Expert in Aging Life and Geriatric Care Management
Watch interview I did on March 27, 2013 with Ramsey Bahrawy -Your Money Your Life- on psychosocial assessment of an elder and how this assessment can pinpoint the holes and losses in an older person’s life and create a care plan to weave a new strong safety net to fill these holes.
Interventions in a care plan- how do you craft them? First of all, what are they in simple terms – they are solutions to the problems of your geriatric care management or aging client.
Where do you find them? You find the interventions for your care plan in your completed assessment tools and their care plans. You tailor these interventions to the client.
For example, consider my You Tube Dual Assessment March 14 with Mr. Tommy Jefferson – Mr. Jefferson problems includes self-care deficits. His care provider is his “significant other-“Sally Hemingway, who is in her 80’s. They are living together as a couple. She is presently assisting him with bathing, dressing, making meals shopping and driving.
You, the geriatric care manager , or aging professional ,has done a dual assessment of both Sally, the family care provider and Tommy, the care receiver. Through your functional and psychosocial assessment a have Mr. Jefferson and caregiver assessment of Sally Hemingway, you know you need to craft new interventions for this couple. .
You realize that a new intervention is needed, as Sally is 80 and risks injury to herself both physically and mentally. So the new intervention to this problem might be hiring a paid care provider to come in to protect her health and give her respite. Each intervention must have a clear plan.
What is undue influence?
Undue influence is when an individual who is stronger or more powerful gets a weaker individual to do something that the weaker person would not have done otherwise.
What is undue influence? A stronger person uses various techniques or manipulations over time to gain power and compliance.
Undue influence can be wielded in one-time events. An example would be a discussion of transaction at an unusual or inappropriate time for example with a widow with recent bereavement someone says” let’s you sign your stock over to me”. There might be a consummation of a transaction in an unusual place like a funeral home. A person applying undue influence might insist or demand that business be finished at once. Multiple persuaders against a single vulnerable person might use undue influence. It might occur when there is an absence of third party advisors, Undue influence can occur when a perpetrator states that there is no time to consult financial advisor’s or attorneys
Undue influence can be used by totalitarian groups, both religious and non religious. An example of this is the mass death at Jonestown
It can be put forth by, especially, existing or cultivated, close and personal relationships. It can be used in fiduciary relationship like an executor, attorney, or accountant
It can be brought to bear in a non –fiduciary relationship like, clergy, housekeeper, gardener, and physician.
The number one villain in undue influence is family , the group most trusted by elders
There is a common denominator of financial exploitation of elders
Undue influence is most common on trusting relationships of long duration (nephew moves in the help elderly aunt and then takes over stock and changes will)
It many times is perpetrated by cultivated by people who are opportunistic
Undue influence can be exerted by someone Isolates the elder, promote dependency, or induce fear and distrust of others. This after happens with sweetheart scams – where a younger woman marries a much older man wealthier who she takes financial advantage of.
What should a GCM or aging professional do? First meet the client alone.
Few admit because afraid of caregiver abandonment or further abuse
If you work for an agency you should meet supervisor and report the abuse
Finally you should call as you are Call Adult Protective Services– In most states you are a Mandatory Reporter
In the State of California ‘does not keep statistics on how many drivers are 100 or older but they do on people over 90. At the end of last year, 71,111 people 90 or older were licensed to drive in the state. .
These older people have traffic accidents. Thus driving is a part of activities of daily living (IADL ) assessment done by a geriatric care manager or senior health professional.
In our automobile-oriented society, many people drive as their normal mode of transportation. Age-related changes can threaten driving ability, however. Health problems can interfere with functioning in this area in obvious and less obvious ways. Problems with vision, reaction time, information processing, concentration, and visual-spatial abilities all interplay to influence driving capacity. Motor skills and coordination also affect performance.
A GCM of senior health professional should determine through discussion the older person’s usual mode of transportation. They should then integrate that with information with the functional assessment that includes the person’s lifelong habits about driving.
Did the person ever drive? How much? It is also important to screen for any concerns about whether the person should be driving and to probe and gather information from various sources to ascertain whether the self-reported behavior can be corroborated. Observing the car itself can also be helpful to see whether there are dents or scratches present and, if so, to learn about their origin. Assessing the older person’s car can be a great tool to tell the GCM or senior heath professional dangers the older person might face.
Accidents with multiple deaths have happened many times with older drivers
For many men and women, driving is both a symbolic and a functional basic necessity. It affords freedom to come and go when and where one chooses, even for persons who no longer venture far, and thus is the hallmark of independence and full personhood. The idea that one can go when, where, and whether one chooses is key to many people’s sense of autonomy. It is not surprising, then, that many people hold fast to driving as a basic right. Not surprisingly, too, many people continue to drive even when age or infirmity, or even the removal of their driver’s license, dictate that they should not.
It is not within the GCM or most senior professional, except a physical therapist’s, scope of practice to evaluate a person’s driving capacity. The GCM or senior health professional should, however, screen for problems and concerns in this area, note transportation modes being used, and note any need for intervention or evaluation or assistance to afford the older client continued opportunities for freedom of movement.
Older drivers have a higher risk of traffic fatalities because they are involved in more accidents per mile driven than middle-aged drivers are and because they are more fragile and therefore more likely to suffer more serious injuries should an accident occur. For their safety and the safety of others, it is important that concerns about driving ability be addressed. The American Medical Association (AMA) has an Older Drivers Project designed to educate physicians about the public health issues related to older driver safety. It has developed a Physician’s Guide to Assessing and Counseling Older Drivers to aid in addressing issues surrounding fitness to drive. Driver rehabilitation and older driver safety training initiatives are available in many communities. Occupational therapists and driver evaluation programs at universities, state motor vehicle departments, or specialty clinics can aid older persons and their families with driving concerns as well.