Protective Services . I have also included a chapter a caregiver assessment in my text Care Managers and the Aging Family, Jones and that has a section on caregivers and elder abuse. You can order the book on my website as well.