The Elderly Homeless

The epidemic of the elderly homeless is growing rapidly in recent years and has causes from many different fronts. Like any growing homeless population, the elderly homeless population poses a significant amount of unique problems that can cause or exacerbate many individual and societal ills. Though many of these issues seem insurmountable or generally difficult to grasp, there are many solutions that can be implemented to reduce the amount of elderly homeless on the street and in shelters.

Causes 

Although a cause for homelessness can’t be pinned down for every homeless person, or even every homeless person in a particular subgroup, there are generalizations that can easily be made within the groups themselves. The elderly, even ones who are not destitute, are generally at a few stark disadvantages compared to the rest of the population. This can be seen in the fact that 3.6 million American seniors are below the poverty line. Unlike other segments of the population, the elderly may not be able to generate any additional income to get out of poverty.

The effect of poverty can be seen when the issue of affordable housing is discussed. This lack of affordable housing has less to do with the price of the home than you may think. It is due, in large part, to the cost of several other things that the elderly experience, such as health issues that may become costly over time. With certain resources, such as social security benefits, running out, as well as the fact that many workers are unable to save up for retirement, it is no surprise that this problem may worsen significantly as people are able to get less and less money after they are unable to work.

Another concern that many elderly Americans will run into is the likelihood of a specific “trigger event” that will send them into a downward spiral, leading to homelessness. Often the elderly will see the dissolution of a long-lasting marriage, whether from divorce or death. This may cause them to become depressed and withdrawn, leading to a lack of care for themselves and possibly even destitution.

It’s also likely that they will experience their own declining health that, as mentioned before, will bring up a lot of specific economic challenges that other segments of the population may not have to experience. Mental health concerns, in particular, are of consequence when discussing the elderly homeless as many of them will go to their primary care physician for the physical symptoms of things like depression or anxiety rather than recognizing, or admitting, the problem and seeing a mental health specialist.

Unique Problems 

The elderly homeless have significant and unique, problems that are specific to their group. One of the main concerns with the elderly homeless is the fact that many health issues can be caused by or exacerbated by situations that they are exposed to while homeless. Chronic diseases, such as diabetes or arthritis, which may be able to be easily controlled and regulated, may be neglected while homeless. Oftentimes a homeless person of any age will become more physically frail due to malnutrition or even instances of injury or assault. This is especially true of those whose health is already declining due to old age.

Just the act of being homeless can bring about feelings of loneliness and isolation may take over, causing even further withdrawal. These habits and lack of mental stimuli have been shown to have a direct link to Alzheimer’s disease.

Because of these unique problems for elderly individuals, it puts a strain on already under-funded and thinly stretched homeless resources. While many individuals in their late 40s and early 50s in a stable situation may be able to work, the accelerated physical and mental degradation that a person experiences while homeless may take them out of the workforce entirely. This can make it significantly more difficult for homeless resources to help them create a future for themselves until they are in their late 60s.

Solutions 

Many of the solutions that can be implemented to help the elderly are easier to create as preventative care methods, rather than waiting for the elderly to become homeless first. One of the possible solutions is to create community living homes which could be subsidized homes at which professional teams can meet the needs of elders who are at risk of becoming homeless or are recovering from being homeless.

These communities could provide several solutions to the elderly that would not be available to them if they were to utilize the usual homeless resources, such as psychiatric care and old age-centric medical care. They would also allow for some self-sufficiency for those who are otherwise healthy.

Even within, or near, these same communities could be a section of subsidized housing for elderly people complete with in home care from the community. This would be a less restrictive option than a nursing home or even a closely monitored community and could be a good option as a stepping-stone to independence for the previously homeless elders.

Alzheimer’s and the Brain

Alzheimer’s is an extremely debilitating disease that is quickly becoming a more prevalent disease in today’s elderly and, unfortunately, is still far away from being fully understood.

According to the Alzheimer’s Association, the disease is the sixth leading cause of death in the United States. As it stands now, there is no cure and not much in the way of treatment for the symptoms once they begin, although there are things that people can do to slow symptoms or reduce their likelihood of appearing.

Fortunately, research is leading us to understand the ailment significantly better than we once did. We are able to pinpoint certain possible causes and correlations that may lead to, or increase the risk of, the onset of the disease. Hopefully, in the future this current research will allow doctors and scientists to develop treatments for the symptoms and possibly one day find a cure.

Risk Factors 

Age

Age generally plays a large factor in the onset of Alzheimer’s and other types of dementia. There are many reasons that this could possibly be, but it is known that after the age of 65 the propensity for someone to develop the disorder doubles every five years. Startlingly enough, over half of everyone over 85 appears to be in some stage of Alzheimer’s.

Genetics

It is generally known that if members of your family develop Alzheimer’s disease, it is likely that you will as well. As with every disease in which genetics plays a role, the more members of your family that develop Alzheimer’s, the more likely it is that you will as well. In cases of early-onset Alzheimer’s (that which develops in the 40s or 50s) it appears to be spread almost exclusively through genetics and accounts for about 5% of cases.

Trauma

It appears as though head injuries may play a role in the development of Alzheimer’s and other forms of dementia. This risk increases significantly if there was head trauma during which consciousness was lost for any period of time.

Diabetes

For reasons that are somewhat unclear, it appears as though having diabetes of any kind significantly increases one’s risk of developing Alzheimer’s disease in later years. This appears to be even more significantly related to those that have developed type 2 diabetes, although it is not certain whether it is due to the diabetes itself or whether it is due to the unhealthy habits that cause many instances of type 2 diabetes.

Sex

According to studies, it seems that sex plays a role in the development of Alzheimer’s. Over half of Alzheimer’s cases are found in females. It is uncertain as to why this is.

Heart Disease

Heart disease appears to be another correlative factor in the development of Alzheimer’s disease. Although, like many apparent risk factors for Alzheimer’s, it is not exactly certain why this would be but there are hypotheses regarding the development of beta-amyloid.

Mental Stimulation

Studies have shown that those who have a higher education level may be at lower risk for developing Alzheimer’s. It is also said that those who continually engaged in mentally stimulating activities tended to develop the disease less. One leading hypothesis regarding why this may be is because this allows people to build neural pathways that may be able to compensate for damaged or destroyed synaptic pathways.

Sleep Disorders

It has been shown that sleep disorders, especially sleep apnea, may be a significant risk factor for the development of Alzheimer’s symptoms.

 Causes 

Alzheimer’s is still mostly a medical mystery but ongoing research is allowing scientists and doctors to develop an idea about how and why certain symptoms develop, as well as when they begin to develop. This may open up a whole new world of neuroscience as well as tests to determine if someone is developing the early physical symptoms of Alzheimer’s. 

Beta-Amyloid Protein 

The beta-amyloid protein has been named as a possible culprit in causing Alzheimer’s. Beta-amyloid is the main component of deposits that are known to develop between the synapses of patients with Alzheimer’s. When these deposits, known as plaques, become built up in the brain, they impede certain synapses from firing correctly or connecting at all, destroying vital neural pathways. It’s suspected that the cholesterol that causes many types of heart disease are also responsible for the production of excess amounts of beta-amyloid. 

Neurofibrillary Tangles 

Neurofibrillary tangles are often seen in the brains of patients with Alzheimer’s. These tangles are developed in the nerves after the protein (tau) disintegrates. These tangles can develop during significant head injuries or traumatic brain injuries. 

Damaged Blood Vessels 

Damaged blood vessels in the brain are an obvious problem as they prevent oxygen from reaching the nerves in the brain, putting significant strain on the synapses, and possibly causing brain cell death. This brain cell death shrinks the brain and destroys much of the tissue, a pattern often seen in the brains of those with Alzheimer’s. 

Elder Abuse: A Few Things to Keep in Mind

When people look into statistics regarding problems of abuse, they tend to look no further than people under 50. The trouble with that is the fact that many older people suffer significant hardships at a significantly higher rate than many other social groups. While overlooking these facts may allow many the comfort of not having to pay attention to these issues, it does absolutely nothing to serve the people who are being affected by injustice and a society that would not like to acknowledge their plight.

As the aging population continues to rise and is estimated to make up nearly one in five people by 2050, elder abuse is becoming a much more pertinent and urgent problem to tackle. It is also important to determine not only who are likely abusers but also to determine what events trigger elder abuse so that it might be able to be stopped or slowed in the future. 

The Reality of Abuse 

Every so often, a news report will come to the forefront that targets the scourge of elder abuse but it is often quickly swept under the rug for various reasons. The fact of the matter is that many studies have stated nearly 10% of elders experience some form of elder abuse. This abuse can take many forms including:

-          Physical abuse: Abusers may use physical threats and intimidation but it can escalate to violent encounters.

-          Emotional abuse: Abusers may engage in humiliating, degrading, or controlling behavior at the expense of the elderly person.

-          Sexual abuse: Abusers often will use rape or sexual molestation not for sexual gratification but to exert control over the elderly person.

-          Neglect: Abusers may purposefully neglect an elderly person by refusing to help them with necessities such as eating or medications.

-          Financial Exploitation: Abusers may use fraud, cohesion, or simple theft in order to gain financially at the expense of the elderly person.

As with many other instances of abuse, elder abuse is usually committed by someone who is put into a position of trust by the elderly person or the family. Unfortunately, it is estimated that only between 4% and 7% of abuse cases are ever reported to authorities and that a large number of people don’t think about financial exploitation when they think of elder abuse.

More often than not, the elderly are targeted for abuse because they fail to report for any number of reasons. They may not have the mental capacity to report, may be seen as an unreliable source of information, may fear continued or increased abuse if they do report, or may even want to avoid getting the abuser in trouble. Unfortunately, many people who work with the elderly population are not trained in how to spot the signs of elder abuse without being told.

The Signs of Elder Abuse 

Although the following are signs of elder abuse, they can often be signs of many other things, some of which are completely unrelated to any kind of abuse. This is one of the reasons elder abuse can be so tricky to spot by the untrained eye.

-          Elders who are physically abused may exhibit telltale signs of violent contact such as bruises, cuts, scrapes, burns, or broken bones. While bruises and broken bones may be the signs of physical abuse, they are also commonly associated with other medical issues such as taking blood thinners or developing osteoporosis.

-          Elders who abruptly have changes in behavior, attitudes, or moods may possibly be the victims of emotional abuse, though this is not always the case. Sometimes this is a sign of developing dementia.

-          Elders who have a rapidly changing financial status are likely victims of financial exploitation.

-          Elders who are being cared for, whether in a nursing home or by an in home caregiver, who suddenly exhibit poor hygiene, bedsores, weight loss, or medical problems relating to a condition that was once in control may be victims of neglect.

 Results of Elder Abuse 

Elder abuse has extremely significant and long-lasting effects. In some studies, it has been shown that elders who were abused are nearly three times as likely to die as those who were not abused. This can be explained by the fact that those who are physically abused or neglected may have developed or increased the prevalence of chronic, debilitating conditions that were otherwise nonexistent or under control. The higher rate of death may also come from solely emotional abuse as well as emotional abuse may cause significant depression, anxiety, and a host of other psychological problems. These problems may trigger very real and significant physical problems such as high blood pressure, heart problems, nausea, tremors, respiratory problems, or chronic pain. The withdrawal caused by emotional and physical abuse may also be a leading factor in accelerated dementia among the elderly.

Home Care versus Nursing Care

One of the biggest decisions that you may ever have to make in the life of a loved one is where they will spend their later years. Although there are some elderly people who are comfortable with the idea of living in a nursing home, many are vehemently opposed to the idea. What’s more is that most elderly people do not require all of the resources and security that a nursing home has. Frequently, your elderly loved one may just need someone to help them from time to time with things that have gotten more difficult due to the natural aging process (such as arthritis or poor eyesight) rather than putting them into a place that is better suited for people with severe mental or physical disabilities that require 24/7 monitoring.

Being able to weigh the pros and cons of each option with your loved one will help you and them be on the same page and to help make the appropriate decision for them. After all, leaving them in their home when they clearly need continuing care may be dangerous for them and worrisome for you. On the same note, putting them into a facility that they clearly don’t need to be in may strip them of their dignity and take attention away from people who actually do need to be in an institutionalized setting. Making an informed decision is a good idea for everyone and can affect many people, not just you and your loved one.

Home Care 

Home care is the most basic of care methods for your elderly loved one. In most cases this involves having a person come to the home of the elderly person for a few hours per day and providing them with certain, simple services such as grocery shopping, medication administration, and possibly transportation. This is the lowest level of care for an elderly person and provides the least level of restriction with the highest level of independence. Often, when an elderly person is feeling certain physical problems creep up, they will be happy to have this kind of help.

Pros 

Home care is highly customizable, depending on the situation of your elderly loved one. It can range from simply having a helper to do certain tasks for them to actually having someone perform rudimentary medical monitoring or help with more personal tasks, such as bathing or cooking meals. In addition to what can be done by the person helping, there is also an aspect of home customization that nursing homes often don’t have the ability to provide. Simple home modifications may augment in home care and provide further independence for your loved one by addressing their specific needs in advanced ways.

Unlike nursing homes, the people hired for in home care can be carefully interviewed and picked not only by the family but also by the person that will be taken care of. While the elderly person may not get along with certain workers in a nursing home, they can pick someone they actually get along with to come and take care of them in their home.

Cons

In home care does come with some drawbacks that may make a family or an elderly person apprehensive or may make it not appropriate for every situation. For instance, if a person’s health rapidly deteriorates and they have a non-medical helper then the helper may not have the training to help and a new in home care specialist may need to be hired. Additionally, in home care may not be appropriate for every situation, especially if the person’s health is extremely compromised because of severe physical or mental health problems that require 24 hour monitoring and safety precautions.

Although in home care is generally less expensive, especially for non-medical personnel, and may be covered by private health insurance, Medicare may not cover these services. This may require your family to make a decision between an unmonitored but unrestricted environment and an extremely restricted environment that may be monitored more than necessary.

Nursing Home Care 

A nursing home is usually the highest level of care for an elderly person. “Highest level of care” does not necessarily mean the best. Rather, it refers to how monitored and regulated it is compared to other options. Many nursing homes have nurses on staff 24 hours per day and have other staff that checks in on them frequently throughout the day. The patients are usually not allowed much independence and are often not allowed to leave the premises unsupervised. Although these facilities are appropriate in some severe cases, many otherwise healthy elderly people may feel that it strips them of their dignity.

Pros 

Nursing homes are appropriate for those who are largely unable to care for themselves at all. Having a nursing staff around throughout the day can help families feel less worried about leaving their loved one alone because their severe medical problems can be monitored and medication can be administered quickly and easily.

While many elderly adults may not want to go to a nursing home, others may be excited at the prospect of having constant company and being around people throughout the day. As every situation is different, it’s important to discuss these options (and the appropriateness of their medical situations) with your loved one.

Cons

The biggest problem with many nursing homes is the fact that many of the people in them aren’t appropriate for the facilities. Rather than needing constant medical monitoring and a restrictive, institutionalized environment, they may just require a few home modifications or a helper that stops by. This type of restriction may cause your loved one to become extremely depressed, withdrawn, and may actually cause their health to rapidly deteriorate.

Additionally, when a person is admitted to a high and restricted level of care who is inappropriate for the facility they end up detracting valuable time and resources from those who actually need it. In many ways, putting a loved one in an institutional setting if they don’t require that level of care is akin to calling an ambulance because you’ve come down with the cold.

7 Signs of Dementia

As our loved ones age, it is expected that they will have trouble with activities that may have come easy before. They may lose some of their vision or some of their ability to adapt to new and changing technology. These types of changes are normal and usually aren’t a sign that anything is wrong. In some extreme cases, your loved one may exhibit extreme changes in behaviors or attitudes that are worrying and in fact, may be signs of dementia. Although there is no sure way of stopping dementia or curing it, knowing and assessing these signs early may help you and your family find ways to slow the onset of dementia. 

Memory Loss 

Some measure of memory loss is not unusual in someone who is getting older. Simply forgetting small and inconsequential things, or forgetting things and remembering them later, is just a part of aging. With memory loss that is indicative of dementia, your loved one may only be able to retain information for a few hours, or even a few minutes. They may also have a difficult time recognizing familiar people or places, including close family members or their home. Often, this is one of the first noticeable signs of dementia.

 Trouble with Conversations 

Often a loved one suffering from dementia will not be able to converse with family or friends as they once did. For some older people, they may develop a sense of shyness or a quiet dignity about them for one reason or another. For those that are beginning to suffer dementia the cause is much more serious. They may be having difficulty tracking conversations at all and may be unable to remember words or even the topic being discussed. This is much more significant than stumbling over words from time to time as it can impede every interaction that they have.

Some people exhibiting signs of dementia may not realize that they are having difficulty with conversations and may begin to speak in word salad or garden path sentences. While word salad is an easily identifiable speech pattern in which a person speaks in completely random and unrelated words or utterances, garden path sentences are much more difficult to take note of. Garden path sentences have an internal logic where individual words or phrases are connected but they have no context or meaning as a whole. These types of speech patterns can be a quick indication that something is amiss. 

Trouble Planning or Carrying Out Simple Tasks 

What younger people may see as simple and natural some older people may feel to be foreign and strange. This subjective sense of simplicity shouldn’t raise any red flags. However, if a loved one is having difficulty performing or planning tasks that they have been used to for much of their life, such as following recipes or shopping for groceries, then that could be a symptom of dementia showing through. 

Misplacing Items 

Many people have infrequent absentmindedness. We may forget where we put our keys or even forget to take them out of our pants from yesterday. As we age, this will continue unimpeded. While people with dementia will misplace things more often, they will also misplace these things in places that they have no business being. Unfortunately, and more seriously, they may even misplace themselves and become extremely lost and because this also may be paired with an inability to backtrack effectively, they may be unable to even remember how they got to where they are. 

Difficulty Assessing Time 

Many peoples’ sense of time changes drastically as they get older. What may have seemed like forever to you when you were a child may seem like no time at all now that you’re an adult. While this is normal, a person suffering the symptoms of dementia will have difficulty assessing time at all. Not only will this affect what they perceive as the present, but also they may have difficulty comprehending what happened in the past or a concept of the future. 

Poor Hygiene 

When someone you know has developed some sort of dementia, they frequently become plagued with symptoms relating to bad hygiene. Their home, no matter how immaculate it once was, may quickly degenerate into being more cluttered and less sanitary. This lack of hygiene isn’t just seen in the home, but personal hygiene may also take a backseat as well. This can cause several types of nasty infections and diseases, many of which are known to cause or exacerbate an elder’s descent into dementia.  

Hallucinations 

In more rare and extreme circumstances, someone that is exhibiting signs of dementia may develop vivid hallucinations, both auditory and visual. In many of these circumstances, they may have a difficult time discerning between what is a hallucination and what is real, partially because of their already deteriorated mental state. This is one of the most pronounced and severe symptoms of dementia in the elderly.